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HSV-2 auto-inoculation
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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-2 auto-inoculation

My questions relate to the infection and auto-inoculation of HSV-2.

1) What percentage of persons infected do not have lesions upon initial infection?

2) Can you primary infect without visible lesions and then have lesions on a secondary infection site?

3) Although I understand that auto-inoculation is pretty common during a persons first infection, can auto-inoculation occur without contact with an obviously infected region?   For example, when lesions are on the shaft of your penis can seminal fluid carry sufficient virus during this period to infect another area?

4) If auto-inoculated, do you get recurrences at the primary infection site or both?  Equally often and similar timing?

Many thanks
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I'll go straight to your questions.

1) Probably about half to 2/3 of people with new genital herpes get lesions.  However, many of those are mild and not noticed, so up to 70-80% say they are asymptomatic. But many of those would see an abnormality if they knew what to look for.

2) I suppose it is possible to have an asymptomatic or unrecognized initial genital infection, and still have symptomatic auto-inoculation to another part of the body.  But it has to be rare and I have never seen such a case.

3) HSV probably has to be massaged into the skin or tissues for infection to 'take'.  There may be exceptions, but auto-inoculation by less direct transmission (e.g., via semen) either doesn't occur or is very rare.

4) Recurrent HSV-2 outbreaks are uncommon at non-genital sites. I have never seen a person with recurrent HSV-2 outbreaks of the eye, mouth (oral herpes), fingers, etc--even though they are the main sites of auto-inoculation in people with initial genital herpes.  Only a tiny percentage of people with recurrent oral herpes have HSV-2, for example--even though several percent of people with primary genital herpes have oral as well as genital infection.

Good luck-- HHH, MD
4 Comments
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Dr H,

Many thanks for your response.  Just out of interest, do those who experience systemic effects normally have lesions (x & y), or is there no definitive link (x or y)?

Kind regards
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I have never heard of a patient who had systemic symptoms of initial herpes without having recognized lesions.  If it occurs, it is uncommon.
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Many thanks Dr H.  Great site, great service.

Kind regards,
BoxOfRocks
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
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