Specific Oral HSV1 Transmission Question

[sara678889]

So I asked Dr H. roughly the same question but he referred me to you. In a nut shell,15 months ago I had what I'm sure was my primary oral hsv1 infection after kissing a stranger for a prolonged period (got a positive swab on it). I don't THINK I've had a cold sore since that primary episode. I was very sick during the initial outbreak, mimicking strep throat. I had numerous type specific blood tests before that and was negative for both HSV1 and 2. I've learned that asymptomatically spreading it to another person is possible regardless of how frequent your outbreaks are–that shedding occurs at irregular intervals.

1) BUT given the aggressive nature of my immune system during the primary OB, does that set my asymptomatic shedding rate apart from those with recurrent visual symptoms and those with solely underlying (just blood test positive) HSV1? It may just be wishful thinking and I haven't come across any studies on it, but THEORETICALLY could it therefore be true that I don't shed? (<--most concerning question to me)

2) Also, Grace has said that people don't shed 24/7/365. Can activation occur due to heavy kissing?-I'm thinking that since trauma is a trigger that kissing can awaken the sleeping virus, ergo spreading it ANY time heavy kissing occurs–deeming one ALWAYS contagious.

3) How expensive and realistic is it to get a sequence of PCR tests to determine how much I shed?

Sorry for so many questions. I've just gotten ZERO peace of mind about transmitting this to an HSV1 negative partner (majority of people have it but I'm still looking for another silver lining given my particular bodily reaction to the virus).

I've read the parts of your book that I could get my hands on via the internet. Not sure how much HSV2 parallels oral HSV1 regarding the above questions. Ugh. Asymptomatic. I need some good news!!

[Terri Warren, RN, Adult Nurse Practitioner]

I think if you are taking daily therapy, the risk of infecting other people with HSV 1 is much lowered, but we really don't know for certain how much.  I don't think the swab test was a false positive, especially given that you had herpes - consistent symptoms.  

You can arrange daily swabbing through the clinic, yes.  

Terri

[sara678889]

I thought I might add that the swab was taken 1 week after the onset of the sore. They aggressively ripped off the big yellow scab. Yesh.

[sara678889]

I will request antiviral therapy from my GP.

How are my risks of infecting other people given that I'm 27 and would date other 27 year olds?

Is a false positive swab possible? I was extremely, extremely, ridiculously, crazily stressed at the time of the swab.

I would like to pursue the at home PCR testing before I go on antiviral therapy. Can this all be arranged by calling your clinic? Why is there a lack of information regarding PCR testing to specifically evaluate Oral Herpes shedding?

Ok I really promise that will be all from my side of questions.

[Terri Warren, RN, Adult Nurse Practitioner]

If you had a positive HSV 1 swab test, and previous negative HSV 1 antibody tests, then this is likely your first infection.  However, the antibody test does miss 1 out of 10 HSV 1 positives, so you might consider being retested, and see if you are HSV 1 positive now.  If you are, that confirms that you do make antibody and that the episode 15 months ago was your first infection.  

I don't think a microbiology professor is probably a good source of information on clinical herpes simplex.

If you combined seven swabs into one vial, for a week, they would all be run as one swab test.  It would either be positive or negative.  You couldn't know which swabs were positive or negative, just a grouped result.  they keep in the refrigerator just fine.  Most people do about 3 months worth of swabbing.  I would say that 18% of days is way high for HSV 1 oral infection.  Once per month is not 18%.  that's more like 3% which is probably low.  
the studies for oral HSV 1 shedding are all over the board.

My personal advice, if you were my patient, would be to go on daily antiviral therapy, if you get back together with your partner, ask him to get tested, if he is negative, stay on therapy, if positive, you two can decide what you want to do.

terri

[sara678889]

I’m sorry for the amount of questions. This is the last of them I promise. I’m transitioning into the medical field and I’d like to be extremely well-informed not just for me but because there is incredible misunderstanding on this subject everywhere/lack of accessible information, and it will someday be my job to fill people in. (Even my microbiology professor gave some conflicting information vs medhelp.)

I’ve tested the UV/sunlight trigger a few times and I don’t get a cold sore. I also have chronic insomnia and often don’t sleep for a couple days (=stress). Does that indicate that I’m not all that sensitive and most likely trauma isn’t a trigger for me either? Or do the three triggers stand alone depending on the person?

How do I get my hands on the at home PCR tests?

If I did the weekly tests, would the swabs toward the beginning of the week give false negatives when placed into the vial on day 7 if they’ve been sitting out exposed to air for days? How does that work?

How many vials do people usually get if they go the weekly route? How many months worth would give the best estimate?  If asymptomatic shedding occurs an average of 18% of the time (once per month) then maybe 2 months worth would suffice?

Of the positive Oral HSV1 people who undergo a sequence of PCR tests–What percentage get the result of  NO shedding whatsoever? (The very lucky ones).

[sara678889]

My ex is also 27...that's who I'd potentially be dating.

[sara678889]

**typo: neither of us WERE very experienced with kissing etc when we met freshman year in college

[sara678889]

Thank you for your help. I'm 27 and don't really date at all, I've been traveling/working for a long while and recently gotten back to the U.S.. I went on a date overseas one time, and I pulled away when the guy tried to kiss me.
I am more concerned now because my one and only ex who broke up with me 5 years ago (I was in a bad depression, I am much, much better now and he knows that), has kept in touch and wants to meet soon. I was heartbroken for a long time and now that it seems I may have a second chance I don't want to add this complication to things–afraid he'll be turned off and I'll lose him again. We dated for years and kissed just about every day, never saw or said anything about cold sores (neither of us we're very experienced with kissing, etc when we met freshman year in college), and he's been with 1 other girl since me. So I assume there's a good chance he's HSV1 negative.

I got tested two years ago a number of times (for peace of mind), type specific. I was negative for both HSV1 and 2 every time.
––To answer your other question (with more questions), I have not had a type specific blood test since the infection 15 months ago. I thought antibodies usually show up after 6 months? So even though I was negative two years ago, and the infection 15 months ago was very aggressive (well, one huge oozing blister that looked like impetigo, with flu-like/throat symptoms), supposedly symptoms of a classic primary infection–you think there is a chance it was not my primary infection? How much of a chance?

I'll just throw this out there also:

I explained the reason why I'll ask this question to Dr. H. (so I won't go into it) and got an unfavorable response from him on it, but maaaybe (<--someone's in denial!) you have different information.
Is there any chance an oral HSV1 swab would show up positive on what was really a chicken pox lesion? I've read in a few places this may be possible, I did not, however, cite a good source that reflects this for Dr. H.

Thank you thank you thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

1.  No, I don't think that the severity of your first outbreak will change your asymptomatic shedding rate in a positive way.  there is just no evidence for that at all.  wish I could tell you something different.
2.  for some people, trauma appears to be a trigger for outbreaks.  and for some people, heavy kissing might qualify as trauma, yes.  I think the only way you are going to find that out is to observe and maybe even keep a little diary of what activities you are doing, and how outbreaks, if any, fall into that diary.  
3.  we do have people doing daily home swabbing , not as part of a study.  they can do it one of two ways - either a separate vial for each day, or combining seven swabs into one vial for a weekly awareness of shedding, which, if positive, doesn't tell you how often you are actually shedding.  each vial costs $50.  

I know you are looking for good news, and the best news i can give you is  that the virus is so common in the population.  
a few questions for you:
how old are you, do you date people in your own age group?  I might be able to help you know what the risks are of infecting other people.  

also, have you had a type specific antibody test since your infection 15 months ago?  If it is not yet positive, the test may have missed a previous infection that you had.

terri