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STDs (Expert Forum)
Follow-up Qs to: 'I had an oral lesion and did not suspect Herpes...my partner t
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
Follow-up Qs to: 'I had an oral lesion and did not suspect Herpes...my partner t
by passedHSV1, Aug 28, 2005 12:00AM
This is really a continuation of the previous posted comment:
"I had an oral lesion and did not suspect Herpes...my partner then got it genital"
I had new questions however, so I decided to make it a new posting and pay for the additional advice. Thank you for your previous detailed response and advice. I just wanted to clarify just a couple of points:
1. You said: "You are wrong in believing that HSV-1 is no longer transmissible after the initial infection and development of antibody. Recurrent outbreaks, including subclinical viral shedding, are the source of most spread to other persons. Same applies to genital HSV-2 infection."
I did not imply that HSV-1 is not transmissible after the initial infection as I am well aware that the virus sheds. Rather, I was asking if my partner who now has HSV-1 genitally has another sexual partner in the future who has documented HSV-1 antibodies and has had documented ORAL "cold sores" in the past, could my partner transmit HSV-1 GENITALLY to this person, or is he protected? Could they have sex without a condom and not worry that he will get genital HSV-1? The same goes for me and her: could we have sex without a condom when she is not having an outbreak without fearing genital-genital transmission to me?
2. You are not sure if my oral/gingival HSV-1 outbreak was indeed my first or a recurrence from past infection:
"It is clear you have oral herpes due to HSV-1 and transmitted it to your partner by cunnilingus. Your infection most likely is chronic, perhaps acquired in childhood. The atypical part is having an intraoral lesion; most recurrent oral herpes lesions are external, and I have often told questioners in this forum that apparent canker sores rarely are herpetic. On the other hand, initial herpes often is mucosal, and 14 days is (barely) enough time to develop detectable HSV antibody (IgG). But chronic/recurrent infection seems most likely. You'll probably never know for sure"
You said it most likely is a chronic infection. If, however, it was my first infection and I was exposed in the oral AND genital area simultaneously could I not have genital HSV-1 as well despite the absence of symptoms? I just want to understand the reasoning behind the statement at the end of your response "You can be sure you do not have genital HSV-1 infection".
As you can imagine, I have been reading volumes on the topic of Herpes since I developed the infection and passed it on to my partner oral-to-genital. This in fact is the worse part of it. I feel a tremendous amount of guilt and "what if" questions bombard my head.
Last comment:
3. What do you know about the development of Carraguard and other Microbicidals? I have not been able to find Carraguard for sale...still in clinical trials?
Thank you!
"I had an oral lesion and did not suspect Herpes...my partner then got it genital"
I had new questions however, so I decided to make it a new posting and pay for the additional advice. Thank you for your previous detailed response and advice. I just wanted to clarify just a couple of points:
1. You said: "You are wrong in believing that HSV-1 is no longer transmissible after the initial infection and development of antibody. Recurrent outbreaks, including subclinical viral shedding, are the source of most spread to other persons. Same applies to genital HSV-2 infection."
I did not imply that HSV-1 is not transmissible after the initial infection as I am well aware that the virus sheds. Rather, I was asking if my partner who now has HSV-1 genitally has another sexual partner in the future who has documented HSV-1 antibodies and has had documented ORAL "cold sores" in the past, could my partner transmit HSV-1 GENITALLY to this person, or is he protected? Could they have sex without a condom and not worry that he will get genital HSV-1? The same goes for me and her: could we have sex without a condom when she is not having an outbreak without fearing genital-genital transmission to me?
2. You are not sure if my oral/gingival HSV-1 outbreak was indeed my first or a recurrence from past infection:
"It is clear you have oral herpes due to HSV-1 and transmitted it to your partner by cunnilingus. Your infection most likely is chronic, perhaps acquired in childhood. The atypical part is having an intraoral lesion; most recurrent oral herpes lesions are external, and I have often told questioners in this forum that apparent canker sores rarely are herpetic. On the other hand, initial herpes often is mucosal, and 14 days is (barely) enough time to develop detectable HSV antibody (IgG). But chronic/recurrent infection seems most likely. You'll probably never know for sure"
You said it most likely is a chronic infection. If, however, it was my first infection and I was exposed in the oral AND genital area simultaneously could I not have genital HSV-1 as well despite the absence of symptoms? I just want to understand the reasoning behind the statement at the end of your response "You can be sure you do not have genital HSV-1 infection".
