[Question #5933] Herpes Type 1 on the Knee

17 months ago

When I was in 6^th or 7^th grade I had cold sores. I rarely if ever see them today. Later, in my twenties I had some cold sore blisters on the top of my right knee. My family physician, who knew my history, said that this was “mat herpes” and when he cultured it is was Type 1. This was 25 years ago and has never returned. Since, I was getting engaged, (we are in our late forties) my future wife and I took the Western Blot test provided by the University of Seattle. Along with other tests, since we did not know our status for HSV. She too thought she had oral cold sores as well).

We both tested positive for type 1 and negative for type 2. I have read posts were Terri Warren has indicated that genital herpes can present itself all the way to the Knees, and in other posts that it is in the Boxer Short Region. I do know that I have sex partners that have had cold sores (I did see them on their lip, but never anywhere else…which I was always cautious not to spread them, since I too had cold sores). I was concerned that I may have genital Type I herpes, however I have never had these type of “Knee” blisters in my genital region. Obviously, I became concerned about my status, despite the test.

Also, my fiancé was concerned since we could not for sure say that she does not have genital type 1 herpes, since the test does not tell you where your infection could be, oral, genital or both. We both have had rashes in the genital area… I do have some mild eczema on my scrotum, with itchiness confined to my scrotum, and she has had yeast infections, mostly when she is on antibiotics.

Question - Do I have genital type I herpes, and will I infect her other unknowingly?

Question - Could we have been infected again with HSV 1 in our genital region?

Thank you for all your help!

H. Hunter Handsfield, MD

17 months ago

Welcome. Thanks for your confidence in this forum. Apologies for the somewhat longer than usual time it has taken to respond. Herpes questions normally are answered by Terri Warren, but her travel schedule has interfered and I'll be replying this time.

The answer to your main question is straightforward and simple, and it comes from the blood test results, regardless of you and her past histories of HSV. Once someone has HSV, he or she is highly resistant (often completely immune) to new infections with the same virus type, anywhere on the body. Since both you and your partner have HSV1, as indicated by your blood test results, you cannot and will not reinfect one another in the genital area or anywhere else. In case it isn't clear, the terms HSV1 and 2 do not refer to the body area infected, but to the two different viruses. But almost certainly your and your partner's HSV1 infections are not genital anyway. The two of you needn't worry at all about each other's HSV1 infections.

That said, your distant past history is confusing. When you say you had cold sores in your pre-teen or early teen years, are you sure you don't mean canker sores? Canker sores are inside the mouth and are not cold sores (herpes). Oral herpes outbreaks, virtuallly always caused by HSV1, are blister-like and occur outside the lips. I ask because if you really had oral herpes then, you are very unlikely to have acquired a new HSV1 infection, for the reason discussed above. Once in a while people with longstanding oral herpes develop distant outbreaks, e.g on the knee.

But as I said above, when you acauired your HSV1, and what symptoms it caused before, are not important. The main thing is that you and your partner needn't worry about infecting one another with HSV1.

I hope this inbformation is helpful. Let me know if anything isn't clear.

HHH, MD

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17 months ago

Doctor HHH,

To clarify my history, I lived in a pretty big family, my sisters had the traditional type cold sores, on there lips. My cold sores were in my nose, (these were not comfortable)and also the side corners of my nose. However, these were not cultured for virus. I even remember having these even in collage, and late twenties.

My concern since I had eczema on my scrotum this would make me more susceptible to either, self infection, (scratching) or from a girlfriend with cold sores. Obviously, when I had Type 1

blisters on my knee, I though, "did it jump from my scrotum, (which never had blisters!) And this is not characteristic for herpes as you said due to my previous infection. Also, my future wife, heard you can spread the infection due to oral sex, we got concerned, due to our history, and even previous partners with cold sores.

So I guess how immune is immune given prior strain infection? Also, given a long standing HSV 1 infection, as you mentioned, how does a distant infection occur, like the knee. If you could explain?

Thank you for clarification, and indulging a my former dream to be a doctor. You provide a great service, and I value your extensive expertise. Have a good holiday, respond at your convenience.

H. Hunter Handsfield, MD

17 months ago

Thanks for the information. Clearly you had herpes (HSV1) in your youth: not strictly oral, but around the nose is not at all atypical.

Two main thoughts at this point: First, the degree of immunity is high. The chance either you or your partner will ever acquire genital herpes is extremely low. I can't say it's zero, but it's low enough to ignore. (The main issue would be your oral/nasal/facial HSV1 being transmitted to your wife by oral sex.) But second, genital herpes due to HSV1 is a trivial problem. Genital HSV1 rarely recurs (most people with genital HSV1 have no repeat outbreaks or only one or two), and in your situation the initial infection probably would not be particularly painful or bothersome. And in a marital situation -- i.e. presumed permantent mongamy -- what does it matter? The main stress resulting from genital herpes is from transmission risk to new partners. For people not dating and in monogamous relationships, herpes is rarely an important issues.

All things considered, I advise you and your fiance to not give any of this another thought. Herpes due to your mutual past HSV1 infections will never be an important issue for you.

Thanks for the kind words about our services.

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17 months ago

Thank you again Dr. HHH, for your detailed reply, each us know how respected you are in your field, and your email bedside manner is great. Both us became worried about this since I had symptoms of Type 1 herpes, and she really did not, at least she did not remember. I was being protective of her, and so I can clear my mind...given my more pronounced symptoms, oral herpes as a child, type 1 blisters on my knee (which I think is strange) mild rashes on scrotum due to eczema, would I pose any greater risk for transmission due to my symptoms? You had mentioned this in my one post, just trying to understand more fully. Thank you for your kind indulgence. Really, appreciate all your help, have a great week.

H. Hunter Handsfield, MD

17 months ago

In my 40 years in the STD business, I have never seen a patient with genital HSV1 acquired by intercourse. It certainly can happen, but is very rare; virtually all genital HSV1 is acquired by receiving oral sex by an orally infected partrner. In addition, in those 4 decades I have never had a patient with prior HSV1 or HSV2 who acquired a second infection with the virus they already had. This too might occur rarely -- i.e. only partial immunity to new infections -- but this also is rare. W

hatever symptoms you have had now or might have in the future, they make no difference in transmission risk. Also please read and understand my last ocmment above: it shouldn't be a big deal even if, despite overwhelming odds against it, one of you acquired a new genital HSV1 infection. It might be so mild you wouldn't notice; it would respond promptly to treatment; would not recur; and would not be bounced back to the other partner. This really should be a nothing burger for you and your partner!

That completes the two follow-up comments and replies included with each question and so ends this thread. Tjhanks for the grateful comments above; I'm glad to have been of help.

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