HSV-1 Clairfication

Doctor Handsfield or Hook,

Background: I have been with the same girl now for 15 months, used condoms for first 2 months none since then.  Previous to her I had a one night stand (intercourse – no oral) which would have been 21 months ago.  first.  After the one night stand I have been tested for all STDs numerous times including blood tests, the doctors at the university I attended got sick of me coming in to be checked out.  Fast forward to now, I have just (2 days ago) been diagnosed with genital HSV-1 by a culture test.  A few days before that I had a blood test done for both HSV 1 & 2 which came back negative, I went back in because I was paranoid.  Recently my girlfriend had been complaining of 2 sores in her mouth, which is the 2nd time in our relationship I can recall her complaining of a sore in her mouth.   Now, I know you can get HSV-1 from oral sex, but we have never, and I mean never had oral sex.  Which leaves me absolutely clueless on how this happened, I’m dumbfounded.

1) Could she have acquired this before from one of her past partners  and now just passed this on to me through genital to genital? Meaning she may have it in both places? (she has been with more than my 3)

2) Could I have acquired it from the one night sand and never realized it, even with all the blood test I have had done over the nearly 2 years since its happened?

3) How common is asymptomatic virus shedding of HSV-1 in the genital region?

4) The doctor I saw told me that I could have been from her touching a sore and then touching me, is that really likely to happen?

5) Is HSV-1 in the genital region truly a STD, meaning it is something that I should disclose to any future partners? – If the current relationship fails of course.

6)Likely hood of another outbreak happening?

THANK YOU BOTH FOR WHAT YOU DO!!! ITS GREATLY APPRECIATED!!!!

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

Given your sexual history, I also am uncertain about when and where you acquired your genital HSV-1 infection.  That your HSV-1 blood test is negative suggests your genital herpes is recently acquired, i.e. within several weeks before the blood specimen was collected. It would be helpful to know more about the nature of your symptoms that led to the diagnosis of herpes -- i.e. some description of the lesions (how many, where on your penis) and other symptoms (e.g., fever, swollen lymph nodes in the groin).  Pending that information, 4 possibilities come to mind.

First, your blood test is falsely negative and you have actually had your genital herpes for a long time, and the recent outbreaks was a recurrence, not the first infection.  If you have ever received oral sex from other partners, this is a distinct possibility.  The HSV-1 blood test is not as accurate as for HSV-2 and false negatives are believed to be pretty common.

The second possibility is that the test from your genital lesion is wrong, i.e. you don't actually have HSV at all (this is very unlikely)

Third, perhaps you really have HSV-2, i.e. a lab error in identifying the virus isolated from your genital lesion.  This is less likely, but possible.

Finally, your current partner has genital herpes due to HSV-1 and you caught it from her. Genital to genital HSV-1 transmission is uncommon, but it's a possibility.  

To your specific questions:

1) Yes, it is possible your partner has genital herpes due to HSV-1.  (I'm not at all sure your partner's oral sores are herpes, which doesn't usually cause sores inside the mouth.)

2) Unlikely but possible; see my first scenario.

3) Asymptomatic genital HSV-1 shedding is rare, but it happens.

4) Auto-inoculation like you describe is theoretically possible, but very rare.  You'll notice I didn't mention it in my suggestions above.

5) This is a complex question.  If you acquired it sexually, it's an STD.  However, recurrent outbreaks due to genital HSV-1 are uncommon and so is asymptomatic shedding.  It's probably best to inform future partners, but not necessarily in all cases.

6) Among people with initial genital HSV-1 infection, 40% have no recurrences in the next year.  Most of the rest have just 1-2 recurrences in the next year, then few or none.

Here are some things you can do.  First, give me some more information about your symptoms.  Second, talk to your doctor (or have him/her talk to the lab) to confirm the virus type.  Third, have another blood test in a few weeks.  If the test from the penile lesion is accurate, its hould become positive.  Finally, your current partner should have a blood test for HSV-1 and HSV-2.  With all these results, we may be able to sort this out a little better.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Here is a recent thread with expanded information about genital HSV-1:

http://www.medhelp.org/posts/show/969931

[Sparky_Rusty]

Dr. Handsfield,

Thank you for your quick response. A little more on my history, I had a blood test done 3 months after the one night stand, and then another one 10 months later, and now the most recent one....all negative.  (I took an STD class in college and have terrified since = reason for so many tests)

