New genital HSV-1 questions

[cboarder]

Dr. H,
Thank you for your wonderful feedback and website.  It truely is a great service for all who utilize it.  

I was recently diagnosed with genital hsv-1 and had my first noticeable outbreak 6 weeks ago.  I am healthy, heterosexual male and the outbreak was very mild.  There was only one very small sore the size of a pencil tip, which was cultured for HSV-1 and negative for HSV-2.  I have done a ton of reading on your site and understand that my reoccurences should be few and far between.  I currently am in a relationship and we have refrained from sexual contact for the past 3 months so she could be tested as well.  She has had a herpes select test done and was negative for both HSV1 and HSV2.  I want to be as safe as possible not to infect her.  Please bear with me on my laundry list of questions because I want to be as safe and smart as possible since it's just not my self that this affects.  Thanks.

1.  If I am on suppresive therapy and avoid having sex when there is an outbreak, are condoms still necessary since our relationship is going to be long term?  Does Valtrex do a good job of suppressiing HSV-1 shedding?  Does any type of chemical such as spermicide help kill the hsv-1 virus during intercourse?
2.  If she has HPV, can HSV-1 increase her chances of cervical cancer?  I have seen different opinions of HSV-2 and this topic, but not HSV-1.
3.  Is herpes encephalitis only caused by HSV-1 in the facial nerves (since I have genital hsv-1, any need to be concerned since my infection is not of the sacral region)?  Is herpes encephalitis only seen in immuno-compromised patients such as HIV and cancer?
4.  Can HSV-1 cause any type of Neuralgia, or other CNS problems?  Or, is just shingles that cause post-herpetic neuralgia?  
5.  As long as I am not touching any open sores, is there any chance of spreading it to my face or anywhere on her after the first year, while I develop antibodies (i.e. occular herpes).
6.  Currently, there are trial sites across the US for a herpes vaccine.  Is it worth us looking into her becoming part of vaccine trial to lessen her chances of becoming infected?

Doctor, thanks for your help because my biggest concern is for her, not myself.  Your feedback is greatly appreciated because I want to handle the next steps in our relationship appropriately and safely.  Take care and best of luck!

[H. Hunter Handsfield, M.D.]

Any other smart-*** comments, or attempts to "out" an STD Forum user with his or her alleged real name, and you will be banned from posting anything on any of the MedHelp forums.  Fair warning.

HHH, MD

[passedHSV1]

....actually I will add a couple more things in response to your questions;

Stress on relationship: yes....it is very stressfull on the relationship. I felt tremendous guilt for infecting her. When I contracted it also I felt personally devastated. We have talked about her animosity toward me...it's hard not to feel it despite the fact that it was not an intentional act. The forces at play are complex and you have to learn how to forgive and that completely depends on how easily and quickly you can navigate a way to move forward. The past is done however.

Recurrences for women: My partner (female) had a rough first two months and then she took suppression for a while (3 months or so). Since then she seems to have been fortunate without any more genital recurrences. It is now 10 months or so past her primary episode.

[passedHSV1]

Yes, I understand your sentiments and concerns perfectly. Our situations are similar as you say.

My experience with HSV-1 is that the recurrences were so frequent in the first few weeks that I placed myself on supression therapy ( 1000mg Valtrex per day) for about 6 weeks. At times I was even taking 1000 mg twice a day. It seemed hard to supress and I wanted a period of psychological and physiological rest. I stopped using Valtrex after that time because it does cause a lot of sedation. When you work out or try to be active and you take Valtrex 1000mg per day your body just doesn't perform as well. You get tired and dizzy very quickly (at least that is my experience). So it's not the most pleasant thing in the world. Valtrex 500 mg a day is a much better experience and is very tolerable. But I would advise to stay on the higher dose for as long as you can during the first few months (again beecause of the shedding).

