[Question #6457] Oral herpes testing

13 months ago
18+ years ago, I went to the doctor with a sore throat. The doctor did NOT do a swab of the area. She said it was herpes, like cold sores.  Months, or maybe over a year later (not sure), I had a genital outbreak.  A swab confirmed herpes, but didn't say 1 or 2.   I waited over the recommended time and had a Western blot and PCR done. Both said HSV-1 ONLY.   I have read it is unlikely that a person would develop it in both areas. I have had sores on my mouth before, but I am wondering if it is something else.   Is there a way to test for oral HSV infection if no lesion is present?  Can saliva be tested? Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
13 months ago
So you know with a high degree of certainty that you don't have HSV 2 infection.  The IgG test picks up 92% of HSV 2.  The swab test should have been typed, for sure.  And if it happens again, you should have it swab tested AND typed, to be sure that the blood test that shows only HSV 1 is correct.
You don't know for sure that the first infection 18 years ago was herpes because no testing was done.  Did you have sores on your lips as well or just in your throat?  No strep testing was done?  Were you sexually active at the time?

Terri
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13 months ago
Forgive me, I'm confused and scared. You say I don't have HSV 2  based on my test results, but then you say to have the oral lesion swab tested and TYPED.
Am I correct that I don't need to worry about HSV 2? Then WHY would I need the swab TYPED?  Sorry, just not following...
Should I have any genital lesion swabbed and typed now, too?
(I am really hoping that I don't have to worry about the tests being wrong, and that I have not had HSV 2 this whole time...)
So, a lesion swab test is the only way to know if I have it orally. Saliva can't be tested, correct?
I did not have sores on my lips that first time. I had not had cold sores before that time, but I have had SOMETHING on my lips a few times since then. 
I was sexually active at the time.  My boyfriend (now husband) got cold sores, and we thought I got it from him.
I'm sorry for rambling!
Thanks again! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
13 months ago
I said with 92% certainty you don't have HSV 2 - typing of any future lesions would just eliminate any possibility that the test missed an HSV 2 infection. It would be really unlikely that you would have oral HSV 1 infection and then many years later acquire the same type in a new location.   So since you were sexually active at the time you got the oral lesions, it is possible that you  acquired HSV 1 both orally and genitally at the same time and only recognized a genital outbreak more recently.  It is also very possible that what you had in your throat was not herpes  at all and you recently acquired HSV 1 genitally from your husband who gets cold sores.  Certainly if you have a genital sore again you should have it evaluated and swabbed if the clinician is concerned that it could be herpes.  Let me be clear that I don't think you have HSV 2 genitally - I just thought swabbing any future lesions would give you even greater clarity about what's going on here.
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13 months ago
Thank you. I think this is my last question for now, and I realize it may sound insane...if I go swimming in water with no chlorine, and then I sit somewhere, say a bench, would the virus present in my vaginal secretions/water be able to survive in the warm, moist environment to spread to someone who sat in the same spot after me?  (With everyone wearing swimsuits. ) 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
13 months ago
The situation with the swimming that you present has no risk for transmission to others, nope, not at all - and it's always fine to ask rather than wonder!

Terri
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