STDs Expert Forum
HPV and HSV-1...Questions
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The STD Forum 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.

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HPV and HSV-1...Questions

Hey Doc. A couple of different questions. I recently went to the doctor to have a growth on the right side of my scrotum looked at (about an inch off the base of my penis). It is around 4-5mm in diameter and has a hair in the dead center of it. The doctor took a pretty non-chalant look at it, said it might be a wart and that we should freeze it. She said that if something happened it was definitely a wart and if nothing happened it indicated something else. This is where I got concerned as I'm pretty sure that isn't the case. I started reading up here and decided to go to another doctor about 10 days later ( approx. 3 weeks ago as of this post). He took a much more careful look at it and said he didn't think it was a wart but didn't want to say for certain. He froze it and told me to come back for another treatment if it didn't fall off, or if I noticed any other abnormalities. No change in the growth (going to go for another treatment), but I shaved 2 days ago and noticed a small pink growth on the left side of my scrotum about 1/2 an inch away from the base of my penis. It was about 1/3 the size of the other growth, and pretty round and smooth.  This second bump got dry and most of it just flaked off yesterday. There's just a small pink raised bump now, not even the size of a pin. I'm now panicking again that these are genital warts.

1. Do any of these sound like wart symptoms???  I recall seeing a post that said hair won't grow through a wart.  Did the first doctor just wreck my head because of a poor diagnosis?

The second part. A girl I have been dating for 1.5 months just told me she contracted HSV-1 from a boyfriend 5 years ago. She had one outbreak in Feb. of last year.  We have not had sex yet and I'm wondering a few things....

2. Is it worth going to get an HSV-1 test to see if I'm immune? 50-70% of people have the antibodies correct? I have no oral/genital symptoms of HSV.

3. What are the risks I would contract it from her, if using condoms and she has no signs of outbreaks? Would something like Valtrex be a worthwhile drug to use? Any added protection?

4. What are the risks involved if I perform oral sex on her? Is it just as easy to contract for me as genital/genital sex?  Is there any concern with manual stimulation, and say an eye infection (not that I'm putting my finger in my eye directly after manual stimulation, but should I be aware of it)?

Sorry about the long post, but I'm new to this whole STD discussion, so I need some solid answers. Thanks.

Tags: genital
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1) Verbal description is no match for examination by a health care provider; that is, my judgment as to whether or not you have a genital wart is meaningless, especially since two docs weren't sure and gave somewhat conflicting opinions.  It doesn't sound much like a wart, but atypical lesions are common.  I partly agree with the perspective of grouchomarx [below], except that I understand there is legitimate concern and a certain amount of fear about sexual transmission.  But I agree that a wart is just a wart; that is, as a medical condition, genital warts generally are a trivial problem.

2)  There would be no harm in testing for HSV-1 antibody, but I do not particularly reommend it, because...

3) The risk of sexual (genital-to-genital) transmission of HSV-1 has not been well studied, but appears to be low; certainly a lot lower than for genital HSV-2.  Both symptomatic outbreaks and asymptomatic viral shedding are less common than for HSV-2, and you probably are largely protected if she is careful to avoid sex in the event she has an outbreak.  The effectiveness of antiviral therapy in preventing transmission of HSV-1 has not been studied, and there are reasons to suspect it doesn't make as much difference as for HSV-2.

4) If you are susceptible to HSV-1, there is some small risk of getting infected by cunnilingus.  But as for genital transmission, the risk probably is very low in the absence of a recongized outbreak.  I wouldn't worry about it.  The risk of genital-hand transmission is too low to worry about.

Finally, a perspective on HSV-1:  Even if you are susceptible, don't worry much about it.  If you become infected, you may never know it; effective treatment is available if you get symptoms; and you would be unlikely to transmit to other partners (just as for your partner and you).  See other discussions about this; search the threads and archives for "Genital HSV-1" or just "HSV-1".

Good luck--  HHH, MD

13 Comments
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Hey tonguetied those are some good questions, I've read so many conflicting things about HSV transmission. I heard that a woman performaing oral sex on you who has HSV-1 can give you genital HSV-2 for that, which makes no medical sense to me.  Then I heard that giving oral sex on a woman with HSV-2 can give you HSV-1 in the mouth.
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Why are you getting so worked up about warts? Is it because it's sexually transmitted?  I venture to guess you wouldn't be that concerned about a wart on your foot. Regardless of the mode of transmission it's just a wart.  It will just be frozen off, just the same as if you had it on your foot or on your arm.  Something you would rather not deal with for sure, but not a serious health issue.  If  genital warts are the worst thing that ever happens to you, you will have lived a pretty charmed life.  I had a couple years ago, they were frozen off and I have never gotten one again.  I guess a reccurence or two is possible but this is not a lifelong infection.  Lots of more important things to worry about.
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I guess I'm more concerned about passing them on to her if in fact this is a wart.  It clearly eats away at her that she has HSV-1, as she broke down crying when she told me. I just don't want her to have another burden. I have really strong feelings for her (which is why I'm looking for all of this info) and I don't want there to be another obstacle.  And your right about the warts on other parts of my body. I've had them on my foot before, and they went away, and I have one on my hand right now, and its not even a concern - in fact I forget that its there 99% of the time. Its just all of the fear mongering that is driven into you when your young I guess. Its hard to shake 10 years of being told that all these STD's are the worst thing that will ever happen to you. Anyway, thanks for all the solid responses. Its appreciated.
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50% of US population has HSV-1, including Doctor Handsfield, and I read that 90% of people get it by the time they are 50 years old.  Here's some info I read on the Asha wesbite: STI's are all about social stigmas, if you are experiencing a strong emotional response to a diagnosis, it might be helpful to explore why those feelings may be happening. Closely connected to the issue of self-image is the matter of how we believe others see us. This is where the social stigma about HPV and HSV
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Tonguetied..be very careful with your decision about how much prtection you need to use if you decide to have intercourse with her. It would be useful to know if you have IgG's against HSV-1 because this would allow you some partial but not complete immunity to catching HSV-1 genitally from her. There will be some misleading information on this website regardding infection of HSV-1 genitally after having contracted it orally. Anna Wald, MD (an international expert in Herepes) has expressed in her emails to me that in this case "you are mostly protected but we do not think it is 100%".

