Reoccurance of HSV1 or new inoculation of HSV2?

[cali1995]

Hi,

I was diagnosed with genital HSV1 in December 2008. I had a very mild first outbreak with about 3 sores on both sides of my vagina. This was accompanied with fairly intense lower back pain/tingling. I have not had a reoccurrence since.

I had unprotected sex the weekend of February 22nd and had an outbreak on my vagina that began March 23 and lasted until about March 17th. The sores were identical in location and pain to my prior outbreak and occurred on both sides of my vagina again. One week prior to this outbreak I was diagnosed with BV (bacterial vaginosis). In the months leading up to this outbreak, I had  extremely stressed and had lost about 20 pounds, making me somewhat frail. The fact that I hadn't had an outbreak in years and then suddenly got an outbreak after having random sex seemed like a strange coincidence, even though my body was fairly rundown and I had an BV infection at this time. At this point, I was assuming my outbreak was a reoccurance of HSV1.

After my outbreak in March had been cleared up for about 3 weeks, I got a severe sunburn. The next day I started to have severe lower back pains again accompanied by fairly intense tingling. This has been on and off in severity for about 2 weeks now. I've did one 5 day cycle of taking 800 mg of Acyclovir in the morning and 400 mg at night and then started taking 400 mg AM and 400 mg PM. This doesn't seem to be helping with the tingling but I have NO sores.

Is this intense back pain/tingling occuring so recently after my outbreak in February indication enough that I contracted HSV2 genitally from my sexual episode in February and that this was not simply a reoccurance of my HSV1 genitally?  Does the fact my outbreak occurred on both sides again indicate it was a primary onset of HSV2? (I read somewhere that outbreaks only occur on both sides of the vagina only if its a new infection).

thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

Interesting situation.  Recurrences can be bilateral so that characteristic by itself is not diagnostic of new infection.  I doubt that this is new infection but it is certainly possible.  have you spoken with your partner about this concern?  The only way to know if you have new HSV 2 infection is antibody testing or, if you get another lesion, to have it swab tested and typed.  There are some experts that believe that having HSV 1 genital infection MAY provide some protection against getting HSV 2 genital infection - that has not been proven but I think there is some validity to that thought but I would emphasis the SOME protection as we know people can have both genitally.

The leg issues are unclear about their relationship to herpes honestly.  If antiviral therapy is not making it better then I'm thinking it might not be related.  

The antibody testing should be done about 12-16 weeks past the encounter.  Alternatively, you could ask the other person to get tested to see their HSV 2 status.  If they are negative and you've had no other partners in the past four months and you test negative for HSV 2 IgG antibody, then you aren't infected.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

We don't have specifics on this, but my guess is that people who have both did NOT contract it at the same time.  Your body has several times of immune responses to herpes - some are systemic (like antibody) and some are local to the genital area.  It is those local ones that we think might offer some protection against getting a new type genitally.  

As for flu symptoms - that is quite variable.  They are far more common with first infection than subsequent outbreaks but some people have them every time with an outbreak so I don't think your lack of them helps us sort this out in any way

Terri

[cali1995]

Thank you so much for your input. It helps so much to get feedback from someone who is knowledgeable on the subject.
To follow up, (I completely understand if you won't comment on this thread again but I thought it's worth a shot!) I had flu-like symptoms when I initially contracted genital HSV-1 in Decemer, 2008. I had no flu-like symptoms this time. If you're already infected with a strain of herpes and end up catching the other strand, do people typically exhibit these flu-like symptoms?
Also, given that I've had genital HSV-1 for 5+ years, I would think my area down there would have built up fairly decent antibodies against the virus, especially since I've never had another outbreak. For the majority of people who have both HSV1 and HSV2 genitally, did they catch each strain fairly close in time, meaning their bodies didn't have time to build up a defense mechanism? Sorry if my logic is skewed...I'm an engineer, not a biologist!
Again, any input at all would be GREATLY appreciated and thank you so much for the previous help.