[Question #6110] Herpes question

16 months ago

Dear Experts,

 

I think I can keep things much more streamlined if I skip the story and ask my questions in hypothetical terms. So here goes: 


Let’s say a person acquires oral AND genital HSV2 during the same sexual encounter. As would be expected, this person get’s genital symptoms which is what prompts him to get tested. 


Am I correct that it would be highly unusual (or maybe even unheard of) for a bout of visible oral symptoms to occur more than a year later? My understanding is that those people with HSV2 in their mouth and genitals are almost never visibly symptomatic in their mouth, and if any oral symptoms did occur, they would do so within days or a few weeks after the initial acquisition of the virus. 


My other question: If a person has HSV2 genitally, does that act like a vaccine against getting oral HSV2 from a different partner later on? Or can they still get oral HSV2 from a subsequent partner. If they can, is it likely to be symptomatic? Or will the prior genital infection kinda lessen the likelihood of visible symptoms?


Thanks!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
I would say that if a person was infected both orally and genitally at the same time (and it happens for sure), that it is far more likely that symptoms would appear in both locations at the same time, not a year later.  If there are symptoms that appear a year later, they should be swab tested to determine what they are and the PCR or NAAT test is superior to culture.  If a person has genital HSV 2, it is extremely unlikely that they would acquire HSV 2 orally at some later date, correct. 

Terri
---
16 months ago
Dear Terri,

Thank you so much for your response. Let me just ask a quick follow up because it might make things more clear. The scenario I described is basically my own (which Im sure you guessed). 

15 or so years ago I sought testing for HSV2 after noticing genital symptoms and came back type 2 pos/type 1 neg. (I actually got a second test because I read that false positives were relatively common with HSV2. The second test was pos as well). Over a year after getting tested I had this aggressive mouth incident...I remember there being sores on the inside of my mouth and that my tongue hurt...stuff like that. This incident has  bugged me for years and every time I start to date someone I  feel guilt as to whether to not I could be passing from my mouth. I am always disclose my status before my pants come off but I have definitely kissed people without telling them I am HSV2 and have felt guilt specifically tied to worrying that my mouth outbreak might have been HSV2  But from your response to my initial question it sounds like it is highly unlikely that my  mouth 'thing' was the result of HSV2 randomly flaring up in my mouth a year after getting it, and that my symptom might be more easily explained by something non-herpetic, like an aggressive canker sore outbreak or stomatitis, etc. Does that sound about right to you?

Thanks!
16 months ago
Also-I am an HIV negative gay male, for what it's worth.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
So actually false positives on the HSV 2 test  are NOT common.  You need to pay attention to the index value of the test.  If the value of the test fell between 1.1 and 3.5, then you need a confirmatory test, like the herpes western blot because half of THOSE results are false positives.  95% of people who are truly positive for HSV 2 are infected genitally.  Your explanation about this makes a lot of sense.  Please go back and look at your index value on the HSV 2 antibody test and below 3.5, get a confirmatory test.

Terri
---
16 months ago
Hello Terri,

I have my exact results written down:

'Out of range >5.00'  (Which I'm pretty sure is as positive as one can get).

Terri, in your last response you said that my explanation made a lot of sense. Did you mean that you agree with my assesment that the oral symptoms I had might be more easily explained by something NOT related to oral HSV2?  I'm really trying to figure out what to do about this nagging guilt feeling I have after kissing that 'I should say something about oral HSV2 because what if I have it!'

On the other hand I have zero actual proof that my HSV is in my mouth in addition to my genitals ...only a concern based on that one random incident I had in my mouth. 

Thanks again Terri. Your expertise is greatly appreciated!



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
The >5 value just means that you have a value higher than that, so yes, it could be 20 it could be 6, no way to know and it isn't really important, it's strongly positive.
I agree that you oral symptoms could be something other than HSV 2 and likely is.
The only way to know if the symptoms in your mouth are related to herpes is to have them swab tested for herpes. 

Terri
---
16 months ago
Terri,

Thanks again your expertise. That outbreak of oral symptoms happened only once and that was back in 2007 so I'm guessing I will never see it again. 

Am I correct that you do not think it is necessary for me to tell kissing partners about my HSV2 status?

 (Of course, if things progress past kissing and start to involve my genital region, I know it is my duty to disclose).

Thanks again!

PS-I realize that this has become a long post.Please advise me if I should purchase a new thread.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
I do not think you need to notify people of your HSV 2 status if the only contact is kissing, correct.

Terri
---