The legions that I had were located on the base of my penis but mostly off to the right in the "hair" region.  I had one scab that did form however on the midpoint of the shaft, from my research it didn’t look like a 'typical' outbreak.  I noticed one open and a red dot on Sunday (when I had the blood test).  Monday night into Tuesday I noticed soreness on the right side of my groin, which is the same side as the legions.  I figure this was due to swollen lymph nodes.  On Thursday morning I noticed 1 red bump at the base of my penis and one out in hair region, I went back in, that’s when the doctor took the swab test.  He told me that my lymph nodes were indeed swollen, and that even though it didn’t look typical it could very well be herpes.  In all there were 3 bumps off to the right in the hair region, and 2 actually on my penis.  All scabbed over, but what made it look un-typical was that they were not closely grouped together, i.e. a cluster.

I called the doctor again, and had them confirm that it was indeed HSV-1.

I had my girlfriend go in and get tested (blood test). She got her results today and was positive for HSV-1.  She has never had an outbreak that she can recall, and doesn’t know how this happened either.  I guess my gut feeling right now is that she had it, didn’t know, and unfortunately I was one of the few un-lucky that acquired it through asymptomatic shedding.  Or that her symptoms were very un-noticeable. Regardless I plan on getting a blood test in a few weeks to confirm.

I hope that this further information will help form a better picture of my situation.

Thank you for your time!!!

[Sparky_Rusty]

I was hoping to hear more back from you regarding my last post.  More specifically, your expert analysis on how I may have contacted this virus given my scenario, and what I can expect going forward (i.e. likelihood of transmission to possible future partners, and outbreaks).  Lastly I’d like to get your opinion on how accurate/inaccurate I am in my above post.

I guess I have been stressing myself out a lot the last few weeks, trying to figure out how this happened, what I need to do going forward, and what to expect.

Thank you for your time!!

[H. Hunter Handsfield, M.D.]

I guess I missed your first follow-up comment.  Sorry.

As to the stress factor:  If someone must have genital herpes, HSV-1 is the type you want to have. Most likely you will have few or no future outbreaks.  Same for your partner.  Don't let this become a bigger deal than it is.

There is no way to get genital herpes other than by sexual exposure.  You caught your infection either by oral, vaginal, or anal contact with your genital area.  HSV-1 is very common in the oral area, where it sometimes is associated with asymptomatic viral shedding, i.e. the virus is present and can be transmitted.  When HSV-1 is genital, asymptomatic shedding is uncommon.  For these reasons, the most likely scenario is that your girlfriend has oral herpes and that you caught it by oral sex.  However, it is possible she has a genital infection and you caught it through genital intercourse.  Unless she has future outbreaks, either oral or genital, you'll probably never know exactly when and how the transmission event happened.

Anyway, from here on out it shouldn't be a big deal.  You and your partner cannot "ping pong" the infection back and forth; you both are immune to a new infection with HSV-1, anywhere on the body.  Transmission could become an issue in the future, if and when either of you has other sex partners.  But even then, the transmission risk will be low.

Bottom line:  Don't let an impersonal virus spoil your holidays.  All will be well.

[Sparky_Rusty]

Dr. H if it’s ok I'd like to ask one more question.  How likely is Auto-inoculation (i.e. spreading to other areas)???  I ask because I have done plenty of research on HSV-1 and am worried that I could have spread this to my mouth.  Last night I noticed a bit of numbness on one side of my upper lip. This is still there.  I have read that this can be a preceding symptom of a cold sore coming on.  So after another night of minimal sleep, I thought I'd ask.  Now I can’t stop feeling and looking at my lip to see what is going on.  I guess I’m super worried that I may be spreading this virus all around, since it’s a new infection.

Thank you for your time, and I can’t wait to hear back from you.

[H. Hunter Handsfield, M.D.]

Autoinoculation with HSV is pretty much limited to the initial infection, i.e. someone with their first oral or genital herpes infection may transfer it to other body areas by scratching etc.  But it is very rare in recurrent herpes, i.e. once someone has had their herpes for several months.  Also, light touch never transmits HSV; the virus has to be massaged or scratched into the newly exposed area.  And if you're not having a repeat genital area outbreak, autoinoculation is exceedingly unlikely.

For the next 3-4, be on the lookout for new genital sore(s), and if you have one, be especially careful to wash your hands after using the toilet or touching the infected area.  Other than that, stop worrying about it.  And almost certainly you have not transmitted the infection to your mouth.

As I said above, please don't let this become a bigger deal than it is.  When all is said and done, this is going to fade into a transient, minor inconvenience in your life.

That will have to end this thread.  Take care.