Positive, now what??

[sebeca2007]

I was diagnosed about 6 weeks ago with Genital HSV 1.  I went to my doctor and she did a culture which came back positive for HSV1 and no HSV2 present. At what point can I have a follow-up blood test to confirm that I do have HSV1?  Can the blood test also tell if I have HSV1 both genitally and orally?  I have a friend with genital HSV2 and she always informs partners if she is going to have intercourse (condom protected) but does not feel obligated to tell them if she participates in oral sex.  We are fairly young and we do participate in oral sex outside of committed relationships.  Do you feel that I have an obligation to inform a partner if we do not have intercourse?  I am afraid they will hear Herpes and run for the door before we get to know each other well. If my infection is genital, can I pass this along by kissing or performing oral sex on somone without a current outbreak? Can transmission occur from masturbation, rubbing, fingering, etc without sexual intercourse? Can a man obtain HSV1 orally if he performs oral sex on me without an outbreak?  Also, can you tell me the statistics on transmission with condom protected sex while not having an outbreak? I am on Valtrex daily, thanks.

[t1234]

Did you mean to say " In people with new genital HSV infection (at least HSV-2, I'm not sure about HSV-1), a high proportion gets infection orally as well as genitally. (25% sounds about right, but I don't recall the exact statitistics.)"???

If I'm reading it right, that means a 25 per cent autoinoculation rate for
HSV-2 either genital to oral or oral to genital????????

If that's what you meant , can you point me to the author and publication
where this was published.  

Would be much appreciated.

[sebeca2007]

Ok, now after reading the follow-up comments I have a few additional questions.  Is there a test I can have done to determine if I also have HSV 1 orally?  I have not had any cold sores, etc.  Is it safe to assume that if I were to be positve for HSV 1 that it would be unlikely to pass it along if I don't have any symptoms?  Do you feel I have an obligation to disclose the possibility of HSV 1 if I kiss someone or perform oral sex on them?  Just want to know what would be the right thing to do.  
Thanks.

[gracefromHHP]

Thanks for taking the time to read that and talk about it here HHH.  Hopefully it didn't just confuse folks more but I just wanted to throw that out there.  

grace

[H. Hunter Handsfield, M.D.]

Grace may have a point.  To clarify:  If someone has had previous HSV-1 (usually oral) and they are exposed genitally to HSV-1, they won't get infected--or at least highly resistant if not immune.  If a person without prior HSV-1 is exposed both genitally (oral sex) and orally (kissing) to an infected person, s/he could be infected at both sites.  In people with new genital HSV infection (at least HSV-2, I'm not sure about HSV-1), a high proportion gets infection orally as well as genitally.  (25% sounds about right, but I don't recall the exact statitistics.)

However, I suspect it is very unlikely that someone would get symptomatic new infection at one anatomic site and asymptomatic infection at another.  Since sebeca2007 acquired symptomatic genital HSV-1, if she had no oral symptoms, I doubt she also acquired it orally.  But she should know that this is a judgment call, not fact; there are no data to prove the point one way or another.

sebeca, this means you should look at my previous responses not as fact, but as best guesses.  You need to assume maximal infectivity for other persons for the next few months, and it would be wise to consider it possible to transmit orally as well as genitally. Valtrex will reduce that risk, but we don't know by how much.  The prevention efficacy of Valtrex has been studied only for HSV-2, and HSV-1 is less susceptible to the drug than HSV-2.  It is probable that it reduces the risk but we just cannot say how much.

To all readers:  All this reflects the complexity of herpes.  It is the most complex of all STDs to understand and explain, more so even than HIV/AIDS.  For that reason, it is very hard to give easy, quick answers that cover all situations in forums like this one.  Every person with new herpes must have personal, verbal counseling and not rely solely on the superficial information that comes from sources like this one or from other web sites.

HHH, MD

[gracefromHHP]

HHH - I always see you ( and others ) say that if you have hsv1 genitally then you don't have it orally but I really have to question that advice.  I know I read recently in a study that showed that 25% of the folks in the study also had hsv1 orally ( sorry - looked thru the pile here but couldn't find it to cite it - been trying to remember which article it was I read that in ). Even in the lafferty study from 1987 which I know you are familiar with 5 out of th 12 patients who were diagnosed with hsv1 genitally later on had oral-labial reccurences.  JID 2006 and article by kim et al on oral hsv2 reactivation on hiv+ and hiv- men also showed that about 22% had it both orally and genitally ( figure 2 ).  

So my question is - why is this still the advice many folks are giving when the research shows otherwise?

Thanks!

grace

[sebeca2007]

All I can say is thank you, thank you, thank you.  I have tried so many times to get these questions answered by my doctor and they basically do not have the time nor interest in answering them.  Your work here is so very important  for obtaining both correct information and future prevention for people like me that want to be responsible and do the right thing!!!

I will contact the resource you provided.
Many thanks again!!!

[H. Hunter Handsfield, M.D.]

You don't need a blood test to confirm your infection; the positive culture proves your infection beyond any doubt.  No blood test tells the anatomic site of infection, ie does not distinguish between oral or genital.  Since you had a positive genital culture, though, you can be very certain you do not have oral HSV-1.  (If you had that, you wouldn't have caught it again, at any body site.)  HSV doesn't travel through the body; i.e., your genital HSV-1 cannot be transmitted through your mouth.  Therefore you have no obligation to inform partners on whom you perform oral sex.  Hand-to-genital transmission (by masturbation) occurs very rarely, if ever; it's not a realistic concern.

People with genital HSV-1 generally do not have frequent recurrent oubreaks and most seem not to have frequent asymptomatic shedding of the virus.  Therefore, transmission to someone else by contact with your genitals--either by intercourse or cunnilingus--is reliatvely unlikely.  Therefore, you may not need to be on Valtrex. But you (and your partner) could be atypical; unfortunately, there is no way to know.  If you go a year or two without recurrent genital outbreaks, you probably can assume your transmission potential is fairly low.  But until then, you should inform partners of your genital herpes.  Condoms reduce the risk of transmission, but all the available data are for HSV-2, not HSV-1.  All I can say is that with a condom the risk is very low but probably not zero.

On the other hand, the highest risk of transmission is in the first 6-12 months after a new infection.  Even with condoms, Valtrex, and avoiding sex if you have symptoms, you should be particularly careful (and definitely warn all partners) for at least the next 6-12 months.

Your questions suggest you're going to need a lot more information about herpes than is practical on this or any other online source. Rely on your provider; or look up the American Social Health Association (www.ashastd.org), where you can get personalized telephone advice from a very knowledgeable counselor.  ASHA also might be able to help you find a herpes-knowledgeable provider in your area.

Good luck--  HHH, MD