[Question #6315] HSV1 and possibly HSV2

17 months ago
Hi, thanks for this great service!

Three years ago I was diagnosed with HSV1 genitally via a swab test. This was a single, small, sore in my vagina. I don't have many recurrences in that area, but twice in the last year I have gotten lesions around my anus. This is actually not new, before I realized I had genital herpes I had an anal outbreak in 2009, long before I was diagnosed (I was quite innocent then and thought I just had a rash! But looking back at it now I am certain it was a genital herpes outbreak). I have noticed 3 distinct areas get lesions, and typically only one area has an outbreak at a time (vagina, anus, and crack above anus). My question is, is it common for HSV1 to present in all 3 areas? I have received oral sex to have received HSV1, but definitely don't recall any mouths around the anal area. I am not aware of any initial outbreak (it was likely pre-2009) so I don't remember where lesions occurred during the primary infection. Could it be possible to have HSV1 in the vagina, and HSV2 in the anal region? Is this a common scenario?

Until recently I just assumed all of my outbreaks were from HSV1, but for some reason I'm starting to question this.

Thanks so much for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
So this is a common question and I'm so glad you asked me this as others might be curious as well. 
Once the herpes virus gets established in a group of nerves in what is called the sacral ganglia, at the base of the spine, the virus can travel on several different nerves to get to the surface of the skin.  So it can show up on the anus, the gluteal cleft (butt crack), the vagina, labia, buttocks, lower belly, thigh, and pubic hair region.  This is completely normal and to be expected.  The normal number of outbreak of HSV 1 is about one every other year.  If you are having more than that, it is possible that you could have HSV 2 as well or you could just be having a few more outbreaks of HSV 1 than most people.  If you are concerned about the frequency of recurrences and worry about HSV 2, you could get an IgG test for HSV 2 and see for sure.

Terri
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17 months ago
Thanks for you quick reply. 
I had conflicting information that lesions appear where the initial contact had been made, and also what you just mentioned, so wasn’t sure what was correct, thanks for the clarification!
Also, the vaginal lesions do probably appear just as often as the anal lesions (they’re just not as obvious) so I’m thinking it’s likely still HSV1. I don’t see much research on this topic and this is news to me - it is entirely possible to be infected with both HSV1 and HSV2 genitally, this is common?
And - how likely is it to transmit HSV1 to the genitals of another?

Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
It is extremely unlikely that you would transmit HSV 1 genitally through intercourse but it has been documented in the literature to have happened.  While you could have HSV 2 as well, that would be uncommon though I have seen it.  You could do an antibody test to sort that you if you wished, as I mentioned above.  Primary outbreaks happen at the place of contact, but recurrences can happen anywhere in the boxer shorts area.

Terri
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