[Question #6376] To Dr. Handsfield

14 months ago
Dear Dr. Handsfield,

first of all, thank you very much for this valuable service. I am 24 years old female and a year ago I was diagnosed with GHSV1 via swab test. Since then, there was not a single day I would not think about it. Not a single day I would feel happy. And I was not with any man since. I had one recurrence after 6 months,  but I was also sick, stressed by moving to another continent and had laser hair removal (interestingly I got recurrence only after 5th session).
I was in three  different countries and saw three different gynecologists, and they all said, that it does not matter if I have GHSV1 or GHSV2, that it is the same thing. After months searching via internet, I found an article, that gave a little hope into my situation. 


In this article, you are quoted saying "It appears that genital-to-genital HSV-1 transmission is rare.". If this article is really true, then I don´t understand. Assuming that almost every adult person will eventually have either HSV1 or HSV2, wouldn´t it make GHSV1 the "best" option? Because GHSV1 is like a vaccine against OHSV1 (which has much more recurrences, shedding and everybody sees it on your face). I even read that having GHSV1 can prevent GHSV2 as it shares antibodies. Is this true?

If so, why wouldn´t  the doctors say it right away? That "girl, you should be lucky, having GHSV1 means that you are actually far less infectious then the majority of the population?!" So many people have GHSV1, why isn´t it the very first information you learn, instead of something you find by accident after months of desperately searching?

I am just very confused because not everything you find on internet is true and that´s why I am very grateful for this service and chance to have answer from one of the best expert dealing with this topic.

Thank you in advance!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
Hi, I answer the herpes questions on this forum.  thanks so much for your question.
It's really unfortunate that the clinician that you saw for your diagnosis did not talk to you more about genital HSV 1.  We actually have some great new information about genital HSV 1 infection based on a paper presented by Dr. Christine Johnson at the University of Washington, this past July.  Once a person has had genital HSV 1 for two years, based on her study, they only shed virus on 4 days out of an entire year.  That's why transmission through intercourse is so rare.  Now some people may shed virus more often and certainly some shed less, and there is more shedding quite early in the infection.  But that's the average after two years and as you can see it is very low indeed.  Based on her paper, I would say shedding at one year is probably around 4-5% of days, so 4-5 days out of 100 days, as an estimate.
We don't know that lots of people have genital HSV 1, though we do know it is becoming more common as a first infection in some populations than HSV 2.  What we do know is that almost half the population has HSV 1 infection but often, we don't know the location of the infection.  People who have oral HSV 1 shed virus far more often than people with genital HSV 1.  So in this way, you are fortunate.  I would  not necessarily agree that HSV 1 genital infection offers protection against genital HSV 2.  We don't honestly have that information - it's possible, but we just can't say that with any certainty.  But what we do know is that someone who is infected with HSV 1 anywhere and acquires HSV 2, the HSV 2 infection is far more likely to mild or without any symptoms. 
I personally have not diagnosed someone with HSV 1 genital infection who has only had intercourse without receiving oral sex. That doesn't prove that HSV 1 cannot be transmitted via intercourse - that has been documented in the literature - but it does suggest that it is really rare as I practiced for 35 years with a specialty in genital herpes infections. So this is a bit of an overview of HSV 1 - please let me know what questions you might have.
I'm so sad that you haven't been happy on even one day since your diagnosis!  this is truly quite a benign infection from a medical point of view and it's too bad that you haven't had sex with anyone since your diagnosis.  If you have sex with someone who already has HSV 1 infection, regardless of the location of their infection, it is highly unlikely that they would ever acquire HSV 1 in a new location, and about half the population has HSV 1 infection.  Perhaps you can try to re-evaluate how you are thinking about this.  What do you think?

