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Genital HSV-1, again
OK, so this has been somewhat of a hot topic recently and I just wanted to clarify a few things:
A) Let's say a person who was negative for both HSV1 and HSV2 had an intimate encounter involving both deep kissing and oral sex. Let's say that person later tested positive for HSV-1,having had oral symptoms but no noticeable genital symptoms. Would the assumption be that the person had most likely also contracted HSV-1 genitally?
B) On a similiar note..while HSV2 can often by asymptomatic, does HSV1 operate the same way genitally, or in general does HSV1 manifest with symptoms on the genitals?
C) How would the general appearance of HSV1 look? I know there is a "classic" case and then a million other possibilities, which is what makes it difficult...you rightfully say that the best bet is to go see an MD, but this would mean going to see an MD on a weekly basis, for some. Is it true that individual bumps are generally not herpes, and that HSV1 would manifest as a number of bumps, or a cluster?
Also, PLEASE respond to the comment below, from a forum of about 1 week ago...VERY confusing and contradictory...
"I am an MD and I have posted here before.
Some of the advice given on this web site is way too categorical and I think can be misleading. For example Doctor HHH advises many here that if one has genital HSV-1, that person can not transmit HSV-1 genitally to another individual who has documented oral HSV-1 with existing IgG antibodies "even if they tried".
This I think is wrong and should NEVER be said to anyone in these terms. I have done my share of reading and have emailed back and forth with Anna Wald, MD...the one person who knows most about this since she did the 2002 studies with Valtrex in discordant couples. She also generated the study that Dr. H quotes in which he says 40% of HSV-1 does not recur and the rest have 1-2 receurrences the first 1-2 years then none at all.
Well, Dr. Anna Wald and me and "gracefromHHP", and my Infectious Disease MD Dr. Nakada in Torrance, CA all understand that you can still pass HSV-1 genital-gential to an individual who has oral HSV-1 with documented IgGs. It DOES NOT OFFER 100% protection. I know from personal experience. It happened to me. I contracted HSV-1 genitally months after my oral infection (and I already had IgGs) by having unprotected sex with my partner who has HSV-1 genitally. In retrospect, I should have worn condoms.
So, if you have genital HSV-1 and think you can't pass it on to 50% of the population out there who already has oral HSV-1....think again. They have significant resistance to contracting HSV-1 genitally, but it does happen. It's still HSV and it becomes a burden (big or small depending on where you are in life, attitude, etc) that you carry with you for the rest of your life. Unless you HAVE HSV of any kind genitally, you do not know exactly what it feels like emotionally and no one should attempt to minim
A) Let's say a person who was negative for both HSV1 and HSV2 had an intimate encounter involving both deep kissing and oral sex. Let's say that person later tested positive for HSV-1,having had oral symptoms but no noticeable genital symptoms. Would the assumption be that the person had most likely also contracted HSV-1 genitally?
B) On a similiar note..while HSV2 can often by asymptomatic, does HSV1 operate the same way genitally, or in general does HSV1 manifest with symptoms on the genitals?
C) How would the general appearance of HSV1 look? I know there is a "classic" case and then a million other possibilities, which is what makes it difficult...you rightfully say that the best bet is to go see an MD, but this would mean going to see an MD on a weekly basis, for some. Is it true that individual bumps are generally not herpes, and that HSV1 would manifest as a number of bumps, or a cluster?
Also, PLEASE respond to the comment below, from a forum of about 1 week ago...VERY confusing and contradictory...
"I am an MD and I have posted here before.
Some of the advice given on this web site is way too categorical and I think can be misleading. For example Doctor HHH advises many here that if one has genital HSV-1, that person can not transmit HSV-1 genitally to another individual who has documented oral HSV-1 with existing IgG antibodies "even if they tried".
This I think is wrong and should NEVER be said to anyone in these terms. I have done my share of reading and have emailed back and forth with Anna Wald, MD...the one person who knows most about this since she did the 2002 studies with Valtrex in discordant couples. She also generated the study that Dr. H quotes in which he says 40% of HSV-1 does not recur and the rest have 1-2 receurrences the first 1-2 years then none at all.
