[Question #1525] HSV Diagnosis? IgG vs. Western Blot?

45 months ago
Hello. I've made what I think is some good progress in light of your last post. Leaving my toothbrush out with everybody else's (instead of tucking it away in a plastic bag), NOT sanitizing the sink/counter after brushing, and more. Western Blot kit arrived and am coordinating with my doc to get it drawn soon. I'd like to ask a few more questions, if that would be ok. 

Because the lesions in my mouth are almost constant, I am wondering about kissing my kids. I've been kissing them on their heads & on their cheeks, away from their mouths. I can't imagine not kissing them at all (I'm their Mama, right? They should have that physical affection...) but I do feel a bit guilty with the sores in my mouth, like I'm not protecting them enough. Do you have any thoughts? If the sores were on the outside of my lips would the recommendation be different?

Also - if someone had an active cold sore on the outside of their lip, would you suggest they wash their hands after eating, either finger food or a sandwich (where the fingers might brush the mouth) or when using utensils? And would that recommendation be different if the lesions are inside the mouth?

In regards to the pimples on my buttocks area.  I think it is just bad timing & stress that is causing them to crop up much more often than usual. They continue to be small & only slightly uncomfortable if pressed hard. No noticeable fluid or pus. Just red & raised. They mostly seem to be located in a line that follows the outside seam of my underwear. There are currently about 8-10 on my right side, on the upper/outer area of my leg/hip. And a couple on the left side. And a few scattered on my actual buttocks. How confident should I be that they are not herpes, without having them swabbed? I am worrying during intimacy w/my husband that he is going to touch them & spread them to himself. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I am so very very pleased that you are making progress on the items that you listed.  That's wonderful!  Good job!

Normally, herpes lesions show up on the edge of the lip rather than the inside of the mouth - lesions in the mouth are most often cold sores.  But even if those lesions are herpes, kissing them on the cheek or on the head is absolutely fine.   If you had an active cold sore on your lip, I would probably recommend the same except if they happened to turn their head up for a kiss on the lips, that might not be great.  If someone has an active cold sore, I don't think that warrants washing hands after eating or using utensils and that wouldn't be different if lesions were inside the mouth.  Again, I don't think herpes is quite as contagious as you might think.

The pimples on the buttocks sound nothing like herpes to me and the fact that they follow your underwear line also suggests that they are not herpes.  I would say virtually everyone I have examined in my career have some or more red bumps on their buttocks or thighs at some point.  I don't feel like you have to have them swab tested to determine that they are not herpes.  Herpes on the buttocks ( and I have seen many many outbreaks) are remarkable - nothing like what you are describing.

You are making great progress with you sometimes irrational herpes concerns = keep up the good work!

Terri
---
45 months ago
Thank you for your quick & helpful reply, as usual. Although I've made more progress (including, in light of your last post, no longer washing my hands after eating, which was quite a big deal for me, as well as kissing my kiddos guilt-free!), it has been challenging. I have been struggling lately as the sores in my mouth have continued & I have also developed a cough/cold. I am having a hard time letting go of my doctor's earlier statement that she believes HSV is often spread through coughing by someone with an active sore, as well as her statement that it would be possible for me to spread to my child if I coughed or sneezed on them during a diaper change. I know you have already responded that you disagree with those statements entirely - and in my mind I think you are right - but since she is the doc in front of me, & as I'm walking around my house coughing my head off, it's hard for me to let go. If you are willing to speak to this issue again, just for additional reassurance, I would appreciate it. However, I understand the rules of the forum & I don't want to be asked not to post anymore, so if you feel this is too repetitive, please just disregard that question & I won't bring it up again. 

Besides that, I'd like to ask a follow-up question to try to pull together some of the answers you've already given me. I believe you said at one point that there has never been a case of herpes transmission via an inanimate object that you are aware of. So does this mean, for example, that 1)if I have a sore on or in my mouth and I drink a cup of coffee or eat a meal at a friend's house, there is no chance of the friend contracting herpes if she picks up my cup or plate or silverware, touches them where my mouth had been on them, & then touches her own face/mouth? 2)Any concerns if she washes my dishes by hand rather than using a dishwasher? 3)Or if she touches my dinnerware right where my mouth was & then uses the restroom without washing her hands first? I am a little anxious about how to eat/drink responsibly during this holiday season at other people's homes. 

Finally - in a previous post you reassured me (thank u so much! yay for not having to sanitize the sink every day!) that I would not transmit oral herpes to my family during my normal 'oral hygiene' routine. Since one of my questions about that was in regards to inadvertently spraying saliva/toothpaste onto the toilet seat or toilet paper while brushing my teeth, 4)I assumed that even though your wording just said 'oral herpes', you also meant that I could not give them *genital* herpes in this manner (saliva/toothpaste landing on toilet paper or toilet seat)....? This would probably also fall under the category of "no transmission via inanimate objects," yes? I just want to make sure I understood correctly. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I have not seen a case of herpes transmission via an inanimate object (sex toys are a clear exception), but I will say that I advise that people not to share lipsticks or chapstick type products.  I have no concerns about transmission in the ways that you describe.  None.  and yes, if you sprayed saliva or toothpaste onto the toilet seat, I don't see that as a risk for transmission of oral or genital herpes.  Besides, knowing you just a bit, if you did that, I think you would wipe it off right away! 
In terms of the oral herpes question about sneezing or coughing, I have written a note to Dr. Anna Wald regarding your question to be absolutely sure she agrees with me - she has just published a very lovely paper on the shedding of HSV 1 orally and I thought it might be good just to touch base with her on this since I have recently seen two normally reputable sites quote this.  I promise to get back to you on her response, though maybe not until after the holidays.

