Aa
A
A
A
Close
STDs Forum
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Avatar universal

HSV-1 Reinfection Multiple Sites

Hello Dr. Handsfield, Dr. Hook I've had something very peculiar happen to me over the past month or so.  I began dating a man that I knew to be hsv-1 positive in late September (two months ago), he had a round of std testing which included hep a,b, c, syphilis, gonorrhea, chlamydia, hiv, and hsv-1 and hsv-2.   I have only had oral sex as my sole sexual experience  w/ a boyfriend 2 years ago (confirmed hsv-1 negative through blood test).  I have also been std tested and the only positive was hsv-1 as ive had coldsores frequently throughout my life.  Being that both my partner and I are orally hsv-1 positive, I assumed that genital transmission was nearly impossible (given what Dr. Handsfield has said about significant protection against acquiring the same hsv strain in a different location on the body) through oral sex.  On september 28th, I allowed the hsv-1 positive man to give me oral, I was just recovering from a cold and feeling a bit run down.  On oct 1st, I began to break out on my pubic mound, crease, near the buttock area, on my inner thigh, behind my left knee, back of my thighs, left breast, and left ear in lesions (right breast/ear remain uninfected, but also made contact with his mouth).  The breast and ear lesions healed within 4 days before I could get them swabbed, as w/ the mound and the crease, the buttock lesions kept multiplying and the thigh lesions dried up too much to be cultured.  I had the buttock lesions cultured and they came back positive for hsv-1. I have significant scarring on my thighs and inner buttock area from the outbreak that has not improved that significantly.  I've given him oral 4 times and do not have any throat hsv-1 symptoms nor did my coldsores reactivate through kissing. How do you explain such significant reinfection with hsv-1?  I've had this virus orally since 5 years old.  Could I have an autoimmune disorder?  I'm concerned because I'm dating this man right now, and would like to avoid being infected in other areas.  
19 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your question; I'll try to help.

As you already know, this is a most unusual situation.  However, unusual doesn't mean never.  My usual phraseology is that people are usually (not "always") are "immune, or at least highly resistant" to new infection with the same HSV type they already have.

The positive test for HSV-1 from a buttock lesion certainly suggests you might have acquired a new genital area herpes due to that virus. However, many aspects don't fit well with new herpes.  In order for an HSV infection to take hold, typically the virus has to be massaged into the tissues.  Therefore, initial lesions almost always are dominant at the exact site(s) exposed --- e.g. the labia minor, vaginal opening, the head of the penis in men -- the sites that receive the most friction during sex.  Initial herpes rarely causes lesions in the pubic area, on the leg, buttocks, etc.  Also, herpes lesions generally do not cause scarring when they heal, and active lesions do not persist more than a couple of weeks; lesions that have "not improved that significantly" after 2 or more weeks are probably not herpetic.

For those reasons, even if you have acquired new genital HSV-1, I suspect something else also is going on.  Are you being treated now with an anti-herpes drug like valacyclovir or acyclovir?  If so, that is additional evidence against herpes; resistance to these drugs is extremely rare.  Perhaps your own pre-existing HSV-1 infection was somehow transferred to a buttock lesion caused by something else.

Also, I would ask whether your oral herpes since childhood is typical, and whether it has ever been documented by lab testing.  Can you describe those outbreaks for me?  Exactly where to they occur (lips? face? elsewhere)?  How often?  Do they respond promptly to anti-herpes drugs?

I doubt you have any kind of immune deficiency. But as noted above, I also doubt that HSV-1 is the main cause of your symptoms.  I recommend you discuss all these things with your doctor.  I'll be interested to hear how things turn out; please return and let me know.

Best wishes--  HHH, MD
Avatar universal
*Hsv-1 positive man did not have any lesions around his mouth at the time, so I was essentially re-infected asymptomatically
239123 tn?1267651214
MEDICAL PROFESSIONAL
This is also somewhat unusual. Although transmission from a asymptomatic oral herpes can occur, it's more common with overt herpes outbreaks.
Avatar universal
My oral herpes outbreaks in the past have occurred on the outer edge of my bottom or top lip, but in recent years they have occurred near my cupid's bow
and near the entrance to my nose.  I can go months w/o a coldsore (8 months is my record) but if I'm stressed I can get outbreaks that happen in succession (one heals and then another forms right after) this happened in may and a few yrs ago as well.

