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possible herpetic rash
Dear Doctor,
I have written in this forum before and there is a new development for which I wanted your advice. To recapitulate, I developed an oral sore which I did not recognize as herpes until about 14 days later when my girlfriend developed a classic genital herpetic rash. Her genital cultures came back positive for HSV-1 and my serology (taken one day before her culture was sent) was positive for HSV-1 IgG (IgMs were negative). Since then she has taken the 10 day, 1gm twice a day of valtrex. I did the same. We both stopped the valtrex but she developed another rash about 5 days later. She then went on another 10 days of valtrex, 1gm twice a day. I also had to go back on valtrex temporarily for another second oral lesion, but this one was at the edges of my lips and not gingival.
During the times when she had active lesions we did not have sex. After her lesions dissapeared we began having protected sex with a condom. After a while, I decided that I am probably at minimal, if any, risk of contracting HSV-1 from her genitally since I already have HSV-1 IgGs. A few days ago, I trimmed my genital area with clippers and a spacer. She and I had unprotected sex (she did not show a lesion or symptoms)after. Now I see redness in several spots around the base of the penis and I can not tell if it is foliculitis or the tiny white-centered vesicles I now identify with my mouth lesions. I have used clippers before and have never had a problem with foliculitis.
I am out of the country for a week and can not get these red areas cultured where I am.
1. What would indicate that this is more of a foliculitis than a genital HSV-1 infection? Would the presence of IgG's in my blood several weeks ago make it unlikely that I contracted HSV-1 genitally? I was still fighting an HSV-1 oral recurrence only a few days ago and I am worried that my immune system was still weak and perhaps unable to ward off a genital infection
2. How accurate is a postive HSV-1 culture? Is there much of a chance that she may have HSV-2 genitally instead and the culture results were an error?
I am concerned that in both her case and mine, we have seen recurrences right after the initial infection. You have said that during the initial infection the virus can have a sputtering course. It makes me think that maybe I was having my initial infection also with the very first oral lesion. The only piece of the puzzle that doesn't fit is that I had IgG HSV-1 titers of around 5.0 only 14 days after my very first outbreak....
Thank you!
I have written in this forum before and there is a new development for which I wanted your advice. To recapitulate, I developed an oral sore which I did not recognize as herpes until about 14 days later when my girlfriend developed a classic genital herpetic rash. Her genital cultures came back positive for HSV-1 and my serology (taken one day before her culture was sent) was positive for HSV-1 IgG (IgMs were negative). Since then she has taken the 10 day, 1gm twice a day of valtrex. I did the same. We both stopped the valtrex but she developed another rash about 5 days later. She then went on another 10 days of valtrex, 1gm twice a day. I also had to go back on valtrex temporarily for another second oral lesion, but this one was at the edges of my lips and not gingival.
During the times when she had active lesions we did not have sex. After her lesions dissapeared we began having protected sex with a condom. After a while, I decided that I am probably at minimal, if any, risk of contracting HSV-1 from her genitally since I already have HSV-1 IgGs. A few days ago, I trimmed my genital area with clippers and a spacer. She and I had unprotected sex (she did not show a lesion or symptoms)after. Now I see redness in several spots around the base of the penis and I can not tell if it is foliculitis or the tiny white-centered vesicles I now identify with my mouth lesions. I have used clippers before and have never had a problem with foliculitis.
I am out of the country for a week and can not get these red areas cultured where I am.
1. What would indicate that this is more of a foliculitis than a genital HSV-1 infection? Would the presence of IgG's in my blood several weeks ago make it unlikely that I contracted HSV-1 genitally? I was still fighting an HSV-1 oral recurrence only a few days ago and I am worried that my immune system was still weak and perhaps unable to ward off a genital infection
2. How accurate is a postive HSV-1 culture? Is there much of a chance that she may have HSV-2 genitally instead and the culture results were an error?
I am concerned that in both her case and mine, we have seen recurrences right after the initial infection. You have said that during the initial infection the virus can have a sputtering course. It makes me think that maybe I was having my initial infection also with the very first oral lesion. The only piece of the puzzle that doesn't fit is that I had IgG HSV-1 titers of around 5.0 only 14 days after my very first outbreak....
Thank you!
I am know 25 years old when I was 19 I was treated for a herpes outbrake. I have not had an outbrake since then I just recently had an HSV 1 and 2 blood test and they both came back negative? Am I free of the virus if they treated me for it back then or possibly did I have something else that they might have thought was herpes?
I am a little bit rusty on my immunology, but I was reading a bit about HSV-2 vaccines and there was commentary that the Glycoprotein D antibodies formed by humans when exposed to the vaccines were not sufficiently reliable to make the vaccines marketable. A new mutant strain vaccine is showing new promise:
From : http://www.sciencedaily.com/releases/2004/12/041219162315.htm
"In contrast, dl5-29 is a live, mutant strain of HSV-2 that is missing two of the genes necessary for it to replicate and persist inside its host. "The proteins that are expressed are able to induce immune responses but the virus can't spread," said Knipe, who is a coauthor on the paper. Normally, HSV-2 infects the cells lining genital areas, but makes its way into nearby sensory neurons, where it persists in a latent state. Because dl5-29 actually enters host cells and expresses many of its proteins within them, it not only elicits a broad spectrum of antibodies but also stimulates T cells, which directly attack infected host cells and release cytokines that further strengthen the immune response. The clinical trials of previous herpes vaccines suggested that T cells as well as antibodies must be activated to launch an effective defense.