Well, Dr. Anna Wald and me and "gracefromHHP", and my Infectious Disease MD Dr. Nakada in Torrance, CA all understand that you can still pass HSV-1 genital-gential to an individual who has oral HSV-1 with documented IgGs. It DOES NOT OFFER 100% protection. I know from personal experience. It happened to me. I contracted HSV-1 genitally months after my oral infection (and I already had IgGs) by having unprotected sex with my partner who has HSV-1 genitally. In retrospect, I should have worn condoms.
So, if you have genital HSV-1 and think you can't pass it on to 50% of the population out there who already has oral HSV-1....think again. They have significant resistance to contracting HSV-1 genitally, but it does happen. It's still HSV and it becomes a burden (big or small depending on where you are in life, attitude, etc) that you carry with you for the rest of your life. Unless you HAVE HSV of any kind genitally, you do not know exactly what it feels like emotionally and no one should attempt to minim
I am writing to clarify my previous posting since I was quoted above in the main text of the initial question.
I am an MD and I have written here a few months back when I accidentally passed HSV-1 oral -to- genital to my partner. I had HSV-1 IgGs at the time this happened.
I am posting my correspondence with Dr. Anna Wald so that everyone can see what question I asked and what her expert response was. I have taken out my name from the email header. Her answers are incorporated within the text of my email:
Date: Fri, 23 Sep 2005 14:10:50 -0700 (PDT)
From: "Anna Wald" <***@****> View Contact Details Add Mobile Alert
To: "passedHVS1"
Subject: Re: a couple of questions from a fellow MD
see answers below -
On Fri, 23 Sep 2005, "passedhsv-1" wrote:
> Dear Dr. Wald,
>
> I am an Anesthesiologist in California and I hope I am
> not being too bold for emailing you directly with a
> couple of questions regarding HSV-1. I have had some
> trouble discerning which information to trust and I
> know that you are an authority on the subject matter
> given your research. I know your time is very
> valuable and I appreciate any answer you can provide.
>
> I have HSV-1 orally and serologically (IgG titer 5.1,
> HSV-2 negative). My first (that I can remember)
> outbreak was 2 months ago.
> Soon after my girlfriend contracted genital HSV-1
> (by culture) from me unfortunately (1st episode).
>
> 1. Having oral HSV-1, am I "protected" from
> contracting genital HSV-1 from my girlfriend if we
> have sex without a condom? Should we both be on
> supressive valtrex 500 mg daily?
you are mostly protected. we don't think it's a 100% but we see it
rarely in persons who have oral hsv-1. this is not a situation where
suppressive therapy would usually be recommended.
>
> This source says I would not be protected:
>
> http://herpesonline.org/hsv1vs2.html
>
> Dr. H. Hunter thinks I would be protected:
> http://www.medhelp.org/forums/STD/messages/1438.html
>
> 2. Does having HSV-1 IgG's indicate "Immunity" from
> contracting HSV-1 at a different body site? I have had
> three recurrences of oral HSV-1 recently and I have
> been feeling tingling around the eye area the third
> time. I am worried about spreading the infection to
> myself.
no, we do not see people spread the infection around their body except
during primary infection, so no worries!
take care, anna
>
> Thank you in advance for your time in answering these
> questions.
In conclusion:
I just ask Dr. HHH to consider never telling people who have HSV-1 orally that they can not get it genitally by having genital-genital contact with a genital HSV-1 person. Please do not use the terms "you can't get it even if you tried" when giving this advice. Even the top expert in the field, Dr. Anna Wald whom you attribute 60% of your knowledge to contradicts you (see above). There are plenty of instances in this forum when this advice has been given by you and I will search them out if you want. Other frequent readers know about them also.
>
I am an MD and I have written here a few months back when I accidentally passed HSV-1 oral -to- genital to my partner. I had HSV-1 IgGs at the time this happened.
