Genital Herpes Questions

[kat121]

I’m a 29 year old female and I have gotten cold sores several times a year since possibly Junior High (Middle School). I’ve always been very careful to notice any symptoms as soon as they appear so I wouldn’t pass it on to anyone. However, a little over a week ago my boyfriend developed ulcers on his penis. It started with one and then more appeared several days later. I’ve looked up many pictures online and the ulcers don’t look like anything I’ve seen online. The ulcers were round raised bumps (maybe 3 or 4 mm in diameter) with a depression in the center. They were not weeping, there was a small amount of fluid inside. They did not crust over, they were just red on the inside.  Last Friday we went to the ER at our local hospital to get it checked out and the doctor told him it was herpes. He took swabs from the base of two of the ulcers (we haven’t received the results yet) and gave him a prescription for Famciclovir. He had no pain and no itching until after he saw the doctor and started the medicine. We have many questions and are both very depressed and scared. Is there anything else this could be?

I’ve read in some posts to other people that there is a possibility genital HSV-1 may only have a few recurrences, if any. Is this true? Also, I want to have children someday but I’ve read that we can never have unprotected sex without high risk of me getting genital HSV-1, even if there is no outbreak. Will there ever be a time when there will be less risk for unprotected sex? Also, is there danger with me giving him oral sex when neither of us has an outbreak? If he has genital HSV-1, would there be in virus in his saliva either during an outbreak or not?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.

The lesions your BF has experienced could be genital herpes, possibly due to HSV-1.  While many people (including health professionals) still believe that all genital herpes lesions will follow the classical pattern of groups of painful, small, fluid filled blisters of the sort you describe, the fact is that this is not the case.  Some people can get HSV lesions which cause little or no discomfort.  I cannot tell you how many patients I have taken care of who say that "Gee, I thought it was supposed to be worse" of "hurt more".  This is one of the reasons such a large proportion (80-90%) of persons who have genital herpes are unaware that they do have GH.  The same fact is part of the reason that HSV infections continue to be spread from person to person- they do not realize that they have the infection.

In your case, you have been taking appropriate precautions to avoid transmission be reducing contact if you have lesions.  You may have transmitted infection at a time when you were asymptomatic.  Studies show that persons who have genital herpes due to HSV-2 have asymptomatic shedding of the virus (that is the virus is present without lesions) about 10-12% of the time.  Although there are less data about HSV-1, the virus that causes cold sores, at any location (oral or genital), it is clear that asymptomatic shedding also occurs with HSV-1 infections.  While most contacts to asymptomatic shedding, as well as most contacts to lesions do not result in transmission, it certainly occurs with regularity.  There are , of course, other possibilities as to what his lesions may have been but HSV is a possibility - I'd wait for the culture results.

You are correct that statistically persons with GH due to HSV-1 have fewer, and less severe recurrences than persons with GH due to HSV-2, if that is what your BF’s lesions turn out to be.  

I'm not sure I follow your 2nd question.  If you have oral HSV-1 and your partner has it as well (genital or otherwise), you will not get it again in another location and therefore there is no reason to worry about unprotected sex- transmission will not occur when you and your partner are infected with the same type of virus, even if your infections are in different locations.  Furthermore, there is no reason to worry that you cannot become pregnant and have a healthy baby if you have HSV infection of any sort-  when the time comes, just discuss it with your OB so that she/he will be aware.  

No risk for him to perform oral sex on you since you already have HSV-1.  As I said above, you will not get another infection at some other location if you already have that infection.  

Finally, HSV is a complex infection and there is much to understand.  You are asking good questions.  There is excellent, highly informative additonal information available at the web site run by the American Social Health Association, I encourage you to take a look (Disclosure. Dr. Handsfield and I are both members of the American Social Health Association Board of Directors.)  EWH

[Edward W Hook, MD]

If your BF has genital HSV-1, he will not be shedding the virus at his mouth.  Even people with oral HSV-1 do not have the virus in saliva.   EWH

[kat121]

I was looking through your responses again and there was one question that I couldn't find an answer to. When my BF has a genital outbreak of HSV-1, would the virus be present in his saliva like it is with Oral herpes? If he were to kiss someone on the cheek who is not infected, like a child or baby, would there be a chance that he could pass the virus to them?

Thanks

[MLWTR]

I think I see what you're getting at. What you mean is, if you are shedding, and your partner already has HSV 1, could your shedding trigger another outbreak in him. The answer is no. He may have periodic outbreaks but they will have nothing to do with whether you are shedding or not so there is no reason to avoid contact with him when you see a cold sore or think you are getting one.

[Edward W Hook, MD]

Glad to help.  Take care.  EWH

[kat121]

My apologies for sounding redundant. I wasn't sure if the antibodies could help prevent a recurrence if a person was exposed to asymptomatic shedding.

Thanks you very much for all your help!!

[Edward W Hook, MD]

You have now asked the same question three times and the answer is still the same--yes, asymtpmatic shedding can result in transmission of infection to another person, causing an outbreak.  

As I also said, when a person gets HSV, the virus does not spread to other locations on their body.  EWH

[kat121]

Thanks again for this information!

I would like to know if asymptomatic shedding can cause an outbreak in the other person. As in, if I preform oral sex on him and one of us has asymptomatic shedding, could it cause an outbreak for the other person?

Also, could asymptomatic shedding cause the virus to spread in the area where it attacks, i.e. to a spot on my mouth where I currently don't get cold sores?

[Edward W Hook, MD]

Thanks.  Glad to hear my comments were helpful.  I repeat, if both you and your BF have HSV-1 infections, no matter where they occur, you are most unlikely to get infection at a second site on your body.  The reason for this is that your body develops a systemic protective response to infection which works throughout your body.  There are a handful of cases in which people have gotten infected at more than one site but when one considers the millions upon millions of persons who have HSV infections this should be considered proof that, for all practical purposes, you do not need to worry.  

It would be a good idea for you and your BF to get a blood test with a specific test such as the HerpeSelect for antibodies to both HSV-1 and HSV-2.  this will help to inform you of where you stand.  If your BF has just gotten HSV-1 as you describe above, he may not have antibodies yet.  If you both have HSV-1 and neither has HSV-2, you do not need condoms.

Finally, with respect to your latex allergy, there are also condoms made of polyurethane which are safe for persons with latex allergies.  EWH

[kat121]

Thank you so much for your response!

To clarify one of my questions, if I have oral HSV-1 and he has genital HSV-1 but neither of us has an outbreak, and we have unprotected sex or oral sex, can the asymptomatic shedding cause either me to get genital herpes or my BF to get cold sores? (I know this is basically what you said, but it sounds too good to be true)

Also, can asymptomatic shedding cause an outbreak in the other person. As in, if I preform oral sex on him and one of us has asymptomatic shedding, could it cause an outbreak for the other person? Also, could asymptomatic shedding cause the virus to spread, i.e. to a spot on my mouth where I currently don't get cold sores?

I've read so many websites that have said that we can pass the virus back to each other. My BF believes he can never have sex again without great risk of transmitting the virus. He's also scared to kiss me now in case he gets cold sores as well.

I am going to get tested for HSV-2. If I've never had an outbreak would the antibodies be present in my blood?

If it turns out we both have HSV-1 and neither of us has HSV-2, would you recommend we use condoms anyway? I have a latex allergy, which is the reason we didn't use them to begin with.

Again, I really appreciate your responses. We have been so frightened and my BF feels like he's no longer himself.