[Question #5132] Herpes

25 months ago
Dear Drs

I recently read a post on a different website where the expert seemed to imply that a person could NOT get Oral HSV 1 if they already had Genital HSV 2..and that the only way you could have both types (in their common locations) was to get Oral HSV 1 first and then get Genital HSV 2. This seemed like incorrect information to me (although it is possible that I misinterpreted the answer) and I wanted to check with the experts here. 

As someone with known Genital HSV 2, isn't it absolutely possible for me to acquire Oral HSV 1 in the future?
(In case you are wondering, the test that confirmed my HSV 2 a decade ago also said I was negative for HSV1)

PS-I lost my net connection as I was submitting this question the first time. Please forgive me if it went through twice. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
It is absolutely correct that HSV 2 offers almost complete protection against HSV 1.  This information is based primarily on a pregnancy study done be Dr. Zane Brown many many years ago looking at antibody status of pregnant women.  I have not seen anyone who is HSV 2 positive acquire HSV 1.  However, you should know that the traditionally used IgG test misses 30% of HSV 1 infections so if you turn out positive for HSV 1 at some point, the substandard IgG test is almost certainly to blame.
Why do you think that is incorrect information?

Terri

---
25 months ago
Dear Terri,

This new information completely changes everything. At the time of my HSV2 diagnosis, I came back negative for HSV1. The other day I had  two very tiny circular cuts on my lip that healed over in about 24 hours or so. They may have been related to chapping but I'm worried that it was a herpes outbreak and I  have HSV 2 in my mouth (given this new information: that I could not have acquired type 1 after having already acquired type 2). Also, there is something a bit familiar about these symptoms...I'm not 100% sure, but I feel as if I may have had a similar cut type thing on my lip in the past. I'm always so careful about telling people my status but now I'm worried about even kissing people. I'm a little overwhelmed by the chaotic aspects of having HSV....you can't be 100% where you have it and you can't be sure when you are shedding. I would have gotten a swab of my mouth, but like I said, the openings healed in about 24 hours and it is borderline impossible for me to get a same or next day doctors appointment in NYC where I live. Who knows when I will ever experience these oral symptoms again. Should I be telling people I have Oral HSV 2 as a precaution? I'm so confused.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
It would be good to have one of these things swab tested although I have to say that herpes outbreaks don't last 24 hours - they last longer. 
Do you get genital outbreaks?  How were you diagnosed with HSV 2? 
I'm not sure how this changes everything - are you thinking you may have HSV 1 orally because I told you that the IgG test misses 30% of HSV 1 or do you somehow think that you have HSV 2 orally INSTEAD of genitally?  I'm a little confused as well. 

Terri
---
25 months ago
Dear Terri,

I am sorry for the confusion. I refrained from telling you my whole story but I think doing so might clear some things up. I will try to be brief:

Summer of 2005: I test positive for HSV2 (and negative for HSV1) after seeing mild genital symptoms. Who knows when I actually caught it. For all I know I had HSV2 for years prior to my positive result. 

Summer of 2006: I got some very aggressive mouth thing with sores/redness. It was very painful! At the time I wasn't worried about Oral HSV2 because I didn't know it was possible to get in the mouth and had already tested positive for type 2 genitally anyway. I thought 'Maybe I finally got type 1.' I know now this is impossible having already acquired type 2 (unless, as you brought up,  my initial HSV1 result was false).  

In retrospect, I'm not convinced this incident was Oral HSV2 mainly because it occurred a full year after my positive result (meaning it couldn't have been a primary bout) and that it was so aggressive.  My understanding is that Oral type 2 rarely recurs, and that when recurrences do happen they are very mild.  (Please correct me if I'm wrong) Maybe it was angular cheilitis or some very aggressive bout of canker sores. 

Years later I learn that Oral HSV2 is a thing and I start worrying that I might have it. I think there is an extremely good chance that I performed oral sex on whoever it was that gave me HSV2. As I mentioned above, I'm not totally convinced that my aggressive incident was Oral HSV2. I just figured I should mention it because it was such a memorable herpes-like incident in my mouth. 

