HSV-1 = devastated

[downandout_23]

Hello Doctor,
I don’t know how to go about this but here I go. I am 23-m who has been in a sexual relationship with my GF for a year and a half.  I have only had sex with 2 people in my life (never had oral sex) and had have always been STD negative (including HSV blood tests).  2 months ago I was diagnosed with HSV-1 (genital region), my blood was negative but swab came back positive, upon these results my GF was tested and positive for type 1.  Given this I assume she has HSV-1 genital.  The last two months I have been plagued by anxiety and depression, and every where I look for info it is always about HSV-2 and not genital HSV-1. I need to know what i am dealing with.

1- There are so many mix percentages out on the web - How common is HSV-1 both oral and genital?
2- I seen a stat that 80% of people 50 and up have HSV-1, is this accurate?
3- I have read other posts that you have not seen G to G transmission of HSV1 - is this still true (it seems that this is how I acquired the virus)
4- Do you have any figures on how rare/common G to G transmission is?
5- Are there cases where the virus is not active at all both symptomatic and asymptotic?
6- If it is really that common, why isn’t it part of regular STD screenings? - it has had a huge impact on my life
7- I have read that 95% of Genital HSV1 will not have any more outbreaks after 2 years - this true?
     7a - if so, does this mean that the virus has gone dormant and will not come back?
8 - True that it doesn’t occur in hair-bearing areas?
9 - I have heard that fatigue and sun can trigger it to come back; do I need to draw back my workouts and stay out of the sun?

Sorry for so many questions, but all genital herpes info seems to be about type 2 and never type 1.   I think that the best way for me to beat the depression is to know what I am dealing with.  Just stinks that this happened.

Thank you so much doctor!

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  Too bad about catching genital herpes.  But you are way overreacting.  Nobody wants genital herpes, but if it happens, HSV-1 is definitely the type you should prefer, compared with HSV-2.

Research shows the main concerns of people with genital herpes are the symptoms of recurrent herpes and fear of transmission to partners.  However, for genital HSV-1, most people have few if any recurrent outbreaks and generally they are at low risk of transmitting the infection to their sex partners.  It can happen, but genital-to-genital HSV-1 transmission appears to be uncommon.

To your specific questions:

1) Most people with herpes of either type are infected at only one site:  oral or genital, but not both.  If you have had no oral symptoms (cold sores, etc), you can assume your infection is genital only.  Likewise, your partner probably has only an oral infection.  There are exceptions, but they are uncommon.

2) The proportion of the population with HSV-1 varies from country to country, and within countries, between various population groups.  For the US population over age 30, it's around 50%.  By age 50 I think it's closer to 60-70%, but it probably reaches 80% in some population groups.

3,4) It is true that genital-to-genital HSV-1 transmission is a lot less common than oral to genital.  But of course it can happen from time to time, as apparently it did in your case.  There are no data on the exact frequency -- but I don't see that it matters.  What happened happened.

5) I'm not sure exactly what you are asking here.  It is generally true that every HSV infection is active to some degree, whether or not there are symptoms.  In other words, all infected people live forever with the potential for a recurrent outbreak and for transmission to others, given the right kinds of personal contact.  That doesn't meat it is frequent, but the possibility continues for life.

6) I don't accept the premise.  Genital herpes is pretty prominent in public education and in professional concerns about STD prevention.  It is true that HSV-1 is less emphasized than HSV-2, but that's certainly legitimate, given the different natural course (fewer outbreaks) and less potential for transmission.  Also, genital HSV-2 increases HIV risk if exposed, but HSV-1 does not.  You can't expect enhanced public health prevention efforts just because you happend to be unlucky.  (Society doesn't beef up its lightning strike prevention efforts every time someone gets hit!)

7) You are somewhat overstating the available data on genital HSV-1 recurrences.  Research shows that in the first 2-3 years after initial HSV-1, about 40% have no recurrent outbreaks; and most of the remainder have only 1-2 outbreaks during that time.  Many have only a single recurrence then no more.  There are no data beyond 2-3 years, but some such persons probably have recurrent outbreaks, sometimes many years later.  7a) See no. 5.

8) Recurrent herpes lesions usually are on the genitals, but any place from waste to upper thighs ("boxer shorts" distribution) is possible.  That includes hairy areas.  The hair business comes up because folliculitis -- inflammation around hair follicles -- is a lot more common than recurrent herpes, so most such lesions in hair-bearing areas are not herpes.

9) Oral herpes due to HSV-1 clearly can be triggered by local trauma, including sunburn of the lips.  No research has ever documented any particular triggers for genital herpes due to either HSV-1 or -2.  There are plenty of rumors about stress, lack of sleep, menstruation in women, and other things -- but nothing actually proved by any credible research.  There is absolutely no reason for you to curtain your workouts.  And somehow I doubt your penis and genital area are likely to be directly exposed to sunlight, so obviously that's not an issue.  

