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Genital HSV questions (probably HSV-1)
History: My wife and I have been together for 10 years - we don't use barrier contraception since she uses an IUD. I've had recurrent oral cold sores for as long as I can remember (which are presumably HSV-1). Until just recently, my wife had never had one. We have always tried to be careful not to have oral sex while I have a sore. She is on Roaccutane for an unrelated skin condition - side effects include drying and thinning of oral/vaginal mucosa. Recently, her Roaccutane dose was increased.
Last week she started to experience vaginal irritation, muscle aches, and cracked lips, which we put down to Roaccutane side effects. These subsequently got worse, erupting after ~3 days into cold-sore type blisters/ulcers in both oral and genital locations. She's subsequently been diagnosed with probable herpes (awaiting the culture results).
Questions:
1) She seems to have simultaneously contracted it orally and vaginally - is this unusual? Could I have passed it to her in both locations simultaneously, or is it more likely that it was passed on in one location and then auto-inoculated to the other? I understand spreading HSV from one location to another is quite easy during the primary outbreak.
2) Why would it suddenly happen after 10 years? Could the Roaccutane treatment have lowered her defences, or did we just finally get unlucky?
3) What can we do to lessen the severity of the initial attack, and reduce the chance of recurrent attacks (a) vaginally and (b) orally?
4) Am I at risk of contracting it genitally (assuming we're not idiots and don't have sex while there are any active lesions or within a week afterwards)? Should we start using barrier contraceptives routinely to prevent this?
5) (semi-unrelated) I'm very prone to mouth ulcers - any trauma from hot food / over-vigorous toobrushing almost always turns into a painful flat erosion. Could these be internal herpes lesions, or are they just apthous ulcers?
Last week she started to experience vaginal irritation, muscle aches, and cracked lips, which we put down to Roaccutane side effects. These subsequently got worse, erupting after ~3 days into cold-sore type blisters/ulcers in both oral and genital locations. She's subsequently been diagnosed with probable herpes (awaiting the culture results).
Questions:
1) She seems to have simultaneously contracted it orally and vaginally - is this unusual? Could I have passed it to her in both locations simultaneously, or is it more likely that it was passed on in one location and then auto-inoculated to the other? I understand spreading HSV from one location to another is quite easy during the primary outbreak.
2) Why would it suddenly happen after 10 years? Could the Roaccutane treatment have lowered her defences, or did we just finally get unlucky?
3) What can we do to lessen the severity of the initial attack, and reduce the chance of recurrent attacks (a) vaginally and (b) orally?
4) Am I at risk of contracting it genitally (assuming we're not idiots and don't have sex while there are any active lesions or within a week afterwards)? Should we start using barrier contraceptives routinely to prevent this?
5) (semi-unrelated) I'm very prone to mouth ulcers - any trauma from hot food / over-vigorous toobrushing almost always turns into a painful flat erosion. Could these be internal herpes lesions, or are they just apthous ulcers?
MEDICAL PROFESSIONAL
Most HSV infections are transmitted by persons who are asymptomatic. You are a victum of bad luck more than anything else. Statistically she is unlikely to have recurrences and if she does they should be less severe than the first episode. Getting yourself tested would at least provide closure on the situation. EWH
Culture was positive for HSV-1. I'm not sure if they did a blood test to look for pre-existing antibodies, but given the severity of the attack (among the worst the doctor had seen) and the associated flu-like symptoms, it seems very likely to have been the primary attack. It's responded rapidly to aciclovir, which is a relief!
They only cultured the genital outbreak, not the oral one, so it's possible the latter was something else - seems unlikely though.
I suppose I should get myself tested too, but it's hard to see the point. "Hi, I have no symptoms, please do a blood test to detect the cold sores I've been having for 25 years..."
What if anything is there to be done at this point except wait and hope it doesn't recur? And beat myself up for having passed it on :-(
They only cultured the genital outbreak, not the oral one, so it's possible the latter was something else - seems unlikely though.
I suppose I should get myself tested too, but it's hard to see the point. "Hi, I have no symptoms, please do a blood test to detect the cold sores I've been having for 25 years..."
What if anything is there to be done at this point except wait and hope it doesn't recur? And beat myself up for having passed it on :-(
MEDICAL PROFESSIONAL
Welcome to the Forum. My initial reaction to your questions is that I would be a bit surprised if your wife had acquired HSV-1 at two sites simultaneously from you. This is VERY unusual. While I am not familiar with Roaccutane I note that is causes a wide variety of skin and mucous membrane side effects and it would not surprise me if her problems relate to her increased dose of the drug. That is not to say that you could not transmit your own HSV-1 infection to her through kissing or through oral sex but to transmit it to both sites at the same time after years of not transmitting would be most unusual. Before you assume you have infected your wife, wait for the culture results and when they come, believe them.. With this general statement as background, let's address your questions:
1. See above. It would be unusual to infect two sites simultaneously. I would also add that you may have been misinformed- even during initial outbreaks herpes infections are RARELY transmitted from one location to another.
2. Herpes transmission is largely a matter of luck. the vast majority of exposures do not lead to infection. Transmission is a bit more likely when there is abrasion or friction and I note the accutane is reported to cause thinning of skin but it is unlikely that this would set up infection.
3. There are good treatment options IF this is HSV. Let's cross that bridge when we get to it.
4. No, if you have HSV-1 and she has gotten it from you, she will not pass it back to you at a new location.
5. Aphous ulcers. HSV typically causes lip and mouth lesions and when the mouth is involved it there are typically mouth or lip lesions as well.
Hoe this is helpful. Please let me know what the culture results show. EWH
1. See above. It would be unusual to infect two sites simultaneously. I would also add that you may have been misinformed- even during initial outbreaks herpes infections are RARELY transmitted from one location to another.
2. Herpes transmission is largely a matter of luck. the vast majority of exposures do not lead to infection. Transmission is a bit more likely when there is abrasion or friction and I note the accutane is reported to cause thinning of skin but it is unlikely that this would set up infection.
3. There are good treatment options IF this is HSV. Let's cross that bridge when we get to it.
4. No, if you have HSV-1 and she has gotten it from you, she will not pass it back to you at a new location.
5. Aphous ulcers. HSV typically causes lip and mouth lesions and when the mouth is involved it there are typically mouth or lip lesions as well.
Hoe this is helpful. Please let me know what the culture results show. EWH
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
