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HSV autoinoculation
I have genital HSV2 3yrs+. 7 months ago, I had a little cut that I did not yet realize to be herpes. I had the palm heel of my hand on my lip in that spot while plucking eyebrows. I then moved my hand directly in contact with my left cheekbone. I did not vigorously massage it in by any means but it was planted for a while. While the cut on my lip went away quickly,it was followed by a white tongue with a few sores on my tongue, tingly nose and itchy face.Once I realized that must have been a herpes outbreak I went on the meds I already had daily. My GP just had me re-tested around the 6 month mark. Still no new infection.I had been having strange symptoms around the area by my eye. A little itchy from time to time, and a throbbing pain. It felt like there was something pressing on the inside of my L eye. It seemed to go away,other than itchy irritated eyes.But it came back about 3 weeks ago. Throbbing pain, then sometimes dull achy pressure.I went to my GP. He says we will figure it out but it is not herpes. But 3 days ago, the pain was too much, I went ahead and took 2x500mg doses of Valacyclovir, up until today,which is how it is was prescribed to me to treat an outbreak. Following day1 the throbbing pain went away. Still tightness around my eye and tingling all the way to the tip of my nose, down my chin.Last night I still had some throbbing underneath my eye,and today,I still feel that dull ache around my eye,pressure, including the bridge of my nose,but it is fairly diminished. Am I having an outbreak that never developed because of the daily 500mg I was taking?Or could it be something else completely,and my paranoia has gotten the best of me?I know it is highly unlikely to transfer HSV to yourself after the initial outbreak.But since I have no new infection,I was able to transfer it from my genitals to my mouth, right?So why not again?The symptoms feel like HSV.If it is not,what could it be and why would anti-virals change the symptoms?
MEDICAL PROFESSIONAL
Welcome to the forum. I glanced at your thread on the HSV community forum, but not the several posts on the eye forum.
As you were told on the herpes community forum, I very much doubt you have autoinoculated your face or eye from your genital herpes. I also do not believe the oral sores you had were the result of autoinoculation of your genital HSV-2. Perhaps you have oral herpes due to HSV-1, but even that seem unlikely based on the symptoms you describe.
You already understand that autoinoculation of HSV is rare after the primary infection. And the symptoms you describe don't really sound at all like ocular herpes -- which is always a dramatically painful infection that would not be missed by your GP or other physicians. In other words, your doctor's belief that you don't have ocular herpes probably is correct. The apparent improvement in symptoms after starting anti-herpes therapy probably is just a coincidence, i.e. the symptoms were about to improve anyway.
The one thing I'm not clear about is what is meant by "My GP just had me re-tested around the 6 month mark. Still no new infection." Was this a blood test or a test for the virus by culture or PCR? It would be good if you can confirm all HSV testing you have had, including the basis for your initial diagnosis of genital HSV-2, but expecially any tests to diagnose your eye, face, or oral symptoms.
At this point, my advice is that you stop taking valacyclovir. The next time you have recurrent symptoms, whether oral or involving your eye or your mouth, return to your GP for possible additional diagnostic testing. It sounds like s/he is pretty much on top of the issues. And if you want to return with further information about the tests done so far, I might be able to fine-tune this advice. But based on what I know so far, I'm quite certain you have not autoinoculated your mouth or eye; although I'm a little less certain whether you might have an oral/facial HSV-1 infection in addition to your HSV-2.
Regards-- HHH, MD
As you were told on the herpes community forum, I very much doubt you have autoinoculated your face or eye from your genital herpes. I also do not believe the oral sores you had were the result of autoinoculation of your genital HSV-2. Perhaps you have oral herpes due to HSV-1, but even that seem unlikely based on the symptoms you describe.
You already understand that autoinoculation of HSV is rare after the primary infection. And the symptoms you describe don't really sound at all like ocular herpes -- which is always a dramatically painful infection that would not be missed by your GP or other physicians. In other words, your doctor's belief that you don't have ocular herpes probably is correct. The apparent improvement in symptoms after starting anti-herpes therapy probably is just a coincidence, i.e. the symptoms were about to improve anyway.
The one thing I'm not clear about is what is meant by "My GP just had me re-tested around the 6 month mark. Still no new infection." Was this a blood test or a test for the virus by culture or PCR? It would be good if you can confirm all HSV testing you have had, including the basis for your initial diagnosis of genital HSV-2, but expecially any tests to diagnose your eye, face, or oral symptoms.