What I currently have on my mouth are two very tiny openings in my lip, one on top of the other, each about the size of a poppy seed... so small I have to kinda spread the skin apart to see them. For one day I could see the fluid from the opening kind of glistening in the light. Within about 24-36 hours they had dried out or scabbed over...its hard to tell because they are so small. As I write this 50-something hours later I can barely see the marks. As I said in my last email, I have a vague sense that something like this has happened before...a very tiny opening/openings that heal rather fast. It certainly doesn't look like the unmistakable oral herpes outbreak I see on people..but I know that not everything follows a textbook model. I was praying that the symptoms were unrelated to herpes or simply HSV 1. I now know that is impossible for me to have type 1 unless my initial type 1 result way back were wrong. 

That's basically my story. My fear is that I have Oral type 2 in addition to my genital infection and don't know if I have an ethical obligation to disclose a suspected infection. (I always disclose my proven genital infection) Having looked through some of the questions on here, it seems that you and Dr. Hook think it's very difficult for even someone with PROVEN oral HSV2 to pass it during kissing/oral. But in one post, Dr. Hook does advise that a person with known Oral HSV2 should disclose before deep kissing. Granted, I am not a known case. But there is this thing on my lip...

Do you have any advice on what to do until such time as I am able to swab? God only knows how long it will be before another potential outbreak. It might be years before there is something to swab at all. Any advice you have on how to handle disclosure in the meantime would be very helpful.

Thank you for bearing with this long email. I really appreciate your time and expertise!!


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
Honestly, the thing on your lip just does NOT sound like a herpes outbreak to me.  And I agree with Dr. Hook about disclosure of oral HSV 2, but I don't think this is herpes.  And if you get it again and are still worried, have it swab tested right away for clarity.
Going back:  you said you tested positive for HSV 2.  Was that a blood test or swab test?

Terri
---
25 months ago
Dear Terri,

I actually got two tests. The first was a blood test that came back positive for HSV2 and negative for HSV1. The second test (also a blood test) was one that I requested from a doctor several months later in the vain hope that my first was a false positive. No such luck. I don't remember if HSVS1 was part of that second test. 

Terri, am I right that you don't think I need to tell kissing partners that 'I might have Oral HSV2' or something to that effect? (If I ever find out via swab that I unequivocally have it, I would definitely disclose)

Also, the impression I have been getting from looking through the various questions on here is that HSV2 is much easier to get IN one's mouth than to give FROM one's mouth. Am I right that even if my worst case scenario was true and I had oral HSV2, that I would be unlikely to pass it from my mouth to a partners mouth or genitals? 

(PS, If my new questions warrant the purchase of follow-ups please let me know!)

Thanks again Terri! I know in the grand scheme of things having HSV2 is not that bad, but it's been something of a trial in my life and I greatly appreciate being able to turn to you for your expert advice.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
You are correct that you don't need to tell people you have oral HSV 2 and I couldn't say for sure if it is easier to GET or GIVE - both are quite uncommon.
Do you recall the index value of your HSV 2 antibody test?  There are some false positives in the range of 1.1 to 3.5  I take it you have never had a lesions swab tested?  Are you certain what you have experienced are herpes outbreaks genitally?

Terri
---
25 months ago
Dear Terri,

I used to have the paper for my second test (taken sometime in early 2007). I'm having trouble finding it, but my memory is that my index value was decidedly positive.  You are correct that I have never had legions swabbed. 

My genital symptoms are very mild but I have had them: A raised red area of skin on my penis with 2-3-4 very small openings that scab over quickly. One time I 'caught' them in the unopened blister stage. Usually, I don't notice until I look down in the shower and see the raised area with very small scabs. This is what had prompted me to get tested to begin with. They aren't painful unless I literally poke them. 

I have also experienced anal symptoms that ARE painful and seem to take significantly longer to heal. A few times I have been able to look by straddling a mirror. What I see is something like a circular erosion in the skin...it's clean looking, not crusty or anything...just open and painful the way an open blister your ankle is painful. As I said, this one seems to take much longer to heal.  

Both my penis and anal symptoms have been recurrent. It's been a very long time-maybe years-since I have had anything on my penis. I believe my last anal symptom was more recent, but still a long time ago. The only thing approaching a non-HSV excuse for these symptoms that I can think of is friction. I'm an avid runner. But before this year I didn't run at all during colder months and I'm almost certain I've had symptoms in the winter. 

Thanks
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
Well, these definitely sound herpetic to me.  I just always want to confirm that people have been diagnosed correctly, you would be surprised how many people have been told they have herpes, based on visual exam alone or a low positive index value, and live with that for years, and disclose and take medicine and it turns out they are indeed not infected at all.

Terri
---