Herpes I and II

[mangard60]

I am 76 years of age. I have had various episodes of lesions on my tongue for about 15 years, many doctors have said it was either cold sores or canker and prescribed zovirax. I have been living with and having both oral and natural sex for 5 years with one sex partner,  she never had a problem, we no longer live together.  Prior to that time I lived with several women...no problem.   Since February I have been living with my latest friend (which should be the last)..we practice both oral and natural  intercourse  sex (yes I regret unprotected...yes I know it is foolish and dangerous) yet  she does not have a problem.     I have never had lesions on my genital area, lips or outside the mouth, only on the sides of my tongue.  Because I never had a blood test to diagnois the problem I recently had the test.   The blood test indictated under Procedure: H Simplex I IgG AB1 I the results was 4.8H; under  Simplex II IgG AB I the results was 2.3H. The assay stated that "A single positive result only indicates previous immonologic exposure...my doctor says I have Herpes I and II.  My understanding of  the definition of Genital Herpes (Simplex II) most likely manifested by lesions on the genitals, anal area. Simplex II generally around the outside of the mouth (lip) area.  Have you any explanation why I have had the tongue lesion problems for the past 20 years, have had many sexual encounters and none of them ever had any kind of problems with lesions on the mouth, or genitals and I have only had a problem with  my tongue.  Can the test be a false positive?   Can you explain this for me?   Thank you.  Mangard60

[mangard60]

Thanks for the additional comments, I will follow your advice.   I can see that I need to have a thorough conversation with my DR....he seems very cavalier about this matter. Although I have read bullentins and papers until I am blue in the face I still do not not feel conversant enough to ask the right questions.   Realizing the care you must excercise in your advice on such a complex and sensitive matter, you have been immensely helpful.   Mangard 60

[H. Hunter Handsfield, M.D.]

Glad to have helped.  The numbers (1 and 2) refer to the two types of herpes simplex viruses, HSV-1 and 2.  Either virus can infect the genital area, oral area, or both.  Most genital herpes is due to HSV-1 and almost all oral herpes is caused by HSV-1.  Therefore, a confirmed positive HSV-2 test generally means someone has genital herpes; a positive HSV-1 result usually indicates oral infection but sometimes genital infection.  Among persons your age, probably over 95% of positives are due to past oral infection, with or without recognized sympotms of cold sores.

Beyond that, you're asking additional questions about genital herpes that are simply too basic, and would require too much time, to fully answer here.  There are some excellent online resources that you can read.  Start with the information provided by CDC (www.cdc.gov/std), the American Social Health Association (www.ashastd.org), and/or the Westover Heights Clinic of Portland, OR (www.westoverheights.com).  (Full disclosure:  Dr. Hook and I serve on ASHA's board of directors, and Terri Warren, moderator of MedHelp's herpes forum, is owner/operator of WHC.)  Finally, consider participating in MedHelp's herpes community forum, whose moderators are excellent and highly expert herpes counselors.

Please return with a final comment after your have the results of follow-up testing by Western blot, if you and your doctor decide to have the test.  In the meantime, you can stay pretty relaxed, and can get additional questions covered on the community forum.  Best wishes.

[mangard60]

Dr. Handsfield...you are a Godsend.  When I was told by my Dr. that I had HSV1 and HSV2 (Genital herpes) I think I experienced a mild stroke.   Thank you very much for the information and encouragement... you have no idea how much relief you have given me.  I suppose my question is still this...in the case of HSV-2...is genital herpes by definition HSV2..and to have genital herpes it is usally if not always manifested by some kind of lesions in the genital area or in the lower body?   Since I have never had such an experience how would I have genital herpes?  It is my understanding that by definition in order to have genital herpes you mostly like would have lesions (visible infection)  in that part of the body?   I will surely speak to my Dr. about the Western blot test. I just need a better understanding of exactly what is genital herpes?    Worst case scenario, should that test come back positive...how does one explain that others with whom I have had unprotected intercourse and deep kissing,  have not been infected?   I have been treated for the tongue lesions for many years all the doctors I have seen,  have told me (as you suggested) that they are canker sores?    By the way almost 3 years ago I had my prostates removed and I still enjoy a satisfying sex life, albeit I have to go through a lot to engage...therefore, am looking at the penil inserts to eliminate the preparation erection issues.  By the way I have found a lady who excites me to no end.  And yes at 76 she is 65...tells me I am a great lover (that makes me very happy).   Take care  Mangard60

[H. Hunter Handsfield, M.D.]

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

First, a couple of general (somewhat philosophical) comment:  Congratulations!  I am so happy to hear of someone your age who enjoys an active, rewarding sex life.  It happens all the time, but many younger people don't know it.  Also, I do not believe it is irresponsible at all for you to be having unprotected sex.  STD rates are very low at your age.  If you're having sex with much younger partners -- under age 30 or so -- I would recommend you use condoms.  Otherwise it's probably no big deal.

Second, you really should not be worried about STDs.  In the overall scheme of things, especially at your age (I'm not all THAT far away), it's pretty much a trivial issue.

To your specific concerns.  First, your tongue lesions probably are not herpes.  Recurrent oral herpes -- almost always due to HSV-1 -- occurs on the lips or elsewhere on the face.  Lesions in the mouth, such as on the tongue, usuallly are canker sores, not herpes. At your age, in the US, over 75% of people have positive blood tests for HSV-1.  So your test result is typical.  It is possible that your test result and your recurrent tongue lesions are related to one another, but probably not.

Second, your HSV-2 test result is in a gray zone -- it isn't possible to conclude whether or not you have HSV-2.  Your doctor, saying you have both HSV-1 and -2, may or may not be right.  Only ELISA ratio results over 3.5 are definitely positive.  Your value of 2.3 indicates a 50:50 chance you have HSV-2.  In other words, at least a 50% chance the result is indeed false positive.  If you have HSV-2, almost certainly it does not have anything to do with your tongue lesions.  HSV-2 infections usually are exclusively genital.

What to do now?  You can sort out your HSV-2 results with an HSV Western blot test, the ultimate HSV gold standard blood test.  Although WB is done only in one place in the US, the University of Washington clinical laboratory in Seattle, any lab knows how to refer a specimen to them for testing.  Talk to your doc about it.  This would sort out once and for all whether or not you have HSV-2.

I hope this helps.  Best wisehs-- HHH, MD