Genital Herpes 1 through oral sex

I really appreciate your site. I posted on 8/22/05 under morgan2, I'm sorry, I can't remember my passord, but I wanted to update you on my test results and new developments. I'm also concerned because my dr. has made some judgments based on igm results (I know).

You said it's possible I had folliculitis and my doctor said the same thing and put me on a round of Keflex. After I wrote you, I was convinced myself as hair started growing back in the center of each infected spot. But because I had a secondary rash over the apparent folliculitis, my doctor ran blood tests on both types of HSV. I also have had neuralgia at the site of the infection (bikini area) and the top of my thigh (new development since I wrote).

The blood test came back positive for HSV 1 only. This, after receiving negative blood tests for both types almost exactly a year ago. At first I was not concerned, and neither was my doctor. All along I had been very suspicious the test I had done a year ago was wrong anyway as I had what I thought was a giant cold sore on my lip once as a child (hard to forget as it was captured in a school photo.) But I have been pestering my doctor because the neuralgia doesn't make sense. At first she said it could be from shingles, etc. I was exposed to a lot of junk at the time of outbreak as I was living in a third world country.

I wasn't worried until I realized I had oral sex (only) performed on me once about a week to a week and a half before the bikini area rash (this was my only sexual contact with anyone in more than a year). Until today, I had never worried about that encounter because the person I was with had zero symptoms . I discussed this with my doctor and she says because of positive igms on the recent test and negative everything on the one a year ago, plus positive HSV 1, I likely contracted HSV 1 genitally through that oral sex encounter. I have told her igms don't count. Regardless, I just read today it is true I could have gotten HSV 1 genitally through oral sex with someone not having symptoms. I'm starting see a clearer picture and to understand that. gulp.

But, I don't know for sure and that's what's making me crazy. It's my understanding if I DID have a cold sore as a child, I would unlikely have had a genital outbreak. That would mean the test I had done a year ago was wrong though, and then there's the neuralgia. I have started a long distance romance with the man who performed the oral sex on me. I plan to see him in a month and am/was planning to have sex with him. What do I need to do/say? How do I handle this? Also important: how do I handle this for myself? (I would like to mention: I planned the upcoming encounter with him after my doctor's nurse mistakenly told me over the phone all my recent tests came back negative, talk about nightmare when I had to go be retested because my doctor found the labs were actually never drawn. Today I also made an appt. to see a therapist.) Many thanks for your time.

[H. Hunter Handsfield, M.D.]

Being positive for HSV-1, you can more or less forget about any problems with genital herpes.  Given your childhood history, it is probable your infection is oral acquired many years ago.  In that case, you almost certainly do not have genital HSV-1, because your earlier infection made you immune to re-catching HSV-1; and people almost never auto-inoculate their own infections from mouth to genitals.  And if you do have genital HSV-1, you can expect few or no recurrent outbreaks, little or no asymptomatic viral shedding, and little risk for sexual transmission (by vaginal intercourse) to current or future partner(s).

You have no ethical obligation to tell your current or potential partner(s) of any concern about herpes.  But if you want to do so, the gist of the conversation is "Like about half the population, I have HSV-1, probably orally.  There was a brief concern about genital infection, but that probably was folliculitis, and I almost certainly don't have a genital HSV infection.  If I do, it probably can't be transmitted by vaginal sex.  But you can always have an HSV-1 blood test to learn whether or not you are susceptible.  If your HSV-1 test is negative, we'll have to be careful that I don't perform oral sex on you whenever I have a cold sore."  

Good luck--  HHH, MD

[morgan2]

Hello, it's me again. I've been racking my brain some more and thought of one more point I'd hope to add. Even though I see it's possible to have contracted genital HSV 1 through the oral sex I received, I also thought of something else that came up in the past year. About a month before I had the first HSV 1 & 2 blood test a year ago, I did have a blistery breakout along the lower inside and partially outside of my nose that lasted about a week. I guess it's possible I could have contracted HSV 1 then and that the first round of tests didn't pick it up. Also, I've been reading tonight and would love to hear more confirmation that if I did receive HSV 1 genitally through my oral sex partner, that I can't in turn, give him HSV 1 genitally if we have sex. Thank you so much (I'm embarrassed for my obsessing - sorry!)