I was prescribed acyclovir 400 mg to be taken 3 times a day, I have just finished the bottle.  The lesion that was swabbed on my buttock that came back hsv-1 positive is still leaving a big red scar, it is the most pronounced scar that I have.  What do you make of the lesions on the breast/ear/back of knee?  The examiner also said my outbreak was atypical because it looked constellation like with several lesions appearing in a straight line.  I took a picture of the primary vaginal outbreak as well as the breast outbreak.  Should I bring those to a Dr?  What types of questions should I be asking them?  I also went to a clinic prior to the swab and they prescribed me keflex as an antibiotic because they thought it was bacterial.  It didn't help at all and now I have acquired a persistent yeast infection.  Should I refrain from sexual contact with my boyfriend?  If this is ghsv-1, could I give him the infection genitally and then have him give it back to me orally in the throat through oral sex?  Should we refrain from kissing?  I've have seen two physicians already and both are at a loss for what has occured.  Do you think a staph bacteria co-infection is what is causing the scars?  The other lesions disappeared without scarring of any kind which makes me suspect those are herpes.
Avatar universal
And to your initial post, the examiner didn't see lesions of any kind on the labia or surrounding vaginal area, but a few days prior to the exam I had redness on my clitoris and one side of it appeared to be swollen.  A week ago I had what appeared to be a "paper cut" looking lesion on my vaginal skin.
Avatar universal
I also should add that prior to receiving oral sex I shaved my genital area in a rush, and did it in a rough manner without much lubrication possibly causing tears in the skin for virus to enter.  My boyfriend was also a smoker at the time that this was done, if that makes any difference.
Avatar universal
Do you think me being slightly ill with a cold could factor into any of this immune system wise?
Avatar universal
And to your initial post, the examiner didn't see lesions of any kind on the labia or surrounding vaginal area, but a few days prior to the exam I had redness on my clitoris and one side of it appeared to be swollen.  A week ago I had what appeared to be a "paper cut" looking lesion on my vaginal skin.
I also should add that prior to receiving oral sex I shaved my genital area in a rush, and did it in a rough manner without much lubrication possibly causing tears in the skin for virus to enter.  My boyfriend was also a smoker at the time that this was done, if that makes any difference. Do you think me being slightly ill with a cold could factor into any of this immune system wise?  If I have future partners, do you have any idea on how I should inform them?
239123 tn?1267651214
MEDICAL PROFESSIONAL
Thanks for the additional details.

As at least one doctor thought, this sounds much more like a bacterial infection problem than herpes, staph would be a typical kind of bacteria to cause this sort of problem.  My guess is that the single positive test for HSV-1, from your buttock lesion, was false.  Alternatively, if you had an oral herpes outbreak at the time, it could have superficially contaminated your buttock lesion

Until a few years ago, the test to detect HSV was a culture -- i.e. the lab would actually grow the virus.  Culture misses lots of infections, so it was a big improvement when tests to detect HSV DNA (mostly the polymerase chain reaction, or PCR) became available.  However, sometimes PCR can be almost too sensitive:  it picks up such tiny amounts of HSV DNA that it is easy for the teeny amount that might be on your finger, which then came in contact with your skin elsewhere, to give a positive result from that other site.  It doesn't necessarily mean that there is an actual HSV infection at that site.  At this point, that is my best guess as to what is going on here.

Therefore, I doubt you have an actual genital HSV-1 infection, and that you need not take any precautions about sexual transmission of genital herpes and need not inform future partners.  (In fact, even with known genital HSV-1 infection, it isn't necessarily required that all future partners be informed.)  

I stress that this isn't definite -- I cannot prove for sure what the explanations are.  The situation is too complex to expect final answers online, either on this forum or anywhere else -- so there's nothing more I can do.  My advice is that you talk to your doctors about referral to an infectious diseases specialist.  If you do that, consider printing out this thread as a framework for discussion.  (You could also print it for discussion of your current doctors.)

