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HSV-1 positive
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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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HSV-1 positive

One year ago I had a classic first herpes outbreak which started 10 days after intercourse with my partner; blisters, fever, nausea, swollen lymph nodes in the groin area. The blisters were only around my bottom and nothing on my vagina and my partner didn't have any symptoms.  My GP conducted an IgM and the IgG HSV-2 test but he didn't do a culture and he didn't test me for IgG HSV-1.   The IgM result was borderline positive and the IgG HSV-2 was negative my partner had the same test results.  We agreed to conduct the tests again in six weeks in which my results came back HSV-1 positive and HSV-2 negative however my partner tells me he is negative for both types.  In Feb of this year I repeated the blood tests with the same results HSV-1 positive and HSV-2 negative.  

Two weeks ago I had a second outbreak three days after intercourse with the same partner (I've been exclusive with him).  I had the same symptoms as the first outbreak; my OBGYN did a culture that came back Herpes positive so she has informed me that I have HSV-1 in the genital area.   Since my partner's HSV-1 test is negative my OBGYN's PA suggested that I could have transferred the virus from an oral sore to my genital area; basically giving this to myself.  Prior to my first outbreak I never had any type of genital ulcer; I've never had a fever blister or cold sore.  Have you heard of such a thing?  

Should I ask my partner to be restested for HSV-1?
Why is it isolated to my buttocks area?
Will the blisters always be in the same place or will they move around and/or spread?
Would friction or trauma in an area trigger an outbreak?
If they only appear in the buttocks area will a condom really make a difference?  I know that sounds crazy but I'm just trying to understand; I want to be safe and informed.  
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I'll try to help, but this is all very puzzling.  Except for the positive culture for HSV-1 during your second outbreak, I would have thought you might have recurrent herpes zoster (shingles) rather than HSV.  First episodes of sexually acquired genital herpes, due to either HSV-1 or HSV-2, almost always involve the genitals per se, not nearby areas like the buttocks.  (But if 'bottom' means that your anal area also was involved, that fits with sexual acquisition.)  

And I cannot explain why this occured or where it came from, since your only potential source of a sexually acquired new HSV-1 infection apparently does not have HSV-1.  The PA's explanation about auto-inoculation of an oral HSV-1 infection to your buttocks is unlikely, for 2 reasons: autoinoculation is rare in chronic HSV infections, and would not be expected to caused the extensive outbreak and systemic symptoms you describe

To some of your other specific questions:  Genital area herpes generally recurs at more or less the same spot each time, it doesn't 'move around' to new sites.  Assuming this really is HSV-1 and not HSV-2, I cannot predict the likelihood that you intermittently shed virus in your genital tract (e.g. cervix).  That is common for HSV-2 (even when the main symptoms are away from the immediate genital area) but never studied for HSV-1.  In general, asymptomatic genital shedding if less common for HSV-1 than HSV-2.  On balance, therefore, I cannot predict how protective a condom may or may not be.  However, if your partner in fact is infected--which seems likely despite his negative blood test results--he is not susceptible to a new infection anyway.  And if he gets it, most likely it won't be such a big deal, without frequent recurrences and easily treatable.  So maybe you will decide together to not worry much about it.

Friction, trauma, or sex apparently do not trigger outbreaks of genital herpes due to HSV-2.  However, oral herpes (cold sores) due to HSV-1 can be triggered by local injury, like facial surgery or sunburn.  Whether that occurs with genital area HSV-1 is unknown (at least by me).

In summary, the whole situation is a mystery and I don't have definite solutions to suggest.  Among other things, though, I think you and your partner both should be retested for both HSV-1 and HSV-2; and to be safe, in the event of yet another outbreak, have the lesions retested (and the virus typed), including a test for varicella zoster virus (VZV), the cause of shingles.  Finally, your partner should be on the lookout for genital area sores and immediately (within 24 hours) see a provider for diagnosis and testing.  And somewhere along the line, you might want to seek out truly expert care, such as consultation with an infectious diseases expert.

Good luck--  HHH, MD
" Genital area herpes generally recurs at more or less the same spot each time, it doesn't "move around" to new sites."

I'm curious as to why you would say this HHH?  I know in myself I can more easily tell you where I haven't had ob's in 20 years than I could tell you where all I've had them. In most other folks I know with genital herpes yes indeed we have our "usual" spots for recurrences but it's not unusual for ob's to show up in different places in the genital area over the years.  

I'm not questioning this to scare the original poster by no means - just trying to make sure folks know that there's nothing "wrong" with them if their ob's are usually in one area but then they get ob's anywhere else in the entire boxer short area.  Just wanted your clarification on this.

Hi, Grace. As you well know, all generalizations have their exceptions, and your own experience is what it is. But the data are clear that most recurrent genital herpes (or genital area herpes, like buttocks) outbreaks involve more or less the same area, give or take a few centimeters.  Surely there are exceptions.  

An even more definite truth is that recurrent herpes always is on one side of the body's midline or the other--up to and including the midline, but not on both sides.

On reflection, I guess I should add that probably most people with genital herpes do not continue to have frequent symptomatic recurrences for 20 years.  Someone whose disease course is atypical in one way might well be atypical in others.  But I think the generalization remains valid.  (As a cross-check, have you ever discussed this with our mutual friend and colleague in Portland? I'll bet her understanding and experience are similar to mine.)

Thanks for your regular insights on this forum!
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H. Hunter Handsfield, M.D.Blank
University of Washington
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