[moet]

Hi Morgan: If you had HSV 1 as a child, I thought you would have built antibodies ao you wouldn't contract it anywhere else. That is everything I am reading. I also just got diagnosed with genital HSV 1 and the only thing to look forward to is not getting it on my face. This now is alarming?? Dr, any thoughts?

Anyway, 2 great websites that have shed numerous light for me:

http://www.herpes.com/hsv1-2.html and
http://www.westoverheights.com/herpes_handbook.pdf

Wish you the best...and I'm also not looking forward to "herpes" discussions ;(

[gracefromHHP]

Having hsv1 orally would provide significant protection against contracting hsv1 genitally later on but not 100%. I do know of a few folks who have contracted hsv1 genitally after having a few established hsv1 oral infection - not many but it can happen.

At this point you would need a lesion culture and typing of any genital lesions to confirm a hsv1 genital infection 100%.  Hopefully if it is hsv1 genitally  your reoccurances are few and far between.

Definitely talk to this fellow about what's been going on.  If indeed it is hsv1 genitally he's already got significant protection against contracting it genitally from you. It isn't often transmitted thru genital contact anyways without an obvious lesion present ( it sheds less often than hsv2 genitally does ).  It's not very likely that you transmitted hsv1 genitally to him the last time you had sex together.

Have you had any other work ups yet? Have you tried anything for the pain you are still having?

grace

[ryn21]

It is possible to have a test done and come up with a false negative.  If you had a cold sore as a child, HSV1, I am sure that a false negative may have been the case.  To add, I believe once an individual has HSV1 on the mouth or lip, they CAN NOT get it genitally.  The body develops a strong immunity towards further infection or spread of the virus.  Folliculitis is quite common. Also, when you have folliculitis, you dont necessarily have to have a hair growing from the center of the red bump or spot.  Doctors often, if not always, can distinguish between folliculitis and herpes.  If in doubt of your doctors diagnosis or your doctors knowledge of herpes, you can always seek the advice of an STD specialist at your local health clinic.  

Did the doctor culture the spot, (swab the area), or did he perform blood testing, (via herpeselect)?

[morgan2]

Thank you for your comments and insight, I really appreciate it. To follow up: the secondary rash I think may have been HSV 1 went away before I was able to see a doctor (I had been working in a third world country at the time of outbreak). So I never received a swab, only a blood test. I never had sex with the person who performed the oral sex on me, but I am planning to see him again in a month. As for the first possible folliculitis rash, a lot of it cleared up once I had access to a doctor, clean water and clothes, etc. (basically once I returned home) but any lingering pimples (on the butt) etc. seemed to clear up with the Keflex. It's tough because I don't want to completely alarm or freak out my partner - he'll feel extremely bad and guilty, especially when I don't know for sure if what I had going on on the top of my thigh was HSV 1. That oral sex encounter was the only single sexual encounter I had performed on me in more than a year. I haven't had intercourse or oral sex for that matter (before this) in nearly two years. Part of my hangup about STDs and even sex is the way I found out my ex husband cheated on me was through an STD scare.

[ryn21]

"Pimples on the butt" are likely to be just that or folliculitis and not herpes.

[morgan2]

My doctor yesterday did give me samples of Valtrex for the neuralgia. The neuralgia is more of an annoyance than anything and it's getting better with time. It's one of those things I can "live with" as long as I'm not worried about giving HSV to anyone, if that makes sense.

[ryn21]

To my knowledge, neuralgia is usually an onset symptom of a herpes outbreak, usually only lasting a day or two before the outbreak occurs.

Neuralgia has many causes, other than herpes.  Example: People who are more proned to experiencing nerve pain in the lower abdomen/back/leg region are those who work jobs which require long periods of sitting, (ie people who work on the computer for most of the day).  It is a condition known as sciatica (do some research on it).  You could also see a neurologist to get some insight on what may be causing your pains.

[morgan2]

Thanks for the insight on neuralgia. The neuralgia is a weird thing that I started experiencing about a month it seems after the outbreak cleared up. The symptoms seem to fit every description of neuralgia I've read. Just a little info on my history - I am an otherwise very healthy 32 year old female, I have actually experienced nerve damage in the past (once through a deep sunburn and once when I had a tonsilectomy). Regarding the outbreak that I believe could be HSV 1 - it was a quarter size cluster of pink bumps that never blistered or burst as far I am aware, they just went away. They "cropped up" over the folliculitis, even then I wondered if I had two different things going on.