I know this is a personal struggle for you and it's OK to ask me questions about specific risks, once more.  I'm fine with trying to help you through this.

Terri
---
44 months ago
Thank you so very much for your kind response. I must say I was both surprised & extremely grateful for your efforts to clarify the risk of respiratory transmission. I look forward to Dr. Wald's opinion. 

If I may, I would like to also express how painfully aware I am that my concerns in regards to herpes transmission are excessive. I do feel that my concerns have been greatly aggravated by the lengthy list (not all of which I have even shared, for fear of sounding too negative) of conflicting information that I have been given by a variety of local healthcare providers - I have found myself with a serious "trust issue" these days in regards to the medical field - *BUT*, in spite of my trust issue & the circumstances that have led me here, I can acknowledge that many (& perhaps all) of my fears are probably excessive.

Although the sores in my mouth began in March 2015, I did not become overwhelmed or make changes to my daily life until this Sept 2016. (This is also when I had some unexpexted warts crop up on my hands, about which I have received clear & helpful information from Drs Hook & Handsfield.) It has been a difficult 3 months, during which I went so far as to feel concerned if I even touched my own face in the slightest way. I washed my hands after any kind of eating or drinking. Started to worry that I had herpes on my buttocks & even herpes whitlow. Etc, etc. I've tried to be clear & upfront about the particulars of my fears, & I have not attempted to disguise them or dress them up in any way. I've tried very hard to keep my questions specific, & to not repeat...I want very much to respect the rules of the forum. And, although I know you only have my word on this, I really have been truthful in the things I've shared in regards to the progress I have made (i.e. I'm not at all worried about whitlow anymore, I'm almost totally over the whole herpes vs. zit thing, and I really did stop sanitizing the sink, & stop washing my hands after eating (unless my hands actually touch my mouth, which is still a struggle for me), and let go of a whole host of laundry precautions that I had been doing previously). I feel kind of like I began rapidly sliding, in Sept, into a very deep pit of fears. I think I hit the bottom in Nov, & I have been climbing slowly back up since then. Much more slowly than I would like, but UP, nonetheless. I credit my faithful Savior with giving me the strength, along w/the many prayers of friends & family, and I am SO grateful for the services of this forum, which have provided a foundation of reliable information upon which I have been able to combat some of my fears. I am not out of the "pit" yet, and I do have more questions about specific daily scenarios, but I can look forward to the future & see a return to my old, relaxed self. I am certainly not there YET, but I am also certain that I WILL get there. Soon. Thank you for your help. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I'm not going to count this last post as a question - it really isn't, and as a grown up, I get to decide where we go from here!  As long as your questions are not repeating questions, I'm fine with them.
I've not heard back from Dr. Wald - I know she is traveling over the holidays with her family, but I will share her response when I get it. 
I hear your struggle here and I want you to know that you aren't the only person, by a LONG shot, who is dealing with this exact same set of fears.  I see them on my clinic forum all the time, lots of moms and some dads fearing for the safety of their children, in regards to herpes.  This disease can push buttons that we don't even know are there! 
You keep working on it.  You are doing so very well with your progress. 

Terri
---
44 months ago
Thank you so very much. While waiting for Dr. Wald's update, a few more questions:
I have to be careful about how much research I do on this topic, bc sometimes it can aggravate rather than alleviate my concerns. At other times, however, it can be helpful. For example, I recently (cautiously) read some of the other posts on this forum about STD transmission in general. The conclusion from the doctors' comments on some of those posts seems to be that STDs are never transmitted from hand to genitals. Am I correct in that understanding, or is "never" too strong of a word? And is HSV (whether oral or genital) considered an STD in that sense, or is it different than HIV or chlamydia or gonnorhea, etc?

What I'm trying to imagine is, IF someone could absentmindedly rub or pick at a juicy cold sore on their lip...and then immediately reach down and touch their sexual partner's genitals...and still the risk of transmission would be zero (or as close to zero as science will allow one to say)......then that could go a long way in reassuring me that the casual interactions I have with my family are not going to result in transmission. Or maybe this hand-to-mouth-to-genitals is in fact a scenario that does pose some risk of HSV transmission... I don't know. I just thought I'd check. 
also did some more reading on PubMed. I tried to look up survival of HSV on surfaces, but most of the articles I found were fairly old (from the 70's, 80's, 90's). Some of them talked about HSV surviving for 3 days, 7days, or a number of weeks on surfaces. It's unclear to me whether the articles evaluated the infectiousness (or lack thereof) of the virus that had "survived" that long, although one of them did use the term "infectious titers." Some of these older articles seemed to hint at possible transmission via benches at public swimming pools, etc, which I am thinking is NOT consistent with current scientific opinion? Could u refer me to any more current articles about HSV on surfaces? I did read the article by Schiffer that u mentioned earlier about transmission probability estimates of HSV-2. Sounds like transmission is unlikely below 10^4 genomic DNA copies. But I don't have an accurate picture in my mind to compare that number to. One website that I looked at (I believe it was herpes.org) said that each cold sore has "billions" of viral particles in it...Does that sound accurate to u? I just need some guidance on how to understand & apply these numbers. It would be a huge step for me if I could let go of my fears of transmission via inanimate objects altogether. Your explanations have helped GREATLY, but I'm just still not quite there. Any statistics or article references u can pass along would be greatly appreciated as I wrestle with this. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I don't think "never" is too strong. 
You've been reading the articles that are available- I don't think I have anything to add here.  You've read it here from me and the two physicians.  You've read the Schiffer article.  You're read other article ( and no, they didn't look at infectiousness I don't believe).  I'm not sure how else to reassure you.   Your fears are not grounded in reality.  This will be my final post on this topic.

Terri
---