As you can imagine, I have been reading volumes on the topic of Herpes since I developed the infection and passed it on to my partner oral-to-genital. This in fact is the worse part of it. I feel a tremendous amount of guilt and "what if" questions bombard my head.
Last comment:
3. What do you know about the development of Carraguard and other Microbicidals? I have not been able to find Carraguard for sale...still in clinical trials?
Thank you!
Doctor's Answer
by H. Hunter Handsfield, M.D., Aug 28, 2005 12:00AM
, Aug 28, 2005 12:00AM
It would be preferable to post follow-up questions in the orginal thread.
Auto-inoculation of HSV to new body sites only occurs with measurable frequency during the initial infection. Similarly, anybody who is infected with HSV-1 or HSV-1 at any body site is immune from acquiring the same virus type again, at any body site. Your partner will not be at risk for transmitting her genital HSV-1 infection any anatomic site of a future partner who is HSV-1-seropositive.
As I said orginally, I think but do not know for sure that your oral infection was chronic, not initial. I am unaware of any data to directly answer your question; I have never heard of someone getting initial infection at 2 anatomic sites (oral plus genital) and having symptomatic infection at only one of those sites. I cannot say it doesn't happen, but my guess is that it does not.
Carraguard is one of a number of compounds under study in the past few years as potential microbicides, i.e. chemicals that might be suitable for genital (primarily vaginal) application to reduce the risk of STD/HIV transmission. In general, those studies have not yet been very promising, and I am not aware of any particularly optimistic results for carraguard or related compounds. Most of the emphasis has been on HIV more than STDs, and I am not aware that carraguard has any particular promise for herpes prevention.
Please post further questions in this thread.
HHH, MD
Auto-inoculation of HSV to new body sites only occurs with measurable frequency during the initial infection. Similarly, anybody who is infected with HSV-1 or HSV-1 at any body site is immune from acquiring the same virus type again, at any body site. Your partner will not be at risk for transmitting her genital HSV-1 infection any anatomic site of a future partner who is HSV-1-seropositive.
As I said orginally, I think but do not know for sure that your oral infection was chronic, not initial. I am unaware of any data to directly answer your question; I have never heard of someone getting initial infection at 2 anatomic sites (oral plus genital) and having symptomatic infection at only one of those sites. I cannot say it doesn't happen, but my guess is that it does not.
Carraguard is one of a number of compounds under study in the past few years as potential microbicides, i.e. chemicals that might be suitable for genital (primarily vaginal) application to reduce the risk of STD/HIV transmission. In general, those studies have not yet been very promising, and I am not aware of any particularly optimistic results for carraguard or related compounds. Most of the emphasis has been on HIV more than STDs, and I am not aware that carraguard has any particular promise for herpes prevention.
Please post further questions in this thread.
HHH, MD
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Recently diagnosed with Genital Herpes (HSV1) (7 replies):I had my first outbreak of sores in my genital area this...[more]
The Carraguard info I found in the following article in medscape:
http://www.medscape.com/viewprogram/2366_pnt
This is the extract from that article, and it is from May, 2003 so it is a little bit old. Newer articles online seemed to show some promise in vivo in African patient involved in studiesl like you said, mostly in HIV prevention but HSV infectivity is also being monitored.
"Microbicides.Over the past few years, there has been an increasing interest in developing topical microbicides that can help prevent sexually transmitted infections. The first generation of broad-spectrum, nondetergent microbicides is currently in clinical development, including sulfated polymer-based inhibitors and acid buffers. Monoclonal antibodies are also in development as specific microbicides.[75] A recent study in mice tested the efficacy of preventing HSV-2 infection and vaginal toxicity of various potential microbicides and over-the-counter vaginal products including K-Y Plus, Gynol II, Advantage S, Replens, BufferGel, PC-550, Carraguard, and No Fertil. Investigators found Carraguard and PC-550 to be most effective in preventing infection.[76] Other research has examined the efficacy of dendrimers, or macromolecules with broad-spectrum antiviral activity and minimal toxicity that have proven effective in animal models. A recent in vitro study found that the dendrimer SPL-2999 inhibits both virus entry and late stages of HSV-1 and HSV-2 replication.[77]"