At this point, my advice is that you stop taking valacyclovir. The next time you have recurrent symptoms, whether oral or involving your eye or your mouth, return to your GP for possible additional diagnostic testing. It sounds like s/he is pretty much on top of the issues. And if you want to return with further information about the tests done so far, I might be able to fine-tune this advice. But based on what I know so far, I'm quite certain you have not autoinoculated your mouth or eye; although I'm a little less certain whether you might have an oral/facial HSV-1 infection in addition to your HSV-2.
Regards-- HHH, MD
Hi Dr. H,
Thank you for your reply. Sorry for the lump paragraph I wrote, I was trying to get my word count down. My original genital outbreak was looked at by Planned Parenthood. I had just gotten through a very physical self defense instructor training. I do not believe it was cultured, but a blood test was preformed. It came back negative, and I attributed the rash due to intense physical activity. Until a few months later, I had another outbreak, went in and had it cultured, and a blood test, came up positive for HSV2 but no sign of HSV1.
I have not had anything on my face cultured, the lip issue came and went quickly. I should mention that before the cut on my lip, it did swell. I went to a med clinic and the doc looked at my tongue she said she thought it was a yeast infection, or oral herpes, no big deal she said.
By the 6 month mark comment, I mean, I was just tested, and it had been about 6 months since the lip thing. My results are as follows:
HSV1 and 2- specific Ab IgG
HSV 1 IgG, type spec <.091
HSV 2 IgG 3.04 HIGH
HSV IgG I/II combo 1.32 HIGH
Thanks you so much for your answers.
Thank you for your reply. Sorry for the lump paragraph I wrote, I was trying to get my word count down. My original genital outbreak was looked at by Planned Parenthood. I had just gotten through a very physical self defense instructor training. I do not believe it was cultured, but a blood test was preformed. It came back negative, and I attributed the rash due to intense physical activity. Until a few months later, I had another outbreak, went in and had it cultured, and a blood test, came up positive for HSV2 but no sign of HSV1.
I have not had anything on my face cultured, the lip issue came and went quickly. I should mention that before the cut on my lip, it did swell. I went to a med clinic and the doc looked at my tongue she said she thought it was a yeast infection, or oral herpes, no big deal she said.
By the 6 month mark comment, I mean, I was just tested, and it had been about 6 months since the lip thing. My results are as follows:
HSV1 and 2- specific Ab IgG
HSV 1 IgG, type spec <.091
HSV 2 IgG 3.04 HIGH
HSV IgG I/II combo 1.32 HIGH
Thanks you so much for your answers.
MEDICAL PROFESSIONAL
OK, that confirms your genital HSV-2 infection: compatible symptoms plus conversion of the blood test from negative to positive for HSV-2.
Still, I do not believe HSV-2 explains your ocular or oral symptoms. So my advice above still stands: stay off valacyclovir for a while, and work out a plan with your GP for a prompt (1-2 days, tops) follow-up visit if and when new eye, facial, or oral symptoms develop. But in the meantime, don't worry about herpes as the cause. It's very unlikely.
I would be interested to know the outcome if and when you develop new symptoms and are reexamined and retested. Until then, there isn't much more I'll be able to say.
Still, I do not believe HSV-2 explains your ocular or oral symptoms. So my advice above still stands: stay off valacyclovir for a while, and work out a plan with your GP for a prompt (1-2 days, tops) follow-up visit if and when new eye, facial, or oral symptoms develop. But in the meantime, don't worry about herpes as the cause. It's very unlikely.
I would be interested to know the outcome if and when you develop new symptoms and are reexamined and retested. Until then, there isn't much more I'll be able to say.
Thanks Dr. H,
I had thought the same, about coming off the medication to see what happens, but I have been VERY scared to do so. Also my Dr. told me to stay on it, but I think that is mostly because I have been such a head-case over all this, and I'm sure the stress would cause an OB at the very least genitally. My Dr. also said the same thing, if something pops up on my lip to go in a show him immediately.
I didn't mention, when the lip happened, I immediately had a genital OB. Also about a month after, I went on a trip, and my lip began to throb in that spot, and I put Abreva on it and nothing popped up but I did have a few sores on my tongue.
Too, through all this in regards to the L side of my face, sometimes the throbbing pain would coincide with the throbbing of my lip.
This does not change your advice or thoughts, does it?
Thanks again.
I had thought the same, about coming off the medication to see what happens, but I have been VERY scared to do so. Also my Dr. told me to stay on it, but I think that is mostly because I have been such a head-case over all this, and I'm sure the stress would cause an OB at the very least genitally. My Dr. also said the same thing, if something pops up on my lip to go in a show him immediately.
