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HSV self-reinfection - risk and proof
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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 self-reinfection - risk and proof

I am literally worrying sick (being treated for anxiety/OCD) about spreading my facial HSV-1 to my genitals, eyes and fingers.
I've had cold sores for more than 15 years, so I know it's unlikely due to antibodies, which is discussed at http://www.medhelp.org/forums/STD/messages/1842.html. However, I believe I had an outbreak on my wrist three years ago - unfortunately I never did a swab test, but topical penciclovir and oral acyclovir seemed effective. This makes me wonder if I am one of the miserable few who may reinfect myself.

I would be very grateful if these questions were answered:
- Assuming it was herpes on my wrist, does this prove I am at risk of further self reinfection? Are my antibodies insufficient?
- I know autoinoculation is rare and happens "almost entirely" during the primary infection. But what does that mean in numbers? One out of how many cases? How many cases (after the primary infection) have you seen?
- Is it possible to reinfect yourself and have a single outbreak, without the virus becoming resident in the new area?
- (Are there other conditions than impetigo, that may be mistaken for herpes and may cause symptoms on the wrist...?)

Thanks in advance.
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239123_tn?1267651214
Your previous thread in 2005 (under a different username) also expressed concern about autoinoculation to new body sites.  As you were told then, this really isn't a worry.  It almost never happens.

As for the the problem on your wrist, I doubt it was herpes.  Most skin problems clear up on their own in a few days, so clearing while taking those drugs doesn't mean they were the reason the problem resolved. (By the way, topical penciclovir is no more effective than placebo in clearing up herpes lesions.  Most herpes experts never prescribe the stuff.)

1) No, it doesn't prove anything. And as I said, I do not accept it was herpes on your wrist.

2) No statistics are available.  But I have never seen a case of autoinoculation except in association with initial herpes (and in 30+ years in a busy STD clinic I have seen only 2 of those).

3) Probably not.  But no data available.

4) There are many conditions other than herpes that could do this.

Almost certainly you correctly identified the only health condition manifested by your question, your OCD.  Your concern about herpes is a symptom of that condition, nothing more.  Work with your mental health professional about it.  But this forum cannot help you further, so I won't have any further comments.

HHH, MD
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Avatar_m_tn
Regarding having insufficient antibodies: A blood test taken some months ago had this result "Elisa HSV IgG > 6400".
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Avatar_m_tn
Thank you for your answer.
I am not sure why you assume I was the one asking a related question years ago. Rather, I found this site - and the above post - earlier this year. I'd recommend not making such asumptions, since people seeking advice may be offended.

Anyway, I will continue treating the OCD with CBT.
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239123_tn?1267651214
Sorry for the misunderstanding.  Even on re-reading, your question seems to suggest the previous thread was your own, under a different username -- and the question and discussion there are consistent with your current questions.  And it is very common for anxious questioners on this and the HIV prevention forum to return with variations on the same questions.   Apologies again.

I don't know the terminology you describe for your HSV test. Apparently it was a different test than the ones I am used to.

Truly, the only herpes transmission risk you need to be concerned about is transmission of your oral HSV-1 to other people.  And as long as you avoid kissing or performing oral sex on someone while you're having an oral outbreak, that's really not a concern either.  Your own immune response protects you from autoinoculation; that is why the phenomenon is pretty much seen only with the initial infection, i.e. before the immune response to the virus is mature.
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239123_tn?1267651214
Topical acyclovir is no different than penciclovir.  Both result in quicker return of viral cultures to negative, by an average of somewhere around 8-10 hours, if I correctly recall.  Neither product is associated with any difference in time to reduced pain or lesion healing, compared with placebo.  Some patients believe the drugs work better than this in their personal experience.  But in 30+ years in the STD business, I have never prescribed topicals for herpes.  If someone needs treatment, they need systemic (oral) drug.

That's all for this thread.
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