[Question #148] Oral/genital hsv1

98 months ago
Hi experts,
I guess I am still shocked at my diagnosis after the advice I had received from the experts in the field of herpes prior to my diagnosis, including the sexual health dr I went to.
I had two swabs done of 2 tiny nicks on my perenium, one was positive (multiplex PCR), one was negative for genital hsv1 (multiplex PCR)
I have heard that false positives do occur, but not often (I was hoping they occurred more frequently :) ) and are due to contamination. Can these swabs distinguish between live and dead DNA? The reason I ask is that I continually played around with the area and is there the possibility of me having mucked up the swab because of this?
Herein lies my problem, I had been told that it was highly unlikely or that I was immune (actual words from the dr at the sexual health clinic I went to and advice on health forums) to contracting it genitally after a long standing oral cold sore infection from childhood (since I was 7) 
My partner suffers from coldsores as well and I can only assume he was in the early stages of one at the time of the oral sex? We didn't notice until a week later, it was hidden in his beard.
My symptoms didn't present until 3.5 + weeks after and there were no other symptoms besides the nicks (which cleared up within a week), there was the slightest temporary itch, no pain, discomfort at any time, not even when they were touched or while urinating. No tingling like you would get with an oral cold sore. We were also able to have sex while they were present with no discomfort. They just looked like 2 little chunks taken out of the skin, that then looked like a graze (like when you take just the top layer of your skin off) and just healed up without scabs or crusts. Is that typical of genital herpes, to change shape like that? I know my oral cold sores were never like that and this did not feel or present in any way like an oral cold sore.
I'm not quite sure what I am expecting out of this question but I guess from the swabs I can assume I am positive for hsv1 genitally? I read false positive results can happen. Any additional information you can give me would be great. Is there any at home swab testing I can do to ensure the positive swab was accurate? I really am struggling with the thought I am the only person who is in this position. After all of your combined years of experience, surely there would have been more cases like mine, acquiring ghsv1 after a long standing childhood hsv1 oral infection? I have noticed there are no reported cases of this on the likes of medhelp etc which further increases my hesitation of thinking I can't be the only one! I know I am special, but not that special ;)

Terri Warren, RN, Nurse Practitioner
98 months ago
I am going to ask Dr. Handsfield or Dr. Hook to answer this as I think I have already answered this question on my herpes forum, correct?  Thanks

Edward W. Hook M.D.
98 months ago

Welcome to the Forum.  As you know, Terri has asked one of us to comment on your situation and I am happy to do so, hoping that I can be of help.  As I read your post, it seems that there are several questions in play here, most prominently, how accurate is PCR for HSV diagnosis and secondly, was the information that you received, that persons who already have HSV-1 (orally) typically do not become infected with HSV-1 in a second location.  I will try to address both.

First, I would urge you to believe your test result.  PCR is the "gold standard" for HSV diagnosis, being far more sensitive than culture while still being highly specific.  You had a lesion, it was tested and the result was positive for HSV-1.  The likelihood that this was a false positive is very, very low.  Commercial lab PCR tests need to be carefully evaluated before they can be offered to clients and are rarely falsely positive.

As far as the second issue is concerned, this is a tough one. Dr. Handsfield, Terri and I each have told numerous clients while we answered questions on MedHelp that once a person has HSV-1, the likelihood of them becoming newly infected at a second site of exposure is extraordinarily rare and that is still the case.  On the other hand, in medicine and science, there are no absolutes and infections and how they are manifest are infinitely variable from person to person.  Statistically, the fact is that second infections due to a HSV virus that a person already had, as is your situation remains very, very rare and I suspect our advice will not change. There are exceptions to every rule.  As far as how it may have happened or how long you have had genital HSV-1, this too is hard to say. 

From a practical perspective, the other issue to explore is whether or not this is of consequence is worthy of consideration as well.  Other than noticing the lesions, it sounds like the lesions did not cause any problems for you- little discomfort and no limitation in sex or other activities.  Thus, since both you and your partner already had HSV, I would hope that you feel comfortable acknowledging that this was an unusual situation and moving on from there without concern or major adjustment in your relationship with your regular partner.

I will be happy to answer a few follow-up questions for clarification.  I hope these comments and my perspective are helpful to you.  EWH