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STDs (Expert Forum)
HIV-1 w/no symptoms?
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.
HIV-1 w/no symptoms?
by harponia, Apr 30, 2009 11:50PM
I have carried genital herpes, HIV-2, for many years. Two years ago I also came down with two outbreaks of shingles along with constant genital outbreaks of herpes. I saw a herpes specialist who tested me and told me that I also carry herpes HIV-1. I was surprised as I don't believe I have ever had any outbreaks on my mouth. My questions are: is it possible I have herpes one (along with two) on my genitals or anus and that's why I have never had an outbreak on my mouth? And how probable is it that I could spread herpes one to someone from kissing them if I've never had an outbreak? FYI, I am on Valtrex daily, 1 gram. I also have Denabir cream.
Secondly, even the herpes expert has not been able to stop my genital outbreaks... after years on Valtrex, sometimes 2 or 3 grams per day, I still outbreak every three weeks or so... this is now accompanied by pain on my hips where shingles occurred. So I get genital outbreaks with shingles pain at same time. Expert does not know...any ideas, please advise me. Thanks,
Secondly, even the herpes expert has not been able to stop my genital outbreaks... after years on Valtrex, sometimes 2 or 3 grams per day, I still outbreak every three weeks or so... this is now accompanied by pain on my hips where shingles occurred. So I get genital outbreaks with shingles pain at same time. Expert does not know...any ideas, please advise me. Thanks,
Doctor's Answer
by H. Hunter Handsfield, M.D., May 01, 2009 10:20AM
, May 01, 2009 10:20AM
Welcome to the STD forum. I'll try to help. (There is a repeated typo in your message: you mean HSV-1 and 2, not HIV. I frequently do the same thing myself.)
Half of all adults in the US have HSV-1; it's 90% in some countries. Most of those infections are oral, acquired in childhood, and most of them have no recollection of cold sores or other symptoms of oral herpes. It is very rare for someone to have genital herpes due to both HSV-1 and HSV-2. Therefore, your positive HSV-1 test probably reflects a distant past oral infection.
Unlike genital HSV-2, which has lots of asymptomatic viral shedding and can be spread when the infected person has no symptoms, for oral HSV-1, asymptomatic shedding is less common and most transmissions appear to occur only from people with overt oral herpes outbreaks. There probably are exceptions, but in general the risk of you transmitting your presumed oral HSV-1 infection is low, either by kissing or oral sex.
As for your genital herpes, I am skeptical that you are having such frequent (nearly constant) outbreaks. Genital herpes almost never causes outbreaks more often than once a month, and rarely more often than every 6-8 weeks. And it is also very unusual that Valtex does not prevent outbreaks more effectively than you are experiencing. Of course I'm not saying you don't have genital herpes; however, probably something else is the explanation for the frequent symptoms you are experiencing. I'm also skeptical about shingles as the cause of your recurrent hip pain. People with post-herpetic neuralgia following shingles typically do not have pain that comes and goes the way you describe. Shingles PHN generally causes pain pretty much continually.
Bottom lines: Don't worry about positive test for HSV-1; it's not an issue either in terms of transmission risk or your genital area symptoms. Second, continue to work with your herpes expert about the cause of your symptoms. I suggest you print out this reply and discuss it with him or her.
Good luck-- HHH, MD
Half of all adults in the US have HSV-1; it's 90% in some countries. Most of those infections are oral, acquired in childhood, and most of them have no recollection of cold sores or other symptoms of oral herpes. It is very rare for someone to have genital herpes due to both HSV-1 and HSV-2. Therefore, your positive HSV-1 test probably reflects a distant past oral infection.
Unlike genital HSV-2, which has lots of asymptomatic viral shedding and can be spread when the infected person has no symptoms, for oral HSV-1, asymptomatic shedding is less common and most transmissions appear to occur only from people with overt oral herpes outbreaks. There probably are exceptions, but in general the risk of you transmitting your presumed oral HSV-1 infection is low, either by kissing or oral sex.
As for your genital herpes, I am skeptical that you are having such frequent (nearly constant) outbreaks. Genital herpes almost never causes outbreaks more often than once a month, and rarely more often than every 6-8 weeks. And it is also very unusual that Valtex does not prevent outbreaks more effectively than you are experiencing. Of course I'm not saying you don't have genital herpes; however, probably something else is the explanation for the frequent symptoms you are experiencing. I'm also skeptical about shingles as the cause of your recurrent hip pain. People with post-herpetic neuralgia following shingles typically do not have pain that comes and goes the way you describe. Shingles PHN generally causes pain pretty much continually.
Bottom lines: Don't worry about positive test for HSV-1; it's not an issue either in terms of transmission risk or your genital area symptoms. Second, continue to work with your herpes expert about the cause of your symptoms. I suggest you print out this reply and discuss it with him or her.
Good luck-- HHH, MD
Member Comments (2)
by H. Hunter Handsfield, M.D., May 01, 2009 10:23AM
, May 01, 2009 10:23AM
You don't say much about your "herpes expert". If that person has diagnosed your symptoms as due to genital herpes and shingles neuralgia, i.e. if s/he obviously disagrees with my opinion, I suggest you seek a second expert's opinion. Either way, print out my reply above and discuss it with whomever you see next.
