[Question #3222] Primary infection vs recurrent infection

37 months ago

Dear Doctors,

 

About 16 months ago I had my very first cold sore outbreak aged 41. Until recently I assumed I got it from kissing. After a stubble rash I felt that tingle, unbeknownst to me it was the foretelling sign of a cold sore outbreak. It took fairly long to heal – perhaps two weeks, but I had no other symptoms. There was a tiny red mark left but now it is as though it never happened. I told my then partner and he confirmed he'd had cold sores too. He sounded ashamed for not having warned me but honestly it was no big deal to me.

 

I am now starting to doubt if I was infected then. I read about primary infection and bang! – the memory of those weird mouth/throat infections I had in the past came back to me. First when I was about 19. The doctor was baffled at how swollen my tonsils were (I'd had tonsillitis as a child too). I had high temperature, and it was so painful even drinking water was excruciating. It was never attributed to anything in particular. Strep throat or some viral infection – I don't know.

Then in my 20s and 30s I had similar infections, with one particular bad one that sounds a lot like herpetic gingivostomatitis. I was prescribed some topical cream (I can't remember what else).

 

To my questions: is there a chance that one of these former infections was in fact a primary infection? Which one sounds more likely: that I was first infected by herpes as a child or young adult, or did it happen after that kissing session over a year ago? I can't find any answers to my questions online. I read that cold sores can develop a few days after infection, which contradicts what I read about primary infection vs recurrent infection. Are cold sores always a sign of a recurrent infection? My guess is I've had the virus for many years and the stubble rash was simply a trigger for my first outbreak? The fact that my partner had had labial herpes would then be sheer coincidence.

 

What do you think?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
It's really not possible to know at this time.  Most oral herpes does present with some external symptoms but it is certainly possible that you've had it a long time - we just can't know now.  It isn't true that cold sores necessarily represent a recurrent infection - primary herpes very often shows up as cold sores.
You mention just in passing at the end of your post that your partner has genital herpes - I'm wondering if you are wondering if you gave that to your partner or does your partner have HSV 1 or 2 or if this question relates to your partner's situation?

Terri
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37 months ago

Hm, thank you, but a disappointing answer – sorry to say… I was hoping this would help me with the disclosing business, especially before kissing. Having read a few posts on this site I must say I am a bit baffled at the rather conservative / doom-like view point on the issue – i.e. one must tell, even before kissing. OTOH HPV is less of a big deal (I have HPV too!!)... It doesn’t make sense to me. Everyone I’ve spoken to about my fear surrounding infecting others with herpes have been like – you’re worrying over nothing, so many people have it, blah blah. Of course they’re not aware of asymptomatic shedding and the plague-like disease it really is.

 

Anyway, I did not use the word “genital” anywhere. I was referring to my ex-partner’s labial herpes (on the lips). I’m not going to worry about that just yet, thanks. However I may discuss the risks with my (new) current partner, which means I have to educate him and scare him after a lifetime of ignorance without consequences.

 

While I’m here I’ll ask two follow-up questions, if I may:

 

1.     Say this first cold sore outbreak was also my last, does it make it less likely that I could contaminate someone as opposed to people with frequent outbreaks?

2.     I think your estimate of hsv1 positive people is around 60%. Why are prevalence figures so divergent (some say 80% or even 90%)? Why are making such a big deal about something that is near impossible to prevent (I mean – no kissing??!).

 

I do hope you will say something reassuring. Otherwise I think I’ll stay away from this site (very anxiety-inducing for me and I already have OCD…). I mean, for one person who discloses her "condition" before a first kiss, 1000+ don’t even compute the issue, don’t bother telling or simply don’t know. Are so many people wrong not to worry?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
Sorry, I read labial as genital - those lips!  We can get them confused!

I'm not at all clear that someone with oral HSV 1 must disclosed that prior to kissing. When I was kissing people before my husband, I did not disclose and I have oral herpes.   It's a topic even experts don't necessarily agree about.  I do think if a person has recurrent cold sores, it is best to disclose this before giving oral sex to someone else as we know now that people with recurrent cold sores shed virus on about 25% of days which means that while giving oral sex to someone else, this virus could be transmitted from mouth to genitals. 

To answer your questions:  yes, in general, people who have infrequent or no recurrences shed virus less often than those with frequently recurring disease.  That is correct for both HSV 1 and 2.

The statistics I quote for HSV 1 prevalence are from the most recent NHANES study - the percentage infected with HSV 1 via an antibody study (using a better test than the usual IgG) reveals that 57% of people between 14 and 49 have HSV 1 infection (and about 17% have HSV 2).  Seventy percent of those infected with HSV 1 are unaware of their infection and about 80% of those infected with HSV 2 are unaware of their infection.

 So does this make you more or less anxious?  It isn't our goal to increase your anxiety but sometimes giving more information that people didn't have before does that. 

Terri
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37 months ago
Thank you very much. Yes, this helps. Sorry I may have overreacted a bit. It's just a lot to handle emotionally with the HPV business as well.
As far as I know I don't have hsv2 and I'm not going to worry about it unless I have symptoms down there.

I think I will disclose before oral sex, if only to find out if my partner ever had cold sores on the lips... If he has, this might lower the risks as he may have some kind of immunity (assuming he has hsv1)?? Either way, if he's happy with the small risk, so am I (even as the receiver).
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
If you have a partner who has ever had cold sores, then the risk of either of you getting genital HSV 1 through oral sex is incredibly tiny.

Terri
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