STDs Expert Forum
Recently diagnosed with Genital Herpes (HSV1)
About This Forum:

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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Recently diagnosed with Genital Herpes (HSV1)

I had my first outbreak of sores in my genital area this past week and went to the STD clinic to have it checked out.  They took blood tests and swabs. My results came back positive for HSV 1.   I have some questions.

1. Could I have been infected with HSV 1 a long time ago and only had my first outbreak now?
2. I hear that outbreaks are minimal for people who have HSV 1 genital herpes. Is this true? And is asymptomatic viral viral shedding common in the genital area for HSV 1?
3. Do I need to be on drugs all the time to suppress the virus?
4. Can you become infected with HSV 2 once you have HSV 1?
5. Other than using condoms, how can I prevent passing this onto my future partners?

Thank you in advance for your answers

AnxiousH
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Welcome to the STD forum.  I'll try to help.

First, it would be good to know a bit more about your symptoms, how the diagnosis of genital HSV-1 infection was made, and your recent sexual exposures.  Which result came back positive for HSV-1, the swab or blood test?  Did you have one or two sores or a large number?  Where exactly were they?  Did you have a fever or other flu-like symptoms?  Did you have enlarged or inflamed lymph nodes in the groin?  Do you have a regular partner?  Have you received oral sex recently?

To the specific questions:

1) Most likely you were infected within 2 weeks before onset of symptoms, but not necessarily.  The additional information I requested above will help sort this out.

2) Among people with new genital herpes due to HSV-1, within the next 2-3 years about 40% have no recurrent outbreaks at all and most of the rest have only 1 or 2 recurrent outbreaks during that time.  This is very different than HSV-2, for which most people have 3-6 outbreaks per year.  Genital HSV-1 also has less viral shedding when asymptomatic, i.e. lower chance of sexual transmission to new partners.

3) Most people with genital HSV-1 probably get little beneift from ongoing suppressive therapy, for the reason above -- i.e., low likelihood of recurrent outbreaks and usually low risk of transmission to partners.  I suggest you not take continuous therapy for now.  It's better to wait for a few months and see what your recurrence frequency is.  Also, if you were infected by a regular partner who already has HSV-1, there is no need to take treatment to prevent transmission to him or her.

4) Yes, people with HSV-1 (either oral or genital) can also catch HSV-2.  The risk may be lower, but only a little.  However, the initial HSV-2 infection tends to be less severe in people who already have HSV-1.

5) If you are in the US, then you can predict that half your future partners already have HSV-1.  They are immune and will not catch it again.  And even if they have not previously been infected, the chance of genital-to-genital HSV-1 transmission probably is low -- for the same reasons as above.  Although most people probably agree you should inform future partners of your infection, you can also reassure them the transmission risk is low, with or without condoms.  However, you shouild wait a few months before you make definite plans about whether and what to say to future partners -- i.e., after you have a sense of whether or not you're going to have frequent outbreaks.

I look forward to providing a bit more help after you answer my opening questions.  In the meantime, don't let this be too upsetting.  Nobody wants to get genital herpes, but if it has to happen, HSV-1 definitely is better than having HSV-2.

Best wishes--  HHH, MD
7 Comments
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Avatar_f_tn
Hello again,

To tell you the truth, I did not clarify with the clinic which test came back positive or if both.  They told me that I have genital herpes and the blood test told them the type (HSV-1)  
When I got the outbreak I also had some kind of bacterial infection in my vagina since I was also experiencing a lot of discharge. They gave me antibiotics for chlamydia and gonorrhea in case this was what I had.  The antibiotics helped with the excess discharge but the test came back negative for chlamydia and gonorrhea.

I was already suffering from a bad sinus cold a week prior to getting this outbreak. So I can not say that I had flu like symptoms since I was already feeling crappy from that. I still have a bit of my cold (which is now more of a cough) and this past week I noticed that I had a swollen lymph node at the base of my neck which has since disappeared. Some of my lymph nodes were tender in the groin area but not swollen.  The sores I have in some places are small and grouped together and I have the few odd single open sores. All of which are on the labia majora and labia minora. But there were nothing out of the ordinary leading up to the outbreak that suggested something was off. But then again, I wasn't looking for anything.  