I didn't mention, when the lip happened, I immediately had a genital OB. Also about a month after, I went on a trip, and my lip began to throb in that spot, and I put Abreva on it and nothing popped up but I did have a few sores on my tongue.
Too, through all this in regards to the L side of my face, sometimes the throbbing pain would coincide with the throbbing of my lip.
This does not change your advice or thoughts, does it?
Thanks again.
MEDICAL PROFESSIONAL
No, this doesn't change my opinion or advice, and I don't quite understand what is so terrifying about stopping treatment for a while; it can always be started if a significant outbreak occurs. Herpes doesn't cause the sort of throbbing pain you describe, especially between overt outbreaks. And contrary to popular opinion, there is no evidence that stress, worry, or other emotional or psychological factors trigger herpes outbreaks. However, I always recommend patients follow their doctors' advice in preference to mine; no online provider can or should give advice in conflict with that from direct care by a knowledgeable clinician. Still, you might consider printing out this thread as a framework for discussion with your doctor.
All things considered, you need to mellow out about your herpes. Nobody wants it, but genital herpes generally settles into an inconvenience, with easily manageable impact on life, including healthy and rewarding sex and romance. With these goals in mind, you might benefit from participating in MedHelp's herpes community forum, which is moderated by highly experienced counselors. Also read the reassuring information you can find from the American Social Health Association (www.ashastd.org) and the Westover Heights Clinic of Portland, OR (www.westoverheights.com). At both sites, you can peruse and order either of two excellent books on living with herpes. (Full disclosure: Dr. Hook and I are on ASHA's Board of Directors, and WHC is owned and run by Terri Warren, moderator of the MedHelp professional herpes forum -- and author of one of the books I mentioned.)
I think that's about as far as this thread can go, until and unless more information becomes available if you stop treatment and/or additional tests sort this out. Good luck.
All things considered, you need to mellow out about your herpes. Nobody wants it, but genital herpes generally settles into an inconvenience, with easily manageable impact on life, including healthy and rewarding sex and romance. With these goals in mind, you might benefit from participating in MedHelp's herpes community forum, which is moderated by highly experienced counselors. Also read the reassuring information you can find from the American Social Health Association (www.ashastd.org) and the Westover Heights Clinic of Portland, OR (www.westoverheights.com). At both sites, you can peruse and order either of two excellent books on living with herpes. (Full disclosure: Dr. Hook and I are on ASHA's Board of Directors, and WHC is owned and run by Terri Warren, moderator of the MedHelp professional herpes forum -- and author of one of the books I mentioned.)
I think that's about as far as this thread can go, until and unless more information becomes available if you stop treatment and/or additional tests sort this out. Good luck.
Dr. H,
Stopping the treatment only scares me because of my facial issue at the moment. I guess I'm mostly worried about the pain. (And not being able to hide it). As backwards as it may seem, considering oral herpes is so prevalent, and basically socially accepted. I had a handle my genital HSV. Have "had the talk" with a partner, and he was totally great. Just recently in light of all this going on have I felt like HSV was taking over my life. I would really hate to be the first moron to autoinoculate themselves, twice. Not exactly what I want to be remembered for. :)
But I will discuss this further with my Dr. I appreciate and respect your insight, as well as his, and I will try to keep telling myself that it is not true, and my mind is just playing tricks on me. Thanks for the book titles.
I will let you know if and when I do stop treatment, and what happens from there.
Thank you thank you.
Stopping the treatment only scares me because of my facial issue at the moment. I guess I'm mostly worried about the pain. (And not being able to hide it). As backwards as it may seem, considering oral herpes is so prevalent, and basically socially accepted. I had a handle my genital HSV. Have "had the talk" with a partner, and he was totally great. Just recently in light of all this going on have I felt like HSV was taking over my life. I would really hate to be the first moron to autoinoculate themselves, twice. Not exactly what I want to be remembered for. :)
But I will discuss this further with my Dr. I appreciate and respect your insight, as well as his, and I will try to keep telling myself that it is not true, and my mind is just playing tricks on me. Thanks for the book titles.
I will let you know if and when I do stop treatment, and what happens from there.
Thank you thank you.
Hi,
Just a thought. Would shingles cause these symptoms? Is that a possibility? Since I was on the anti-virals a rash never occurred? Or is it like you said about HSV, and there would not be that throbbing pain without an overt outbreak? Sorry to bother you again, but just a thought. The tingling I felt a few days back was strong, and seemed to touch every nerve on that left side.