[morgan2]

I can't thank you enough for the reassuring words. I have a scheduled therapy appointment next week and I plan to work hard mentally to put all these obsessions and hangups about sex behind me. Best of luck in Japan!

[loosewheels]

Dear MD

Why doesn't someone with oral HSV1 have a moral obligation to inform a partner of their infection when they could easily pass that infection to someones genitals or mouth or anywhere on the body of that person in light of the fact that person may not have ever been exposed to HSV1 before.

What if down the transmission line that person was female and decided to become pregnant and had never contracted HSV1.  If the woman was to contract HSV1 from an oral carrier, and contracted it either orally or genitally for the first time while pregnant, this is just as dangerous as contracting HSV2 genitally for the first time while pregnant and people should know this and it should be more widely acknowledged.

No wonder there is a stigma about herpes on the genitals.
It may be correct that most people are already infected with HSV1 over HSV2 and orally over genitally, but this kind of thought and information is biased as oral HSV1 carries all the same health risks as genital HSV1 and genital HSV2.

There really is an attitude of good virus vs bad virus and bad location vs good location and sadly "medical professionals" are perpetuating that oral HSV1 is an OK strain to have and to place others at risk of contracting.

We can't have it both ways.
That's unfair and not medically correct.

[H. Hunter Handsfield, M.D.]

Most people with genital HSV-1 infection have few or no recurrent outbreaks and there is little asymptomatic shedding.  Transmission of genital HSV-1 to other persons appears to be rare.  That's why the obligation is different than for genital herpes due to HSV-2, in which asymptomatic shedding and sexual transmission are the norm.  If you look through other threads, you will see I always have characterized this as a personal opinion and that reasonable people can differ about it--although I didn't provide that qualification this time.

HHH, MD

[loosewheels]

Not to argue with you but I guess we will have to agree to disagree.

My research over the last 14 years has uncovered that while HSV-1 infection is traditionally found above the waist, it now is responsible for 20% of herpesvirus infections of the genital area.

And no matter how much HSV2 may shed more than HSV1, HSV1 still sheds itself.  In fact, one would be easily led to believe that  it must be quite good at shedding since at least 80% of the population is said to be infected with it orally as compared to around 25% of genital HSV2 carriers.


All HSV carriers are different.  Some have more outbreaks than others and this means that some genital HSV2 carriers may only ever have one noticeable outbreak or no outbreaks while some genital HSV1 carriers may have 10 noticeable ones even though its "reputation" states otherwise.  There is nothing cut and dried about having either of these strains above or below the belt. Especially since HSV1 causes 1/3 of all neonatal infections.

It seems to me that there "should" be ethical responsibility regarding HSV1 located anywhere when it is very capable of some very nasty stuff.  But of course this is just my humble opinion and I understand that you cannot always be putting all this information about every herpes symptom into every post every time.  But in the end I think it is important for everyone to understand, that no matter where it is or what strain it is, herpes is herpes and that neither is better or worse than the other.  Peace!

[passedHSV1]

I post this in TOTAL AGREEMENT with "gracefromHHP" above:

I am an MD and I have posted here before. I unfortunately passed HSV-1 oral to genital to my girlfriend during an initial(?)  oral breakout. It turns out I had IgG's to HSV-1 already at the time that her genital culture came back positive for HSV-1.

Some of the advice given on this web site is way too categorical and I think can be misleading. For example Doctor HHH advises many here that if one has genital HSV-1, that person can not transmit HSV-1 genitally to another individual who has documented oral HSV-1 with existing IgG antibodies "even if they tried".

This I think is wrong and should NEVER be said to anyone in these terms. I have done my share of reading and have emailed back and forth with Anna Wald, MD...the one person who knows most about this since she did the 2002 studies with Valtrex in discordant couples. She also generated the study that Dr. H quotes in which he says 40% of HSV-1 does not recur and the rest have 1-2 receurrences the first 1-2 years then none at all.

