hsv2 on top of hsv1?

[Erestor]

Dr. Hansfield, I have a question about the possible symptoms of an hsv2 infection when one is already infected with hsv1 genitally.  First, my history:
I was diagnosed with genital hsv1(via culture, and later IgG bloodtest) in 2002. My last hsv1 outbreak was in the winter of 2003.  I have been with my husband exclusively for fourteen years... until eleven days ago.  I made a terrible, drunken mistake and had unprotected sex with a friend.  I know my friend has hsv1 orally, but I'm not sure of his hsv2 status.

Four days after our encounter, I developed burning and itching inside my vagina and around my labia.  It was very red in appearance... and I noticed an extremely small abrasion next to the clitoris.  I wasn't able to see my clinician until two days after onset of symptoms.  She checked for yeast and bacteria, and they both came up negative.  I asked her if it could be a newly acquired hsv2 infection, and she said she didn't think so, because my lymph nodes were not swollen.  She said it may be a mild hsv1 outbreak due to vigorous intercourse, or perhaps an allergic reaction to the man's genital piercing(I have metal allergies).  I wasn't convinced of this last suggestion, though.  I would think an allergic reaction would manifest a little sooner than four days after the encounter.

The itching subsided a bit about two days ago, but it has returned today.  I talked to my friend, and he has agreed to get a herpes bloodtest.  Until then,I would like to know what hsv2 symptoms would present themselves if I already have hsv1?  

Thanks for your time.

[H. Hunter Handsfield, M.D.]

I cannot comment with any certainty as to whether your symptoms were due to herpes, yeast, or something else; and if herpes, whether it was a recurrence of HSV-1 or a new infection with HSV-2.  Both sound unlikely.  Howeve, your doctor is wrong to say it couldn't be herpes because there were no swollen lymph nodes.  Many initial cases of herpes do not have lymph node enlargement.  This is expecially the case in your situation:  initial herpes due to HSV-2 tends to be milder in persons with prior HSV-1 than in people who have never been infected with HSV-1; and this often means that lymph node enlargment often is absent.  

Whether this explains your symptoms or not, I can't say.  But yolu can find out:  have another HSV antibody test.  If still is negative for HSV-2, you can be certain you didn't acquire a second herpes infection from the sexual exposure you had.

Good luck-- HHH, MD

[bluebird05]

Since they are separate viruses the initial infection would be the same if you didn't have HSV-1.  And you would know it because you would have terrible blisters/lesions and they would hurt like heck.  See what the Doc. says......good luck.

[H. Hunter Handsfield, M.D.]

Thanks for your many comments on the forum, which generally are accurate and useful  However, your comment above is wrong.  Most people with herpes don't have severe symptoms; and in people with prior HSV-1 infection, new infection with HSV-2 tends to be even milder than average.  Regardless of prior HSV-1 infection, most people with initial genital herpes do not have "terrible" blisters or lesions, and herpes with little or no pain is very common.

Regards--  HHH, MD

[hboy]

Doctor, so you are saying that you can have hsv 2 and have NO symptoms what so ever?

And you speak of mild symptoms, I thought the initial outbreak is never "mild" (meaning you can easily not notice it and think nothing of it), and that you know at the very least that something is wrong due to the lesions. Is it possible for ONE painless blister/lesion to be your initial outbreak of hsv 2?

I'm not trying to thread jack...just wondering what was your stance on these questions (on topic) if you have time to respond of course.

[H. Hunter Handsfield, M.D.]

You need to read up about genital herpes.  Most genital herpes is asymptomatic.

HHH, MD

[Erestor]

Thank you, Dr. Hansfield.

[bluebird05]

Thanks for that info.

[gotherpeslifeisover]

Can anyone advise me on the type of HSV tests that most health depts. commonly use? I recently tested negative, but I'm concerned about the window period as well as the accuracy/sensitivity of the tests they use. It took them almost a month to get my results in (about 3.5 weeks) if that is of any relevance. I guess it's best that I contact the health dept. and ask them, but I'm aware that they don't like to give out that type of information sometimes. Is 5 to 6 weeks post exposure long enough to wait to test?

[moet]

HerpeSelect test at 6 weeks and 12 weeks or just wait the 12 and only ask for IgG for 1 and 2 (not IgM)...Good luck!!

[jrl0222]

I got tested for HSV-2 and it came back negative.  It was an igg test for HSV-2.  Do I need to get tested for HSV-1, to see if I have genital herpes?  My doctor says that I don't need to because that test is for oral herpes.  But another doctor says that if both test are negative then she would believe I don't have HSV-2.  I don't have any signs of HSV-1 and I thought that HSV-1 and HSV-2 are different viruses.  I am just really confused.  Would a positive result for HSV-1 testing mean that I could have genital herpes?