I had great relief from a solution called "Herpigon" which contains Zinc 3%, Tannic acid 2%, and urea 30%. It is not sold anywhere but you can ask your doctor to call it in to a compounding pharmacy if he or she is willing and they will mix the ingredients and prepare it for you specificaly. It costs something like $30-50 for 2 months supply or so (depending on the pharmacy). Both my partner and myself found great great relief in using this solution twice a day externally (for me...she also uses it internally). Zinc is the active ingredient as it is virucidal (zinc lozenges are used orally for the same reason). There are no side effects to using the solution and we both noticed that our recurrences seemed to just drop off immediately after. It was a relief to be off valtrex.

The emotional aspect is very tough.  I have not found a good way to deal with it, but I do recommend talking to a therapist for a few months and perhaps a few herpes support groups. There are many online groups as well if you do not want to go in person. I think when the recurrences start to spread out over time and our bodies return to months of feeling "normal" at at end, the psychological burden will change. After 1 year of having this disease the recurrence rate should drop significantly (as opposed to HSV-2). So will the shedding. If you have ANY tingling or symptoms in the meantime (even in the absence of visible lessions) refrain from sex and wait for a better time to protect your fiance. It would be nice to have a vaccine, but there isn't one that works and no one is even looking for one that adresses HSV-1...all the research is targetting HSV-2. Lastly, ask your fiance what this means to her. She might be feeling "trapped" and scared about sex as much as you are. Give her complete freedom of communication and action. Maybe go to therapy together and assure her that you will do everything in your power not to infect her also. That's all my advice for now...let me know if you have any more questions. I would be happy to add any more input....good luck!!

[need_light]

A related discussion, Experiencing very first outbreak and scared was started.

[just_found_out]

I just found out that i have genital HSV 1.  I went in to the doc thinking I had a UTI, and a couple days later I am told different.  I don't know how to tell my partner that he gave it to me (if he did).  I have not been with anyone else since my divorce, and have never had any of the symptoms before, so I am almost positive that he is the source.  He has a right to know, but I'm unsure how to go about it.  I keep reading everything I can find to get more info, hopeing for some kind of good news (that I won't be able to find.)  I am so confused on what to do.  Any ideas?

just_found_out

[gracefromHHP]

ejk - that question is totally inappropriate to ask here on medhelp.  Get over it already or discuss it with her - don't come here and try to cause trouble.

grace

[Lunker1]

Just a word of caution.  The percentage of HSV-1 infection is more like 50-60% of the overall population, not 60-90%.  Race and economic status play a part in percentages.  It is more of a coin flip than "everyone has it".

[ejk128]

Is Angela from yoshi2me legitimate? I ask because even after my dermatologist told me that a lesion didn't look herpetic at all, I made him run a bloodtest to find out if I did indeed have herpes. My bloodtest came back positive for HSV-1. I've never had a coldsore in my life, but the rash never came back either. She told me that even though I have no idea if I really have genital HSV-1 and even though 60-90% of the population already has HSV-1, I "have no respect for myself or anyone else" if I don't tell everyone that I have HSV-1, even though I have no idea of where it is! She basically told me that I'm a horrible person (mixed with a few choice words) if I don't disclose even though I don't know where my infection is...hmm..not very supportive to me anyway :-(

[H. Hunter Handsfield, M.D.]

passedhsv1's experience is valid, but not typical.  I certainly agree that taking special precautions in the first few months makes sense; for genital HSV-2 infection (and likely for genital HSV-1, although not studied) the highest frequencies of asymptomatic shedding and of transmission to partners occur in that period.

Women and men have equally frequent recurrences of genital herpes due to HSV-2 (and perhaps HSV-1, but data are unclear).  In fact, men report slightly more recurrences than women--but part of that probably is because it's easier to recognize subtle lesions on the penis than on the vulva; true recurrence rates probably are the same, on average.  But outbreaks do tend to be more painful in women (and in uncircumcised men), because lesions ulcerate sooner in mucous membranes and moist areas than on dry skin.