Well, Dr. Anna Wald and me and "gracefromHHP", and my Infectious Disease MD Dr. Nakada in Torrance, CA all understand that you can still pass HSV-1 genital-gential to an individual who has oral HSV-1 with documented IgGs. It DOES NOT OFFER 100% protection. I know from personal experience. It happened to me.  I contracted HSV-1 genitally months after my oral infection (and I already had IgGs) by having unprotected sex with my partner who has HSV-1 genitally. In retrospect, I should have worn condoms.

So, if you have genital HSV-1 and think you can't pass it on to 50% of the population out there who already has oral HSV-1....think again. They have significant resistance to contracting HSV-1 genitally, but it does happen. Even if some people think HSV-1 genitally is no big deal, I beg to differ. It's still HSV and it becomes a burden (big or small depending on where you are in life, attitude, etc) that you carry with you for the rest of your life. Unless you HAVE HSV of any kind genitally, you do not know exactly what it feels like emotionally and no one should attempt to minimize it.

[who_is_this]

If you don't mind, I'll stick with Dr. HHH's assessment of herpes.  You don't provide any credentials that might sway me to accept your assessment.

All herpes viruses are NOT the same.  They behave differently and have affinity for different tissues.  Most of the general population has already been exposed to oral HSV1, so that genital HSV 1 infection is not a viable issue.  

Of course, I have no credentials to offer, either other than reading Dr. HHH's forum.  I thank him for his work in this field and respect his world-renowned knowledge.

[who_is_this]

"Genital infection with HSV 1 is not a viable issue for most" that should have read!

[monkeyflower]

The difference is that HSV1 doesn't "like" the genitals as much as it does the mouth, so it doesn't behave the same way genitally as orally. In other words, you don't have the same frequency of asymptomatic shedding with HSV1 genitally, that you do with HSV2 genitally.

I understand that you're sensitive about the stigma attached to STDs, but I don't think he's saying what you think he's saying. He's not making a value judgment about HSV1 over HSV2... he's just pointing out that you're just not likely to transmit HSV1 genitals to genitals, or genitals to mouth. The increase in HSV1 genitally is from oral sex, not genital to genital contact :-)

[bigmonkeycar]

The above comment seems to be fairly inciteful and a matter of argument on this board...if doctor HHH would respond to that I think it'd help out a lot of people who have legit concerns about genital HSV-1...

[monkeyflower]

Did you ever have your genital lesions cultured, i.e. are you sure that you have HSV1 genitally as well? Also, isn't it possible that you autoinnoculated yourself genitally during your primary HSV1 oral outbreak? I don't know. After reading a bit about genital HSV1 transmission, your experience seems pretty unusual. However, I'm sure it happens, just like weird things happen all the time. That doesn't mean it's likely to happen, though, and thus something to worry about :-)

[Wondering1234]

I have a question of which I am very worried.  I performed oral sex on a female friend of mine.  I had what I thought was a pimple/spot (during a breakout)over my lip.  The next day, it took on more of a "cold sore" look/feel.  I have had cold sores in the past, yet I felt no tingle or burning this time.  If the typical prodromal symptoms were not present, would you know the likelihood of oral to genital transmission?  Any feedback on this particular subject would be greatly appreciated.  Thank you and please help.

[?_?]

Hi,
a while ago I noticed that I had a weird rash on my body, on my inner thigh, very close to where I would sometimes shave pubic hair, closer to my rear end rather than to my labia.  the rash started out as itchy red bumps (about 8 of them, some like large pimples and others smaller), and i have never had anything like this, and didn't know what to do.  so i applied some polysporin.  then a few days later i noticed the skin there was getting dry and flaky, so i applied a scent-free moisturizer.  The bumps started to develop dark scabs on the tips, though there was never a stage when anything was broken or oozing (so it seemed).  anyway, now the 'symptom' is gone and i'm left with scarring in that area.  

someone has been performing oral sex on me, and they have the odd outbreak of a cold sore on their mouth (though we try to be careful, but maybe we were not careful enough and perhaps i contracted herpes, and i'm showing the case for the genital form??)    I have also considered that maybe I caught something from a toilet seat, but the most likely scenario seems like it's herpes (or does it?)  Can anyone give me any insight?  How do you test for herpes (blood?)  

I would much appreciate a reply!  Thanks...

[boss94]

A related discussion, ? was started.