Just a thought. Would shingles cause these symptoms? Is that a possibility? Since I was on the anti-virals a rash never occurred? Or is it like you said about HSV, and there would not be that throbbing pain without an overt outbreak? Sorry to bother you again, but just a thought. The tingling I felt a few days back was strong, and seemed to touch every nerve on that left side.
MEDICAL PROFESSIONAL
This is an interesting idea; I didn't think of it -- but since you mention it, perhaps it is worth thinking about.
Shingles is also called herpes zoster; it is caused by recurrence of the same virus that causes childhood chickenpox. For sure active shingles is not a possibility for your symptoms. However, it is conceivable that the first oral/facial episode that concerned (tongue lesions and tingling of the nose) was shingles -- and unlike HSV infections, shingles is often followed by ongoing neuropathic pain and discomfort, called post-herpetic neuralgia (PHN). So this might be something to discuss with your doctor. However, if that's the explanation, I can't be too optimistic about effective treatment. PHN is difficult to treat, and it does not typically respond to anti-herpes therapy like valacyclovir.
I'll be interested to hear your doctor's opinion about whether the initial episode might have been herpes zoster and if your current symptoms could be PHN.
Shingles is also called herpes zoster; it is caused by recurrence of the same virus that causes childhood chickenpox. For sure active shingles is not a possibility for your symptoms. However, it is conceivable that the first oral/facial episode that concerned (tongue lesions and tingling of the nose) was shingles -- and unlike HSV infections, shingles is often followed by ongoing neuropathic pain and discomfort, called post-herpetic neuralgia (PHN). So this might be something to discuss with your doctor. However, if that's the explanation, I can't be too optimistic about effective treatment. PHN is difficult to treat, and it does not typically respond to anti-herpes therapy like valacyclovir.
I'll be interested to hear your doctor's opinion about whether the initial episode might have been herpes zoster and if your current symptoms could be PHN.
I will let you know. However, after hearing your opinion, this may not be possible, because the original lip and tongue lesions were on my right side...
MEDICAL PROFESSIONAL
I agree this theory doesn't work if the original lesions and your current pain are on opposite sides of your face.
That will be all for this thread unless/until you report more definitive results of lab testing, your doctor's evaluation, etc.
That will be all for this thread unless/until you report more definitive results of lab testing, your doctor's evaluation, etc.
Hi Dr.
I was diagnosed by my chiropractor yesterday with Tic Douloureux. I have been reading on it, and a-typical seems to fit my symptoms more. I realize too that I am a little young, 31. What do you think of this diagnosis?
Also I have read that it can be related to HSV.
"Any areas of painful facial blisters: painful blisters can be a sign that you are suffering from a viral infection involving your facial skin, such as herpes, which is caused by the herpes simplex virus, or shingles, which is caused by varicella zoster, the chickenpox virus. Especially in cases of shingles, facial pain may persist for weeks after the blisters heal. "
Do you think this to be a possibility even with no overt outbreak? (Due to antivirals). I plan to take your advice and get off the valtrex, but I am waiting Until the holiday season is over.
Sorry to bother you again without having gone off the meds, but I was diagnosed, and thought you might like to know, (and I hoped for your opinion/insight).
Thank you.
I was diagnosed by my chiropractor yesterday with Tic Douloureux. I have been reading on it, and a-typical seems to fit my symptoms more. I realize too that I am a little young, 31. What do you think of this diagnosis?
Also I have read that it can be related to HSV.
"Any areas of painful facial blisters: painful blisters can be a sign that you are suffering from a viral infection involving your facial skin, such as herpes, which is caused by the herpes simplex virus, or shingles, which is caused by varicella zoster, the chickenpox virus. Especially in cases of shingles, facial pain may persist for weeks after the blisters heal. "
Do you think this to be a possibility even with no overt outbreak? (Due to antivirals). I plan to take your advice and get off the valtrex, but I am waiting Until the holiday season is over.
Sorry to bother you again without having gone off the meds, but I was diagnosed, and thought you might like to know, (and I hoped for your opinion/insight).
Thank you.
MEDICAL PROFESSIONAL
Trigeminal neuralgia (tic douloureux) may occasionally be caused by HSV-1, but most cases have other causes. To my knowledge, HSV-2 is not a cause. Given your chiropracter's opinion, I strongly recommend you now see a neurologist for confirmation of the diagnosis and, if confirmed, studies to determine the cause. Some causes are serious (e.g., certain tumors) so this should not be neglected.
Beyond that, I can't help. This isn't an STD issue -- and although some cases may be caused by HSV-1 or other infections, I have no experience or knowledge of the condition's diagnosis, causes, or management. Sorry I can't be more helpful.