I don't understand why your genital herpes has already "had a huge impact" on your life.  Presumably you haven't had a recurrence yet, and maybe never will; and probably there will be little risk of transmission to future sex partners.  Your GF cannot catch it again; couples do not "ping pong" their shared HSV infections back and forth.  Most people with genital HSV-1 carry on with little or no impact on their lives.  Most likely that's how it will be with you as well.

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

[H. Hunter Handsfield, M.D.]

A recurrent outbreak certainly could happen 2 months after the intitial infection.  But a simple red dot doesn't sound like herpes.  If it blisters, that would make herpes more likely.  If you remain uncertain, visit a clinic or doctor ASAP.  Diagnosis of recurrent herpes is much easier if the lesion is seen within 2 days of onset.  

You continue to make more of this than you should.  "Needless to say I'm panicing" is inappropriate.  Read my replies above, concentrate, and learn from them.

No forum can provide definitive care.  That's definitely all for this thread, and also please don't be tempted to start a new one with the same questions.

[downandout_23]

Doctor, I know given your last sentence that this thread is to be done.  But i have to ask one more thing.  If i am out of compliance with the services provided here, please just let me know.  But this is the last post by me on this thread.

Simply need to know, how likely is it and if you have seen a 2nd outbreak of HSV-1, two months after the primary OB.  I noticed a red dot in the exact same loaction as the first noticable blister in the primary OB, and needless to say I'm panicing.  Dont know if it matters but i have been under great stress the last 2 months from various things and i hope that this is not a reccurance.

I understand that you are not here to answer all of everyones questions again and again.  I do respect that and this is my last post.  but could use one last piece of guidance. Thanks again and again doctor!!!!!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks. My reply above was intended to assuage your overreaction to the situation. These follow-up questions suggest you're starting to mellow a little bit, but that you're not quite there.

There are no clear answers about the frequency of asymptomatic genital HSV-1. The issue rarely comes up. Patients and their doctors become aware of asymptomatic genital herpes when people are tested for HSV-2 and found to be positive, despite having no symptoms. But if someone is positive for HSV-1, it mostly reflects oral infection, not genital -- so there are no data on the proportion of genital HSV-1 cases that are asymptomatic. Most likely lots of genital HSV-1 infections indeed are asymptomatic, however.

Your concern about future partners is typical. Fear of transmission and informing partners is the single greatest concern of people with genital herpes. However, unlike HSV-2, the chance of unwitting transmission of genital HSV-1 to a partner is low, so it is not clear that you necessarily need to inform future partners of your infection. It will depend in part on the course of your infection, i.e. whether you have recurrent outbreaks. This is controversial, and some people believe there is the same obligation to inform. But if so, the low risk of transmission means it can be done in a way that should not a serious impact on your sex life or the formation of future romantic relationships.

There are two reasons for suppressive antiviral therapy, reducing the frequency of symptomatic outbreaks and helping prevent transmission. For genital HSV-1, neither of these usually applies -- and so far neither of these applies to you. If you end up (atypically) with frequent outbreaks, or if you start a new sexual relationship, discuss suppressive therapy with your provider. In the meantime, it would be a mistake. Treatment would prevent you knowing the potential for recurrent outbreaks. Unless there is an immediate risk for transmission to an uninfected partner, I advise all patients with newly diagnosed GH to stay off suppressive therapy for at least 6 months, in order to understand the recurrence pattern.

When all is said and done, your herpes is going to be a minor issue in your life. Believe it. For expert advice from both experienced herpes counselors and lots of people with GH, consider participating in MedHelp's herpes community forum.

That should end this thread. Take care.

[downandout_23]

Thank you so much for your answers.  I didn’t word my first question very well.  I was looking for how prevalent is HSV-1 in society.  A lot of internet references give a wide range of percentages.  As for this having an impact, someone like myself who has had very few sex partners and no oral sex contact, then this happens is devastating to a certain degree.  My greatest fear is if my GF and I go separate ways, I absolutely dread the fact of having to tell someone about this condition.

If I may I would like to ask 2 more questions.  A lot of references say that people with HSV-2 are unaware of the infection (80% or so).  Is this the same case with genital HSV-1?
Also, would there be any benefits for me to go on any kid of suppressive therapy?

Again, thank you so much for this service and your time!

[H. Hunter Handsfield, M.D.]

Did I misunderstand question 1?  If you are asking what proportion of HSV-1 infections are genital versus oral, the answer isn't known.  As discussed above, in the US about half of people age 30 and up have HSV-1.  The large majority of those are oral, but clearly some are genital.  There are no data as to whether it might be 5%, 10%, or as high as 20% -- but probably no higher than that.