I am posting my correspondence with Dr. Anna Wald so that everyone can see what question I asked and what her expert response was. I have taken out my name from the email header. Her answers are incorporated within the text of my email:
Date: Fri, 23 Sep 2005 14:10:50 -0700 (PDT)
From: "Anna Wald" <***@****> View Contact Details Add Mobile Alert
To: "passedHVS1"
Subject: Re: a couple of questions from a fellow MD
see answers below -
On Fri, 23 Sep 2005, "passedhsv-1" wrote:
> Dear Dr. Wald,
>
> I am an Anesthesiologist in California and I hope I am
> not being too bold for emailing you directly with a
> couple of questions regarding HSV-1. I have had some
> trouble discerning which information to trust and I
> know that you are an authority on the subject matter
> given your research. I know your time is very
> valuable and I appreciate any answer you can provide.
>
> I have HSV-1 orally and serologically (IgG titer 5.1,
> HSV-2 negative). My first (that I can remember)
> outbreak was 2 months ago.
> Soon after my girlfriend contracted genital HSV-1
> (by culture) from me unfortunately (1st episode).
>
> 1. Having oral HSV-1, am I "protected" from
> contracting genital HSV-1 from my girlfriend if we
> have sex without a condom? Should we both be on
> supressive valtrex 500 mg daily?
you are mostly protected. we don't think it's a 100% but we see it
rarely in persons who have oral hsv-1. this is not a situation where
suppressive therapy would usually be recommended.
>
> This source says I would not be protected:
>
> http://herpesonline.org/hsv1vs2.html
>
> Dr. H. Hunter thinks I would be protected:
> http://www.medhelp.org/forums/STD/messages/1438.html
>
> 2. Does having HSV-1 IgG's indicate "Immunity" from
> contracting HSV-1 at a different body site? I have had
> three recurrences of oral HSV-1 recently and I have
> been feeling tingling around the eye area the third
> time. I am worried about spreading the infection to
> myself.
no, we do not see people spread the infection around their body except
during primary infection, so no worries!
take care, anna
>
> Thank you in advance for your time in answering these
> questions.
In conclusion:
I just ask Dr. HHH to consider never telling people who have HSV-1 orally that they can not get it genitally by having genital-genital contact with a genital HSV-1 person. Please do not use the terms "you can't get it even if you tried" when giving this advice. Even the top expert in the field, Dr. Anna Wald whom you attribute 60% of your knowledge to contradicts you (see above). There are plenty of instances in this forum when this advice has been given by you and I will search them out if you want. Other frequent readers know about them also.
>
Did you actually read her response to you? Particularly this quote: "you are mostly protected. we don't think it's a 100% but we see it rarely in persons who have oral hsv-1. this is not a situation where suppressive therapy would usually be recommended."
I think that pretty much says that while they think it may not be 100% (and they key word is "think" - that suggests there may not be actual documentation to back this up), it's pretty darn close.
I wonder if your anxieties about your HSV status aren't blinding you to other possibilities. Sometimes when we're really upset about something, it colors our perception of reality.
The truth is, you may or may not have HSV1 genitally. I'm not a doctor, but I think it's safe to say you very likely don't. But if you do, you may have autoinoculated yourself during your primary outbreak a couple of months ago. There is no reason, aside from your own anxieties and fears, to believe that your gf may have infected you genitally.
I would suggest perhaps seeking counseling, to help you work through your issues with this.
I think that pretty much says that while they think it may not be 100% (and they key word is "think" - that suggests there may not be actual documentation to back this up), it's pretty darn close.
I wonder if your anxieties about your HSV status aren't blinding you to other possibilities. Sometimes when we're really upset about something, it colors our perception of reality.
The truth is, you may or may not have HSV1 genitally. I'm not a doctor, but I think it's safe to say you very likely don't. But if you do, you may have autoinoculated yourself during your primary outbreak a couple of months ago. There is no reason, aside from your own anxieties and fears, to believe that your gf may have infected you genitally.
I would suggest perhaps seeking counseling, to help you work through your issues with this.