Beyond that, I can't help. This isn't an STD issue -- and although some cases may be caused by HSV-1 or other infections, I have no experience or knowledge of the condition's diagnosis, causes, or management. Sorry I can't be more helpful.
Thanks Dr. That is helpful.
Although can you answer something for me i have been wondering for a while now. I have also read, I believe in this forum, that a certain percentage of people that have HSV 1 will never test positive for it. Is that a possibility at all for me, or since HSV 2 antibodies show up in my blood, HSV 1 would most definitely show up as well? I ask because the episode on my lip occurred about a week after I kissed someone who had a history of cold sores.
Although can you answer something for me i have been wondering for a while now. I have also read, I believe in this forum, that a certain percentage of people that have HSV 1 will never test positive for it. Is that a possibility at all for me, or since HSV 2 antibodies show up in my blood, HSV 1 would most definitely show up as well? I ask because the episode on my lip occurred about a week after I kissed someone who had a history of cold sores.
MEDICAL PROFESSIONAL
That's a good question and I don't know the answer. To my knowledge, having a positive test for HSV-2 has no bearing on the reliability of HSV-1 antibody detection, but I will check with a lab expert and get back with a follow-up comment.
Dr. H,
I really appreciate you looking into that for me. I have a follow up question, but I suppose it really depends on your reply.
If the two antibodies' detection are indeed mutually exclusive, does it then seem likely to you that the mouth incident I spoke of is HSV-1, (given I have since found out that the person I kissed a week prior had a history of cold sores, but not an active one at the time), just mild because of already having HSV-2? Or does that still not seem likely to you? But if that does seem likely, then I could have transferred it to the L side of my face from my hand while plucking my eyebrows stupidly with my hands all over my face?
Could the pain, pressure, tingling I have described be attributed to a new infection? Or do the symptoms not fit? Especially since I have been on anti-virals? I no longer feel throbbing pain, or intense pressure, but still have tingling, itching, occasional twitching, and come and go again aching. There has been virtually no rest. I realize the only way of truly knowing is a swab if something ever pops up.
I'm sorry to bombard you yet once again. I just wonder and worry about this. I do not have the electrical shock feeling described by sufferer's of Trigeminal neuralgia, and my lip still throbs off and on where the little sore was. I do plan to go see a neurologist, and have to accept this diagnosis because it is the only one I have gotten.
But if HSV-1 were the culprit of my lip, would this change your belief?
Thank you so much, I'm sorry this thread is so long.
I really appreciate you looking into that for me. I have a follow up question, but I suppose it really depends on your reply.
If the two antibodies' detection are indeed mutually exclusive, does it then seem likely to you that the mouth incident I spoke of is HSV-1, (given I have since found out that the person I kissed a week prior had a history of cold sores, but not an active one at the time), just mild because of already having HSV-2? Or does that still not seem likely to you? But if that does seem likely, then I could have transferred it to the L side of my face from my hand while plucking my eyebrows stupidly with my hands all over my face?
Could the pain, pressure, tingling I have described be attributed to a new infection? Or do the symptoms not fit? Especially since I have been on anti-virals? I no longer feel throbbing pain, or intense pressure, but still have tingling, itching, occasional twitching, and come and go again aching. There has been virtually no rest. I realize the only way of truly knowing is a swab if something ever pops up.
I'm sorry to bombard you yet once again. I just wonder and worry about this. I do not have the electrical shock feeling described by sufferer's of Trigeminal neuralgia, and my lip still throbs off and on where the little sore was. I do plan to go see a neurologist, and have to accept this diagnosis because it is the only one I have gotten.
But if HSV-1 were the culprit of my lip, would this change your belief?
Thank you so much, I'm sorry this thread is so long.
MEDICAL PROFESSIONAL
My lab expert/colleague says there are no data on this; to her knowledge and belief, there is no difference in HSV-1 test performance in people with positive versus negative HSV-2 results.
The more detailed symptoms you now describe do not change my opinion or advice. It is unlikely you have HSV-1 and I doubt your lip lesion was herpes, and I continue to believe it unlikely that your facial pain has anything to do with either HSV-1 or 2. But all this is definitely outside my STD expertise. I certainly endorse your plan to follow through with your neurologist. Good luck with it.
The more detailed symptoms you now describe do not change my opinion or advice. It is unlikely you have HSV-1 and I doubt your lip lesion was herpes, and I continue to believe it unlikely that your facial pain has anything to do with either HSV-1 or 2. But all this is definitely outside my STD expertise. I certainly endorse your plan to follow through with your neurologist. Good luck with it.
Thank you Dr. H for all you do here.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
