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HSV and other illnesses

HSV and other illnesses

I was wondering if either type of HSV presents itself in a more aggravated fashion when coupled with other illnesses.  I've read that it can increase the transmission risk of HIV, but has there been any evidence to indicate that the clinical manifestation of HSV may be worse in people who have fought cancer and endured chemotherapy.  I hope this question doesn't go too far out of your field of practice, but I imagine you see cases similar to this all the time.  

Also, I've read the pre-infection with HSV-1 increases the liklihood that a subsequent infection with HSV-2 would be asymptomatic (or atypical).  In your experience, is there a pretty profound connection between the two?
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Many viral infections, including HSV infections, may be more severe in their initial presentation, or may have more difficult-to-control recurrences, in people with serious immune system deficiencies:  advanced HIV/AIDS, cancer, chemotherapy patients, etc.  
But otherwise I am unaware of any data to suggest more serious outcomes in people with other illnesses.  This doesn't mean that a person who presents with severe initial genital or oral herpes necessarily has HIV or some other serious underlying illness.  The spectrum of severity of initial infections ranges from very dramatic to asymptomatic in people who otherwise are entirely healthy.

People with prior HSV-1 infection tend to have less severe symptoms with their first HSV-2 infection.  But I stress "tend"; the average is less severe, but symptoms still range from dramatic to trivial.  There are conflicting data on whether prior HSV- actually protects against getting HSV-2 if exposed; probably yes, but whatever protection exists is only mild.

HHH, MD
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