Similarly, Dr. Lawrence Corey in a comprehensive review article dating back to 1983 says about aquiring a new lesion of the same virus type in another body location:

"These data suggestes that previous HSV-1 infection protects against the aquisition of HSV-1 genital disease." HOWEVER " Innocculation of high titers of herpes simplex virus (even a patient's own strain) onto a susceptible mucosal surface or into the subcutaneous tissue can result in lesions, and subsequent recurrences in the same anatomic area.  Persons with previous herpes simplex-1 infection should continue to avoid oral-genital contact with a person with active oral-labial lesions" (June 1983, Annals of Internal Medicine.

I hate to keep bringing this up on this website but the statement by Dr. HHH that "once you have HSV-1 or 2 at one body location you can't catch the same type anywhere else on your body even if you try" is simply NOT TRUE. I am going to keep posting on this website about this issue because I belived Dr. HHH's advice and had unprotected intercourse with my recently diagnosed  girlfriend who has HSV-1 genitally which she contracted from oral sex from me initially. I had no genital symptoms but contracted genital HSV-1 eventually  a couple of months AFTER I passed the infection to her, and after I was already documented to have IgG's to HSV-1 (for two months) and in the absence of what I thought were any visible lesions on her. Bottom line is it happens in people who are shedding a lot EVEN if it is the same  HSV type even if it is the same STRAIN as Dr. Corey points out.


By the way: I am an MD also, granted not an Infectious Disease specialist. But I have been doing a lot of homework on this because of what I believe strongly is BAD ADVICE given here.

My advice to you: even if you have IgG's to HSV-1 have her take some Valtrex (especially if she's in the first 6-12 months of infection...thus shedding more heavily) and wear condoms. You may want to use some Non-oxynol-9 lubricant also since it has virucidal properties against HSV. I took these precautions initally and was fine, but when I stopped, I suffered the consequences and developed symptoms of HSV-1 genitally also.
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You are, of course, welcome to believe what you like. And maybe you really are affected both genitally and orally; there are always exceptions to any rule.

However, I still think that this must be a very rare phenomenon, when a herpes researcher like Anna Wald doesn't even really know if it can happen, and your only other supporting piece of evidence is an obsolete article; 26 years is an *eternity* in terms of research and medicine. Although I admit there probably isn't any research being done on this subject because 1. it's rare, 2. there's no money in it, and 3. it's fairly irrelevant from a public health standpoint, so there probably isn't anything more recent or relevant. Still, I think you are way, way overly concerned about this, far beyond what is warranted. I hope you are continuing to pursue counseling.
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Monkeyflower...you sound like a broken record. Your opinion on the matter is noted but if you have no other supporting evidence beside your opinions and speculations, let the science talk. I assume you know that Lawrence Corey, MD is an authority on the subject as much as Dr. Anna Wald. The article from 1983 is old but not "obsolete". Let other people make up their own minds about the topic and stop pushing "therapy" to me for being concerned about this topic.
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Monkeyflower: I believe in science and proof. Unless you have something more concrete to bring to the table than your own opinions and speculations, please take it easy with the suggestions that all I need is "therapy". It's insulting and you sound like a broken record frankly.

Anna Wald, by the way, doesn't say the event doesn't happen just that the protection is not 100% and it happens rarely. As you know people have trouble taking ANY (even if a small) chance when it comes to Herpes. How are you going to know when a "large titer" of virus is being shed by an individual? And Dr. Corey has actually studied this phenomenon by applying virus to mucous membranes. Read the article! He's as much of an expert on the topic of Herpes as Anna Wald or anyone else for that matter.
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Sorry about the second post....I didn't see my first post go up due to a computer glitch so I repeated myself and ended up posting twice. Now I sound like a broken record!
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You'd better know what you're talking about before making such strong stands.  And be careful quoting people and studies out of context.  Speaking as a close colleague of both Drs. Corey and Wald (and Corey has been one a close personal friend for 25 years).  I intimately know their research and their interpretation of it.

There is no doubt whatsoever that people with either HSV type are at lower risk of re-acquiring the same virus type than they were before infected the first time.  Can it ever happen?  Probably, and perhaps it did to you.  But the generalization holds.  As a physician, you should understand the difference between vigorous inoculation (with scarification) of a large amount of HSV-1 into an uninfected body part and the likely infectiousness with a lesser inoculum via typical sexual exposures.  The study Corey described addresses a theoretical potential, not necessarily real-world probabilities. And as a physician, you should know better than to make broad generalizations or epidemiologic conclusions based on individual clinical experiences, including your own.  Is same-type reinfection common enough for most HSV-1 infected people to lose sleep over the possibility?  Probably not, in my opinion.  I would be happy to modify that opinion if contrary data emerges.

Further, your attitude toward monkeyflower and others on this forum is condescending and comes close to ad hominem attacks.  Not permitted.

Moderator's prerogative:  This thread is over.  I will delete any further comments by anyone.

HHH, MD
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The proscription against new comments doesn't apply to you, if the semi-hijack discussion has confused you or you otherwise have any follow-up questions.

HHH, MD
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I have very visable anal warts. I had anal sex both in me and into another guy. We used lotion and we only did it for about a minute or so with no cumming. Will he get warts from me and if so how long until they appear?
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