[Question #3093] Follow up

40 months ago
The above example is why I wanted to know about spitting into cuts (I may have had a cut on my lip while drinking from straw). 

Also about the timeline. You truly believe that I should have seen a breakout on my baby or if the breakout should have been overly obvious?? What about people that show years later and haven't had sex in 2-3 years. I guess I just need facts and scientific numbers to feel rest assured. Such as....

What is the virus load in spitting compared to kissing? What virus load is needed to transfer desease?

 I don't know how you can say you haven't seen a transfer from spit on utensils in all your years. Do you do studies like that? I do understand that the spit wouldn't last for several minutes I guess, but spit from a sneeze is instant. 

DR HHH was fully aware it was concern for spit in cuts NOT merely particles of snot, I was worried about right?

I'll purchase more questions if absolutely necessary. Really my questions are the just want numbers and scientific reasons behind your belief. Thank you.

Also confirm my personal information is not viewed by people on the site. You used my name in the previous post.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
Yes, I believe that if your baby had been infected with HSV 1 via a sneeze from another child you would have noticed symptoms on your baby.  I believe I mentioned in a previous post that you baby would be more likely to demonstrate symptoms than an adult due to an underdeveloped immune system.
I don't know what the viral load in a sneeze might be - you're correct that we don't do a study where we have someone with HSV 1 sneeze into the mouth or genital of someone else. 
I have not see a patient acquire herpes from a utensil, no  And no, we don't do those studies either.  I do feel acquiring HSV  from a lipstick or lip gloss is possible though also very unlikely.  Can I say that it is utterly impossible that you acquired HSV 1 from your daughter?  No.  The reverse is far more common.
But I do have a question for you.  Have you both had lesions swabbed from the lip that were cultured out or PCR positive for HSV 1?
Dr. Handsfield was fully aware that your concern was from a sneeze, yes. 
You personal information is not visible to others on the site, no. 

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40 months ago
So, March 2016 my oldest daughter had a small blister on her lip the day she had a pediatrician appointment. I asked if her doc thought that's what it was, she said, yes, a small one. I know prior to that, 2015, that both my husband and I got igg testing prior to our baby being born confirming no have virus. We had not ever shown signs but I was concerned about shedding, so was relieved to know it wasn't an issue.  Later that day is when the incident occurred.  Two months (may 2016) later I saw a textbook lesion on my fathers lip, whom I had never seen one on ever, in my life. I suspect he gave the virus to my daughter unknowingly when he didn't show signs back in 2015. I also suspect he got it from a niece. I tested again in Aug 2016, neg.

Flash forward Oct 2016, I shared a straw and 24-48 hours later had textbook lesion on top lip, just inside of my mouth. I got another igg test done 6 months later to confirm suspicion, and it's positive.

My oldest now gets them very very small, to where her lips look slightly puffy and chapped. Most people wouldn't even notice. That is how she was when we shared the drink in Oct.

I know she spit at the time on her sister because she had food in her mouth that shot out when she sneezed.

 My concern was that I wanted it to be clear to HHH that I'm concerned about spitting on cuts, not that the virus is in snot.

 I saw a response to a woman on the forum who was just showing signs after 10 years of a manogomous relationship and all I could think is: that's my fear. It'll show later in life when an abrasion occurs and she may not know but it'll pass to a partner.

I'm being so tenacious about being clear on the mode of transmission in this sense because it's hard to communicate via internet. I just don't want there to be any confusion and to not be consoled in order to reduce worrying, since I sometimes feel that occurs on the forum as I know a lot of anxiety is expressed here. If that makes sense?

Appreciate your patience.
40 months ago
To clarify, when I say later that day I mean following the pediatrician appointment, not following my igg test, is when the incident with my baby occurred
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
I'm going to let Dr. Handsfield answer this question himself so you can see his response to you.  Your initial post said "sneezed" and now you are saying "spit". I doubt he will see this differently but he can address this himself.  Just so you know, the IgG test misses 30% of HSV 1 infections so it could have missed an HSV 1 infection initially and then picked it up later - there is no way to know any of this for certain.

Terri
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40 months ago
Thanks and I had a feeling you'd site the 30%. I've been tested 4 times in my life over a course of 12 years. It would be strange for it to be negative all those times except for the one after a lesion. Don't mean any disrespect, I just am trying to match my experience with your advice on utensils. I truly appreciate all the information.

I look forward to his response.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
It might be unusual but I have certainly seen it and I've seen it most often when a lab like Quest or LabCorp switches the brand of IgG test that they use - both have done that several times since I've been in practice specializing in herpes.

Terri
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Hi, Katie. Terri asked me to comment.

I can't think of when or where you came to believe I advised that saliva ("spit") contact with a wound etc would be a herpes risk. It isn't, or at least too little risk to worry about. Herpes isn't known to be transmitted by saliva (or by nasal fluids, e.g. from sneezing) contact with wounds, mucous membranes, the mouth, eyes, etc. Biologically, it is easy to understand how it might happen, and absence of known cases doesn't prove it cannot. However, it is solid evidence that if it occurs, it is very rare. I would not advise taking any special precautions to prevent it.

I also don't buy the notion that your child acquired oral herpes in that manner. Her infection (if she has it) is much more likely from being kissed by you, your husband, or your possibly infected father; or from another child, e.g. in day care; and or others who might have had transmissible contact, e.g. relatives, baby sitters, etc. In any case, based on the information you have provided, I don't think it's clear your daughter has oral herpes. A single lip lesion, even with her pediatrician's confidence in the diagnosis, doesn't cut it. Even the most experienced herpes experts (like Terri) make mistakes. And certainly lesions that are "very very small, to where her lips look slightly puffy and chapped" and "Most people wouldn't even notice" don't sound at all like herpes. (Even a positive HSV1 blood test would not be sufficient to diagnose herpes as the cause. I wouldn't believe it is herpes unless the virus were detected by PCR or culture.)

Thanks to Terri for the opportunity to comment. I hope it has helped.
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