I don't have multiple partners.  My present partner and I have been intimate for 6 weeks and have used condoms with the exception of the last time we were together before the outbreak (which was a week before)  He did perform oral sex on me then and before that but he did not have any visible cold sores.  Obviously we are not having sex right now and have not since before the outbreak. My previous partner was a serious boyfriend I had and we have not been together in over 5 months.

Hopefully this is helpful.  Thank you again for your feedback.

Sincerely,

AnxiousH
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239123_tn?1267651214
OK, that helps sort things out. My guess is that the swab test was positive, in addition to the blood test.  The clinic could clarify this for you.

Apparently you had bilateral lesions, i.e. labia on both sides.  That's a nearly sure sign of a new HSV infection, not a recurrence.  The cervix often is infected in first-episode herpes, often causing vaginal discharge, so that also goes along with a new infection.  All this suggests in turn that your new partner has HSV-1.  You probably were infected the one time you had unprotected sex a few days before your symptoms started -- most likely by oral sex; it is possible your partner has genital HSV-1, but much less likely.  He should have a blood test, which should be positive for HSV-1 (and probably will be negative for HSV-2).

So that clarifies my response to question no. 1.  My replies to questions 2-4 are not changed, and no. 5 (informing new partners) is not an issue, at least not for the immediate future.

It's too bad this happened, but in the long run should not be a big deal -- especially in your current relationship, and probably not that big a problem even if this relationship ends someday and you return to the dating scene.

Thank you for a very articulate question.  This provided the opportunity to make a number of important points about genital HSV-1; they have been said many times, but not all in a single thread.  Someday when we set up an FAQ section on the STD forum, this thread probably will be in it.
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Avatar_f_tn
Hi again,

My partner went and got tested and his results came back negative.  Is it possible that I have had HSV 1 for a long time and I only had an outbreak now? I know that above you stated that it sounded like a first time outbreak from what I had told you.  I have no reason to not believe him.
I know that I have been with partners in the past who did get cold sores.  I am confused and I feel horrible for possibly puting my present partner at risk of getting genital herpes or for any other past partner that I have had.
I know that you stated that the probability of giving my partner genital herpes is low even if he is negative for HSV.  I guess I would like to know just how low it is?
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239123_tn?1267651214
It is possible for a recurrent HSV lesion to be as severe and widespread as you had, but infrequent.  Might you be pregnant?  Recurrent genital herpes sometimes mimics initial infection in pregnant women.

It is equally likely that your partner has HSV-1 with a false negative blood test.  The HSV-1 blood tests are falsely negative quite frequently.  This probably is more likely than the explanation above.  If you want to pursue this possibility, your partner could be restested with the HSV Western blot test.  My guess is he'll turn out to have evidence of HSV-1 after all.  If not, then the first explanation is the only possibility.

Don't be so critical of yourself about putting your partner at risk.  If his WB is positive for HSV-1, it will mean he is already infected and won't catch it again.  And if negative, the chance of sexual transmission to him probably will be quite low -- for the reasons discussed in my original reply.
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Avatar_f_tn
No, I don't believe that I am pregnant since I have had my period twice since having unprotected sex and I am on the birth control pill but I guess I could take a test.  It has been a little over 3 weeks since the outbreak and I still don't feel like everything is quite normal regarding my vagina and area.  I still have a bit of redness at the Perineum and just yesterday I noticed I had two long thin cuts in that area and they were slightly bleeding.  Is this still herpes or something else?  Also, the discharge that I have is fairly normal but it seems to irritate the skin a bit.   I have made an appointment to see my doctor early next week to check for any other possible infections and give me peace of mind.  

As for the WB test, we may pursue. Thank you for your all of your help.

Regards,

AnxiousH
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239123_tn?1267651214
Feel free to report your partner's WB result.  Other than that, it is time to end this thread; I won't have any further comments.  Follow up with your provider if you have ongoing questions, or feel free to use the herpes community forum, which is moderated by highly knowledgeable, professional counselors.
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