Good luck with it all--  HHH, MD
Avatar universal
Thank you doctor, you have been reassuring as always.  I will follow up with my physician and let you know how it goes.
Avatar universal
Dr. Handsfield, there has been an interesting development in this whole situation.  I received a copy of my boyfriend's test results and it shows HSV-1 IGG as negative and HSV-2 as positive...now I'm really concerned.  I'm afraid  my throat will be infected with HSV-2 because I gave him oral many times and even did it after knowing his status because in the moment I assumed my oral HSV-1 would protect me from oral HSV-2.  If his mouth infected my genitals does that mean he has oral HSV-2, is kissing a risk?  I plan on getting him retested for HSV in a month's time as well as myself, so that I allow 3 months from the time my symptoms surfaced in October.  Do you think that's enough time for me to get an accurate result for HSV-2.  We have also had vaginal sex on two occasions, both times with a condom.  How great do you think my risk of genital HSV-2 is?
239123 tn?1267651214
MEDICAL PROFESSIONAL
First let's figure out if your partner truly has HSV-2.  A positive HSV-1 result almost always is true -- but HSV-2 testing is less reliable, especially when HSV-1 is positive.  Can you learn the exact HSV IgG test done on your boyfriend (the brand name of the test? and the numerical results for both HSV-1 and HSV-2?  Or just tell me the exact wording of his blood test report.
Avatar universal
His test results do not show numerical values for the specific types of HSV, that is why I want him to retest at a different facility.  For the IGG results it just says negative HSV-1 and positive HSV-2, but not the brand name of the test.  Then there is a third column that says HSV AB IGM by EIA negative.  On a side note, because of current stress and past antibiotic self use, I have a vaginal yeast infection that has persisted a month.  A few days ago I received oral sex believing that my symptoms were clear.  What is the likelihood of either my boyfriend or myself developing oral thrush either asymptomatically or symptomatically? We also have had protected vaginal sex during the yeast infection and unprotected anal sex?  Could my boyfriend now have a yeast infection, and did I put myself at risk for anal HSV-2?
Avatar universal
What does an internal anal herpes outbreak feel like?
239123 tn?1267651214
MEDICAL PROFESSIONAL
OK, you'll have to assume your partner has genital herpes due to HSV-2.  I sitll doubt you have genital herpes, either HSV-1 or 2.  Your partner should talk to his doctor about getting a prescription to take valacyclovir daily, which will help prevent you from catching it; and you should use condoms routinely for vaginal or anal sex.  And of course if he notices genital hereps symptoms, avoid sex at that time.

This thread has gone as far as it can go; I cannot advise you indefinitely on living with herpes and all your other questions and issues on sexual health. Find a doctor you trust and who is familiar with herpes and so on, and go on from there.

Best wishes.
Avatar universal
Hi Dr. if you could answer this one last question it would be immensely helpful.  If you would rather not, feel free to ignore it.  Let's assume that I do indeed have genital HSV-1.  What would be the chance of me also acquiring my partner's HSV-2 infection genitally as well?  Is supressive therapy even necessary and how would I know if I had both types?  Again I apologize for the barrage of questioning, I just happen to like your style of explanation.
239123 tn?1267651214
MEDICAL PROFESSIONAL
Having HSV-1 still leaves you susceptible to HSV-2; you could acquire your partner's HSV-2 infection.  If he takes suppressive therapy, it would reduce the chance you will catch it.

If you were to catch HSV-2, you may or may not recognize it.  If you develop new symptoms suggestive of genital herpes, you should visit a doctor or clinic for examination and testing.  If you have no symptoms, you might have repeat HSV blood testing from time to time, like once a year, to make sure the HSV-2 result remains negative.
Avatar universal
Hi Dr. H,

I recently got a coldsore on my lip like I usually have my whole life.  I thought I had a cluster of pimples on my cheek, but I think that is a coldsore too.  I have never had them on my cheeks before.  Could this be another infection site?  Or can the virus reactivate on the cheek as well?  This is deeply distressing to me.  There doesn't seem to be any particular herpes specialist in Connecticut where I live, do you have any ideas of where I can get help?  This is starting to scare me, this all started since I've been dating my boyfriend and I don't want to end the relationship even if he is the cause.  Should I post to Terri Warren and have her give me some suggestions?
239123 tn?1267651214
MEDICAL PROFESSIONAL
Your situation is too complex for you to rely on distant advice from this or any online forum, including the MedHelp herpes forum. You're going to need to find a doctor for personal care. There are plenty of doctors in Connecticut who can provide excellent care in this situation. Your primary care provider can recommend someone, such as an infectious diseases specialist.

That will have to end this thread. Happy holidays.
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Here are 16 facts you need to know to protect yourself from contracting or spreading a sexually transmitted disease.
How do you keep things safer between the sheets? We explore your options.
Can HIV be transmitted through this sexual activity? Dr. Jose Gonzalez-Garcia answers this commonly-asked question.
A breakthrough study discovers how to reduce risk of HIV transmission by 95 percent.
Dr. Jose Gonzalez-Garcia provides insight to the most commonly asked question about the transfer of HIV between partners.
The warning signs of HIV may not be what you think. Our HIV and STD expert Sean Cummings reports in-depth on the HIV "Triad" and other early symptoms of this disease.