How much does your doc know about STDs? Sometimes general practitioners fly fast and loose with the STD facts because they don't know the latest research. Last summer, after having some oral sex wtih strangers, my doctor told me I needed to wait one year before taking an HIV test, which is obviously not true. My gut as a layman would say you probably got HSV-2 on your genitals and your doc is functioning on some misperceptions. Can you take a culture from the open sore, because that would answer the question very quickly?
Sounds like you may have HSV 2? Get a herpeSelect now and if 2 is negative (below 1.1) then do it again at 6 weeks. If positive (and you abstain), you will be able to isolate the exposure. That's what I did...
Dear Doctor,
I have the same issue as the thread starter. In your FAQ, you state that if one has had a history of HSV-1 orally then he or she is proteceted from receiving it genitally. Also you state that HSV2 is not transmitted via oral sex.
I have had a history of HSV1 orally (on upper lip up to the nose sometimes), but about 6 weeks ago I received a blowjob from an anonymous man, and 7 days later I saw herpes sores on my penis. The doctor who treated me said it was most likely HSV1 because it is more often transmitted orally than HSV2.
Anyways, your statement was misleading for me. After reading your statement I was lead to believe that having HSV1 orally meant that I would not get HSV1 genitally, but my diagnosis contradicts that (and my doctor told me as well that you could get HSV1 genitally even if you had it orally).
I have had a recurring breakout since my initial one, around my scrotum, and the breakouts have all been very mild, but I am still very traumatized by the event. I am still worried that I might have received HIV, and I am going to get my HerpesSelect test and HIV ELISA test tomorrow. Your comments have been very reassuring about the almost impossible HIV transmission but I was kind of misled by your HSV1 transmission statements.
I have the same issue as the thread starter. In your FAQ, you state that if one has had a history of HSV-1 orally then he or she is proteceted from receiving it genitally. Also you state that HSV2 is not transmitted via oral sex.
I have had a history of HSV1 orally (on upper lip up to the nose sometimes), but about 6 weeks ago I received a blowjob from an anonymous man, and 7 days later I saw herpes sores on my penis. The doctor who treated me said it was most likely HSV1 because it is more often transmitted orally than HSV2.
Anyways, your statement was misleading for me. After reading your statement I was lead to believe that having HSV1 orally meant that I would not get HSV1 genitally, but my diagnosis contradicts that (and my doctor told me as well that you could get HSV1 genitally even if you had it orally).
I have had a recurring breakout since my initial one, around my scrotum, and the breakouts have all been very mild, but I am still very traumatized by the event. I am still worried that I might have received HIV, and I am going to get my HerpesSelect test and HIV ELISA test tomorrow. Your comments have been very reassuring about the almost impossible HIV transmission but I was kind of misled by your HSV1 transmission statements.
Dr. H,
I believe there is some confusion here that you could clear up.
1. The points made by Johnny V in comment 10 were:
"If you've been exposed in one part of your body and another part of your body becomes exposed, then the fact that you have antibodies does not necessarily prevent the new part of your body from being exposed."
2. In previous Forum answers to the question, "If I test positive via HerpesSelect for HSV-1 antibodies due to a prior oral HSV-1 infection during childhood or sometime in the past, would that provide immunity from catching Genital HSV-1 in the future?"
The answer to the above question on previous Forum threads have been, Yes, it would provide immunity as you cannot catch HSV-1 again(anywhere on the body)once you have been infected with it on another part of your body and have had antibodies to the same type of virus.
3. In the "Herpes Frequently Asked Questions" on this site, Question number 18, "I'm pregnant and haven't had herpes, but my husband or partner has herpes. Should we do anything?"
Part of the answer to this question advises folks to get a blood test because if the blood test is positive for the same Herpes type that the partner has, you are immune from catching it again anywhere else on the body.
Which statement are true, those under number 2 & 3 above or number 1, the one quoted above written by JohnnyV under comment 10?
Thanks Dr., this answer is important given the activity of this thread......
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