My question is:
1. I know I already had HSV-1 IgG's 2 weeks after my oral lesion developed. We concluded that I most likely had HSV-1 chronically in the oral region. How quickly does the T cell-mediated immunity develop once IgG's are around?
2. My girlfriend and I have been dating more seriously now only for a few months and, although we love each other and it is going well, we do not know if we are destined to be permanently together yet. We have at least discussed the possibility that we may date other people in the future if things do not work out for us. Should she meet someone new in the future and start dating them, would she have to tell that new man to get his HVS-1 serology done before they engage in uprotected sex? Do the IgG levels stay elevated enough to test positive even when a person has not dealt with a recent or current HSV episode (ie would it be obvious if the person has HSV-1 or not by serology)?
From : http://www.sciencedaily.com/releases/2004/12/041219162315.htm
"In contrast, dl5-29 is a live, mutant strain of HSV-2 that is missing two of the genes necessary for it to replicate and persist inside its host. "The proteins that are expressed are able to induce immune responses but the virus can't spread," said Knipe, who is a coauthor on the paper. Normally, HSV-2 infects the cells lining genital areas, but makes its way into nearby sensory neurons, where it persists in a latent state. Because dl5-29 actually enters host cells and expresses many of its proteins within them, it not only elicits a broad spectrum of antibodies but also stimulates T cells, which directly attack infected host cells and release cytokines that further strengthen the immune response. The clinical trials of previous herpes vaccines suggested that T cells as well as antibodies must be activated to launch an effective defense.
My question is:
1. I know I already had HSV-1 IgG's 2 weeks after my oral lesion developed. We concluded that I most likely had HSV-1 chronically in the oral region. How quickly does the T cell-mediated immunity develop once IgG's are around?
2. My girlfriend and I have been dating more seriously now only for a few months and, although we love each other and it is going well, we do not know if we are destined to be permanently together yet. We have at least discussed the possibility that we may date other people in the future if things do not work out for us. Should she meet someone new in the future and start dating them, would she have to tell that new man to get his HVS-1 serology done before they engage in uprotected sex? Do the IgG levels stay elevated enough to test positive even when a person has not dealt with a recent or current HSV episode (ie would it be obvious if the person has HSV-1 or not by serology)?
MEDICAL PROFESSIONAL
I am not an HSV virologist or vaccine researcher. Reseach is pursuing various vaccine development strategies but I'm not a position to judge whether the one you cite has more or less promise than others.
1) Cell-mediated immunity develops over roughly the same time as the antibody response, but I think it takes somewhat longer to mature and become fully effective, up to several months.
2) IgG antibody levels are unrelated to level of immunity, frequency of recurrent outbreaks, prediction of natural course of the infection, or transmission. Even though the HerpeSelect results are presented quantitatively, the interpretation is purely qualitative, positive vs negative. There is no difference in having an ELISA ratio of, say, 3.2 vs 6.0.
HHH, MD
1) Cell-mediated immunity develops over roughly the same time as the antibody response, but I think it takes somewhat longer to mature and become fully effective, up to several months.
2) IgG antibody levels are unrelated to level of immunity, frequency of recurrent outbreaks, prediction of natural course of the infection, or transmission. Even though the HerpeSelect results are presented quantitatively, the interpretation is purely qualitative, positive vs negative. There is no difference in having an ELISA ratio of, say, 3.2 vs 6.0.
HHH, MD
MEDICAL PROFESSIONAL
I think the answers are clear from the preceding discussion. Regardless of body site infected, people who have had HSV-1 won't get it again, and has antibodies showing evidence of that prior infection. The antibody tests aren't perfect and may miss a few persons, but probably less than 1% of them.
HHH, MD
HHH, MD
One last point related to my last question.
If someone has had HSV-1 anywhere in the body, their IgG titer will always ride above normal so they would be easily identified as previously exposed? I realize most of us have been exposed to HSV-1 already and she would not have to worry too much about transmission of her genital HSV-1 unless the other person was an HSV-1 "virgin" like she was before she got infected genitally....
If someone has had HSV-1 anywhere in the body, their IgG titer will always ride above normal so they would be easily identified as previously exposed? I realize most of us have been exposed to HSV-1 already and she would not have to worry too much about transmission of her genital HSV-1 unless the other person was an HSV-1 "virgin" like she was before she got infected genitally....
MEDICAL PROFESSIONAL
1) With few if any exceptions, everybody with HSV-1 is immune from catching it again; and certainly nobody can be reinfected with the same HSV-1 strain they already are carrying. Your rash sounds more like folliculitis due to shaving anyway. There is no reason for you and your partner to use condoms. Common sense says that for reasons of esthetics and comfort, you probably will want to avoid sex if/when she is having an outbreak. But even then, there would be no risk of transmission.
2) Determining virus type is very reliable. You can be confident in the lab report. Further, the source of your partner's infection was obvious; and nobody has recurrent oral herpes due to HSV-2; your oral infection has to be HSV-1.
You undoubtedly have had HSV-1 infection for a long time, probably since childhood. Your outbreak was a recurrence of chronic infection (even if it was the first outbreak that was symptomatic), not a recently acquired infection. Your serology result is exactly what I would have expected.
Good luck--
2) Determining virus type is very reliable. You can be confident in the lab report. Further, the source of your partner's infection was obvious; and nobody has recurrent oral herpes due to HSV-2; your oral infection has to be HSV-1.
You undoubtedly have had HSV-1 infection for a long time, probably since childhood. Your outbreak was a recurrence of chronic infection (even if it was the first outbreak that was symptomatic), not a recently acquired infection. Your serology result is exactly what I would have expected.
Good luck--
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