Terri   Warren

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14 months ago
Dear Terri,

thank you so much for your reply.  You are writing that having HSV1 can result in mild or no symptoms of HSV2. Is there any possibility that I have GHSV2 if the swab came positive for only GHV1? It is just so strange that I first kissed the guy and yet got the virus genitally and not orally. 
I totally agree with you that from medical point of view, this infection is nothing. I have also chronic bladder inflammation and the pain can´t be compared.  The worst part is the stigma and having "the talk". I understand that some people with GHSV1 decide not to disclose , however, I could not look into mirror knowing I have even a small  chance of passing the virus and not telling to my partner. Do you think it is okay to say that I carry the cold sores virus (because that´s what it is, isn´t it?). Or am I obligated to say that I have GENITAL herpes- and then  we are again at the initial problem of not distinguishing between GHSV1 and GHSV2 and I am pretty sure anyone would be more concerned learning that the partner have GHSV1 than OHSV1 even with all the information you wrote before. It is illogical, but sadly it´s how it is. 
Thank you in advance!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
Mis-typing of the virus from a swab can happen, yes, but it is rare.  It is interesting how people get it one place and not the other while both sites are exposed at the same time. And most often, from what I hear from patients, they kiss and receive oral sex but far more often get genital infection than oral infection.  Puzzling for sure.  Perhaps the very thin tissue of the labia and clitoris is more vulnerable. 
I'm not sure about saying that you carry the cold sore virus - first, I think someone might ask "where?" and second, saying it is the cold sore virus kind of implies that it is oral, don't you think?  In my experience, someone who is open to learning and listening would also be open to hearing the statistics about HSV 1 genital infection.  I hear what you saying about stigma but I think people might surprise you.  Have you told anyone so far just to test out your theory that people would not be open to hearing the difference between the two types?  The truth is that it's a little bit like genital wart virus - some types can cause cancer while other types, though they cause genital warts, are merely cosmetic.  Maybe that's not a great example.  perhaps you can think about it and come up with another example that would be helpful?  Anyway, maybe you could try this out on a good friend, not a future sex partner first and see if they can grasp the difference?  You've got one more post to go - feel free to ask more questions!
Terri
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Greetings. Just saying hello, at Terri's invitation, since you oringially sought my opinon. Thank you for that confidence. However, I agree with all Terri has said; nobody with herpes issues ever goes wrong with Terri! She has managed far more HSV-infected persons than I have.

I'll just elaborate a bit on informing partners. It goes for past HPV infections as well, such as an abnormal pap smear. Because the risk of HSV1 either by kissing or intercourse is extremely low for any one exposure, most experts would agree informing new partners before first sex isn't necessary. In addition, half your potential partners already have HSV1 as well, and are immune (or at least highly resistant) to new infections. As relationships become more prolonged or potentially committed, many couples openly discuss past sexual experiences, including STDs and oral herpes, but primarily in the spirit of openness and commitment more than prevention.

Also remember that half of all adults in the US (a lot more in some countries) have HSV1 and don't know it. You're no more a risk for your partners just because you are among the minority who know their HSV1 status. In fact, you're a lower risk:  compared with someone never diagnosed, you are more likely to be alert to symtoms of a minor outbreak and avoid exposure. For those reasons, over the long run, for someone with other partnerships past and future, telling them about your situation will not materially lower their chance of being exposed or infected. So why go through the anxiety yourself and perhaps heighten their anxiety unnecessarily?

Like Terri, I'm not advising you what to do -- just raising points that might help you decide the path you want to take.
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14 months ago
Dear Terri and Dr. Handsfield,

thank you kindly for your answers and for raising awareness about the importance of distinguishing between GHSV1 and GHSV2. I really wish more people would be aware of it.  And I appreciate very much that you, Dr. Handsfield, replied as well.  It is just so illogical that having OHSV1 is considered as absolutely normal and not even worth thinking or talking about, having THE SAME virus on a place where it is not even visible and where it doesn´t recur and shed that often, people fret and  are so ashamed of. 

I would like to ask if you have ever seen a case of someone who has GHSV1 and GHSV2. I´ve had GHSV1 diagnosed via swab test and had only one recurrence (as painful as the first one) after 6 months even though I went through a lot of stressful time and had laser hair removal. Do you think there might be a chance that I have GHSV2 as well or that I was mis-typed?

I read on your forum that when someone doesn´t have any recurrence of GHSV1 within one year, usually there won´t be any recurrence in the future. Does it mean that if I had recurrence after 6 months, I am more likely to have more recurrences in the future?  If someone doesn´t have any recurrences at all, is there less shedding or shedding and recurrences are not related?

My last question is about HPV. I was also diagnosed with HPV type 56 one year ago. As I am turning 25 years, is there any use of a vaccine? My doctor said that as the vaccine is very expensive, I should rather have a check  every year, and even if there is a small percentage chance of cancer, if diagnosed soon enough, it is well treatable.  What do you think about this?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
I have seen some cases where people have both, yes, perhaps 6 or 7.  Mistyping of the virus is really unusual.  If you have not had a recurrence of HSV 1 within one year, there is an 85% chance you will not have another, but as I read this, you did have a recurrence, 6 months out.  Shedding is related to transmission, yes, so people who have more outbreaks have more shedding. but with HSV 1, the frequency of shedding is far less than HSV 2 and goes down to an extremely low level at 2 years out from infection. 
I don't agree with your doctor.  The new vaccine prevents 9 typed of HPV infection and if I were 25 and had already a diagnosis of HPV, I would definitely get the 9 valent vaccine, no question about it. 

Terri
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