You both should avoid nonoxynol-9.  Despite in vitro (ie, in the lab) activity against gonorrhea, chlamydia, and HIV, the rates of those infections are higher in N-9 users, not lower--after controlling for number of exposures, other risk factors, etc.  This probably is because N-9 irritates and even causes microscopic mucous membrane disruption, which apparently increases susceptibility, outweighing the inhibitory effect.  To my knowledge, its efficacy in preventing herpes transmission hasn't been studied, but antiviral activity per se cannot be assumed to translate into protection.  STD/HIV experts uniformly recommend against using spermicides with N-9 as an STD/HIV prevention strategy.  However, very active research is underway worldwide for other compounds (collectively called microbicides) that might be effective in prevention of STDs, including herpes.  Stay tuned.

HHH, MD

[cboarder]

Thank you for your advice.  I will definitely follow your recommendations to keep my fiance as safe as possible.  I hope you don't mind a few personal questions because it sounds like you have been in a very similar instance.  
1.  Have you had many outbreaks genitally because you acquired HSV-1?  Are you taking suppressive therapy?
2.  Has this situation put much stress on your relationship?  I know I've had a very hard time accepting the fact that I have a disease with such a negative stigma attached to it.  Any advice for moving on and letting go of what I have.  
3.  In regards to my fiance, has your partner (female?) had many outbreaks?  I only ask because it sounds like females have it worse in terms of outbreaks when it comes to herpes than males do.
4.  Do they make condoms with non-oxynol-9 spermicide, or do you have to buy it special in a different package?

I appreciate any additional insight you can provide to help myself and my fiance deal with this situation.  It really has changed a lot of things in my life.
Take Care!
-GG

[passedHSV1]

You are wise to ask specific questions about transmission especially since your partner does not have HSV-1 (or 2) protective antibodies. Be aware that the viral shedding is much higher in the first year with the infection and especially high in the first 3 months after primary episode.

My specific case is unlikely but true: my partner contracted genital HSV-1 by culture by an unfortunate oral-genital exposure to a mouth sore I had. I also tested positive for IgG to HSV-1 at the same time. We were careful for at least two months and used condoms and non-oxynol-9 spermicide (which has herpicidal activity in vitro) anyway. I still had no genital symptoms and we decided to forgo the condoms and spermicide. I developed genital HSV-1 subsequently, despite the fact that I already had antibodies. It never hurts to be more careful because once herpes infects it stays for a lifetime.

My story is just an example and a warning that you should be very careful especially very early in the disease. I would say the first 6 months at least. Why not take all the precautions for a little while: condoms, spermicide and valtrex daily (maybe even 1gm at bedtime instead of 500 mg)? If you do this for 6 more months you can then be more at peace with the low risk to her. You will also not have to worry much about breakouts for yourself. It will let the relationship develop more normally without the extra psychological stress of herpes. After some months have passed you will be in a much better spot to make a decision about what to do next. This is just my advice from a retrospective personal view and as a doctor. Good luck!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks about the forum.  I'll try to help.

1) Data on sexual transmission of herpes are available only for genital HSV-2 infection, not HSV-1.  All anti-herpetic therapies are somewhat less active against HSV-1 than HSV-2 and in preventing asymptomatic shedding or transmissionn of genital HSV-1 has not been studied and should not be assumed.  On the other hand, asymptomatic shedding, as well as clinical outbreaks, probably are less common than for genital HSV-2.  All in all, if you avoid sex during outbreaks and are taking Valtrex, my guess is the transmission risk to your partner is very low, even without condoms.  Spermicides have not proved very effective in STD prevention; to my knowledge, no useful data are available for herpes in particular.

2) HSV probably plays any important role in cancer risk in HPV infected persons.  If there is any increased risk, it is too small and too uncertain to be a concern.

3) I Herpetic encephalitis is very rare.  It is logical to assume it is more common as a result of oral HSV-1 than genital, but I am unaware of data on this.

4) Some people believe that some cases of HSV-1 and/or HSV-2 can cause syndromes similar to post-herpetic neuralgia seen after herpes zoster, but it is controversial.  If it occurs at all, it is rare.

5) Self infection to a new part of the body (autoinoculation) is very rare for established, recurrent herpes of either type.  Almost all cases occur during the initial infection.

6) The vaccine in clinical trial is designed to prevent HSV-2, not HSV-1.  It's not relevant to your situation.

Good luck--   HHH, MD