Genital HSV-1

[rbl]

Hi. I was just diagnosed with Herpes. The doctor said it looked much more like HSV-1 because it literally looks liked a few cold sores near and in the vaginal opening. It just so happened that my boyfriend developed a facial sore on his chin after a sever sun burn recently. We were stupid and thought it was just an infected cut (now it is very obvious that it was herpes). We had oral sex and now about 10 days later, I have these sores. The doctor said it looked much more like HSV-1 (its not tremendously painful and the sores aren't blisters as much as they are small red bumps that have a volcano like opening) I have no other symptoms besides what feels like a mild urinary track infection. Its doesn't hurt when the urine gets on the bumps. my vagina is just kind of sore.

So, here's my questions:

1. what's the likelihood that what was on my boyfriend's face was HSV-2?

2. Assuming I have genital HSV-1, what will my future sex life be like? Will I need to use condoms even if I have no sores? I want babies so, if I always need to use condoms how will that work?

3. How likely are outbreaks? And what are the triggers?

4. I also have HPV, will having Herpes(of any kind) effect that?

5. I have investigated and I read that shedding is not likely for people with genital HSV-1, is this true?

6. Also, in general, would you say that having genital HSV-1 is not something to worry about, and is it necessary to tell people I have it if we use condoms?

Okay, I really really appreciate your help. this is very emotional and any help is wonderful.

[cam54]

I also have herpes and have had it for the past 6 years. I belive my boyfriend and I (we have been together jsut under 6 years) soemhow gave it to one another or somehting, but all I have to say is that you really dont need to worry. Its really common and you would be suprised to see how many people have it. I actually do break out once or twice a year, and as soon as I feel it I take valtrex and it goes away. I notice it comes more often during periods of high stress, and soemtimes after sex. But dont worry, jstu take care of yourself and your immune system and its not that big of a deal. The only worry would be giving it to others, but apparently once daily valtrex helps against that, and of course no sex when you break out, and use a condom.

[H. Hunter Handsfield, M.D.]

You should get on treatment as soon as possible; the sooner you start, the more effective it is.  For that reason, CDC recommends that treatment start as soon as the diagnosis is suspected, without waiting for laboratory confirmation.  UTI-like symptoms are common with herpes and that probable will go away with treatment.  

[rbl]

Thanks so much....its comforting to talk with others who have the same thing.

I hope I'm as lucky as you.

[NYC Guy]

I have herpes 1 and 2.  I can tell you that it hasn't affected me hardly at all.  I had two out breaks over 10 years ago and haven't had one since.  On the second breakout, I felt it coming on and took Valtrex and that stopped it almost in it's tracks.  Since then I carry around valtrex with me in case of another break out (you take it at the first tingling and it is very effective) and I haven't ever had to take another tablet or had another breakout.  I have never infected anybody with the virus (I was in 2 long term relationships)  and hope i never do.  All in all it hasn't been a serious issue for me at all and I think you may find the same thing to be true.

[rbl]

Sorry one more thing. It really feels like I have a urinanry track infection, but I read that is often a side effect of the herpes. Do I need to also get that treated or will it go away with anti-viral therapy?

As usual, deepest thanks.

[rbl]

I am not on any anti-viral therapy. The doctor said she didn't want to give me anything until the results came back. (one week) This makes me nervous after what you said. Why would she want to wait?

The office is closed now, so I'll have to wait until tomorrow, but she may not write me a prescription because she said she wanted to wait. Plus, I am feeling more and more pain and discomfort.

My uncle is an MD. Should I have him call in a prescription? Then of course I would have to tell him the situation.

Is it urgent?

I have a constant feeling of needing to pee and that also makes me nervous.

Your responses are so comforting and helpful. Again thank you so very much.

[H. Hunter Handsfield, M.D.]

1) Cross the HSV-2 bridge if and when you come to it; there is no point in speculating now.  Make sure your doc asks the lab to type the virus; sometimes the lab doesn't do that unless sepcifically requested. Condoms are good protection against genital HSV of either type, but not perfect, because the condom doesn't prevent skin-to-skin contact above the condom's coverage.

2) The initial outbreak typically lasts 2-3 weeks without treatment, once in a while up to 6 weeks.  On treatment, your lesions should start to improve within 2-3 days and pretty much clear up in a week or so.  You should be on antiviral therapy, but now I realize you don't mention it, so maybe not?  If not, call your doc and insist on a prescription for valacyclovir, acyclovir, or famciclovir (unless things clearly are clearing up already). In addition to speeding healing, treatment prevents complications, which occur in up to 10-20% of patients with first-episode genital herpes:  things like neurological problems (e.g., transient bladder paralysis, incontinence of urine or feces), erythema multiforme (a serious body-wide skin rash), or other rare systemic reactions.  Even if you're not having a lot of pain, why take the chance on such problems?

[rbl]

Thanks so much for your help.

A few more short questions:

1. How likely is it to contract HSV-2 from sex using condoms, assuming my partner did not have a visible outbreak at all? My partner has no knowledge of having hsv-2 and I have never seen anything on or around his penis. Clearly his soar on his chin is most likely where I got genital HSV, but I want to make sure.

2. For HSV-1, how long should I expect this first outbreak to last?

My doctor took a culture, but it will be  a week before i know the results, I'm just so worried.

Thanks again.

[H. Hunter Handsfield, M.D.]

First, there is absolutely no difference between HSV-1 and HSV-2 in the appearance of lesions, amount of pain, overall severity, or anything else.  There is zero basis for your provider's judgment that you have HSV-1 based on how the lesions look or feel.  Second, oral herpes due to HSV-2 is rare; almost all cases are due to HSV-1.  Therefore, if your only possible exposure was by oral sex, probably that is the cause.  In other words, your doc probably is right, but for the wrong reason.  S/He should have done a culture or PCR test from your lesions in order to confirm which virus type you have.  If that wasn't done, you should have a blood test about 3 months to confirm that you have HSV-1 and not HSV-2.

To your questions:

1) There is almost no chance your partner's oral herpes is HSV-2.

2) You need to read up about herpes; some sources are suggested below.  Everybody with genital herpes can have healthy babies.  Properly managed, most people's sex lives need not be much changed by herpes, especially for those in committed relationships.  You probably will not need to use condoms routinely, at least not with your currently infected partner; it may or may not be necessary for other partners in the future.

3) When genital herpes is caused by HSV-1, recurrent outbreaks usually are infrequent--indeed, you might not have any at all.  See the thread posted earlier today, immediately before this one: http://www.medhelp.org/posts/show/288854.

4) Herpes will not affect your HPV, or vice versa.

5) Just like symptomatic recurrent outbreaks, asymptomatic shedding is much less frequent with genital HSV-1 than HSV-2.

6) "Not something to worry about" might be overstating it a bit. You won't know for sure how much a problem it will be for you until at least a few months go by.  For HSV-2, asymptomatic shedding and the potential for sexual transmission are highest in the first 6-12 months after infection.  It isn't known whether the same is true for HSV-1, but to be safe, it would be smart to inform partners and use condoms consistently for sex with any new partners for the next year or so.  However, there is no problem with respect to your boyfriend, or anyone else who already is infected with HSV-1.  People are immune or at least highly resistant to new infection with the same virus type, and couples do not "ping-pong" their herpes infections back and forth.

Good herpes information sites are the American Social Health Association (www.ashastd.org) and the Westover Heights Clinic of Portland, OR (www.westoverheights.com).

Best wishes-- HHH, MD