I would totally agree that it is most likely that your infection is oral, yes.
Since the ELISA misses one of 10 cases of HSV 1, you could have him get a western blot just to be certain, yes. A recent study that we are doing indicates it might be even higher than one of 10.
Terri
Hi Terri,
Just wanted to update you. My husband got his test results back. On this particular test positive is greater than 0.9.
His HSV 1 was 0.1, HSV 2 was 0.04. Negative for both. Since I had a false negative on this test and needed a Western Blot to show I have HSV1 I am a little less inclined to say for sure that he does not have HSV1. Then again, I guess the odds of us both having a false negative are kind of small. Right?
Anyway, considering that fact that he had a negative test and the only other sexual contact I have ever had is a one-time unprotected vaginal intercourse (no oral) with another person I am thinking that it is more likely that my HSV1 is an oral infection which I have probably had for quite some time. I think I remember that the odds of contracting ghsv1 from a one-time encounter are extremely low. What do you think?
I will still plan to do the at home PCR swabs if I have any more of the cuts but I wanted to let you know about his results.
Thanks so much!
The proper dosing at the end of pregnancy is either 400 mg three times a day for acyclovir or 500 mg twice a day for valacyclovir
Terri
What is the dosing you recommend at the end of pregnancy? IF we end up getting pregnant and IF the swabs are positive I'd like to make sure my OB prescribes the correct thing. Thank You!
Thanks, Terri. I will let you know after I do the PCR swabbing.
1. Yes, it definitely was caused by something else, though I'm not clear what. She noticed it almost every time after intercourse, and reported that her partner's penis was quite large, so it could have been trauma, don't know.
2. I totally agree with your pediatrician.
So IF you have HSV 1 genitally, it is very likely from your husband which means he is also infected. But again, you will know more when you do the PCR swabs. I don't see a reason to postpone pregnancy. If these fears continue or it is shown that these are HSV 1, then you can take suppression at the end of pregnancy and I think you'll be good to go.
Terri
Terri,
Thank you so much for your reply. The chance to get to pick the brain of someone as knowledgeable is as you is priceless. To further clarify my situation, the one time encounter was only vaginal sex. My husband is the only person I have ever received oral sex from. He has never been tested for hsv but we plan to have that done very soon.
I have just a few follow up questions.
1. Do I understand correctly that you are thinking your patient's splitting of the labia was caused by something other than herpes?
2. During the first few months of my son's life he had all kinds of rashes. Since I had these herpes concerns in my head, I was freaked out about every little bump. Our pediatricians assured me that none of his rashes looked anything like herpes. There were never any blisters or open sores. They also told me that if he had contracted neonatal herpes he would be very sick, and he was not. As I said in my first entry, he is 2 years old and very healthy. Do you agree with my pediatricians that if he had contracted herpes at delivery he would have had obvious blisters and would have been very ill if left untreated?
Thank you again for taking the time to answer my questions and for the reassurance. I would hate for the possibility of gshv1 to keep us from having another child and your encouragement is greatly appreciated. Hopefully, with my husband's IgG testing and the PCR if I get any more symptoms we will get this figured out!
You ask excellent questions.
The herpes medicines are slightly (and very slightly) less effective against HSV 1 than they are against HSV 2. Our clinic experience is that people who have cold sores, for example, suppress very nicely on antiviral therapy. And almost all of this is HSV 1, with some exceptions.
Though genital herpes can certainly present at cracks and splits, at some point most people who have genital herpes will note a sore, not just cracks and splits. I actually have one patient specifically that I recall who has very frequent cracking and splitting of the labia. She was in a herpes study with us ands at first, we believed these were outbreaks. But none of the swab tests were positive so I changed my opinion about that. She subsequently did have an outbreak that was swab test positive and it looked more like a sore than a crack.
Has your husband best tested to determine if he is HSV 1 positive? If he is not, and you only had one other sex partner in your lifetime, did you receive oral sex from this person? If your husband is negative and you did not receive oral sex from the person in college, I seriously doubt that you have HSV 1 genitally. If those facts are true, you most likely have asymptomatic oral HSV 1. However, if your husband does have HSV 1, that changes the possibilities, obviously.
As for your question about delivery and HSV 1. I believe the more correct assumption regarding HSV 1 genitally and delivery is that proportionally those who have HSV 1 genitally are more likely to infect their baby than those with HSV 2. For some reason, the HSV 1 virus seems to have a higher "attraction" for the neonate than HSV 2, but the number of cases of infection are still very very small, and most are in people who don't know they are infected and don't take antiviral medicine.
In my opinion, if you want to get pregnant, go for it. You've got time to sort this all out. Pregnancy is an immunosuppressive state, and since it is, you may get an outbreak somewhere during the pregnancy. Remember that oral herpes is not just oral - it can be in the nose, on the chin, on the face, in the eye. We actually PCR'd a lesion on someone's scalp this week that was positive for herpes. So look other places too for outbreaks anywhere in the head area.
Terri