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Toddler with cold sore
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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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Toddler with cold sore

My little brother recently got a cold sore.  I definitely (im absolutely sure because of the circumstances of when i was tested) have hsv1 genitally but I've had unprotected sex with someone with hsv2 so I know it's possible that I have both.   And I had a cold sore a few weeks ago, and I'm not sure if it's hsv1 or 2.  So I'm worried that my brother got hsv2 on his mouth from me and not hsv1.  I'm worried that he might spread it to his genitals by touching his mouth and then his penis.  He was also itching his butt a lot today and I'm scared he already has.  He has autism so he doesn't understand when we tell him not to touch his mouth.  Im constantly watching him and washing his hands, but I'm afraid it's too late.  Do people spread the virus themselves as commonly as I keep reading they do.  What do you think?  What should we do?  I feel terrible and am so worried for him.
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Welcome to the forum.  I'll try to help.  Your concern for your brother's health is both admirable and touching.  But you really shouldn't be worried.  Almost certainly your brother has garden vareity oral herpes due to HSV-1.

Your question actually reveals some misunderstandings about how HSV infections behave.  Autoinoculation -- i.e. transfer of infection to a new area of the body -- is almost entirely limited to the first few weeks of a brand new HSV infection.  People with longstanding oral or genital herpes, whether due to HSV-1 or HSV-2, rarely autoinoculate a new area.  Second, genital herpes is simply never transmitted in households.  For example, roommates or children of people with genital herpes never are infected (assuming no sex between them), even after years of shaing toilets, kitchens, towels, eating utensils, etc.  Finally, oral herpes (due to HSV-1) is very common in toddlers, who typically catch it from other children in day care, schools, or in day to day playing together.  In fact, that's the most common of all ages at which to acquire HSV-1.

And because auto-inoculation is rare, it doesn't much matter whether or not your brother touches his mouth and/or genital or anal area when he has an outbreak.  And with or without autism, all toddlers -- really all humans of any age -- unconsiously contact their mouths, genitals, etc very frequently.  Don't worry about your brother doing it more than other kids might do so.

As for your own herpes:  genital herpes due to HSV-1 recurs infrequently; many people with an initial infection never have another outbreak, and most have no more than one outbreak every year or two.  In contrast, genital HSV-2 typically recurs 4-6 times a year.  So the frequency of outbreaks may give you a clue as to whether you are infected with both viruses or only HSV-1.  That said, I'm a little surpised you had a cold sore, i.e. oral herpes a few weeks ago -- unless you caught oral herpes at the same time you were infected with genital HSV-1.  Are you sure it was a cold sore (on the outside of the mouth) and not a canker sore (inside)?

To be sure what HSV infections you have, I would recommend some lab tests.  If and when you have a new outbreak, either genital or oral, the lesion can be tested to determine which virus is the cause.  Alternatively, have a blood test.  If it is 3 months or more since your HSV-2 exposure, a blood test will accurately tell whether you are infected with HSV-1, HSV-2, or both.

In the meantime, don't worry about your brother's oral herpes.  Almost certainly it's HSV-1, and he didn't catch it from you.

I hope this has helped.  Best wishes--  HHH, MD
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Thank you it really has.  I definitely had a cold sore, and it was strange because it was the first time I'd ever had one, that's why I was worried it was hsv2.  Also I've had a few small outbreaks even when I only had hsv1.  And I had both an oral and a pretty bad genital at the same time a couple weeks ago.  I just thought it was because I was feeling very sick at the time.  Thank you again.
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