[Question #7058] New diagnosis hsv 1&2

7 months ago
I was recently diagnosed with hsv 1&2 from igg blood test. I waited a month after the incident happened to get tested so these are accurate results. Once I found out I started on acyclovir 400mg bid. I ended up having a possible outbreak on my left lower thigh. It was not painful, I had red bumps and it was red/raised underneath the skin. Was this an outbreak? 
I am in a same sex female relationship and am struggling to find information on safe sex practices and the chances of giving it to my female partner who is hsv negative. What are the chances of giving it to her if I take my medication as prescribed? How often am I shedding? 
Also I have a lot of young neices as nephews and am worried I would give it to them. Can I pass it orally by kissing them on the cheek? What if they crawl on me, drink from the same glass, etc? What is the risk?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
It's really not possible to say if what you experienced was an outbreak or not, without a swab test.  What was the index value of your HSV 1 and HSV 2 IgG test, please?  Just so you know, the IgG test misses 30% of HSV 1 infections compared to the gold standard western blot so your partner may or may not actually have HSV 1.  About half the population does, though the IgG results do not actually reflect that because it is a flawed test, compared to the gold standard western blot. 

We don't have data on the transmission of HSV 1  or 2 to a same-sex couple that is discordant for HSV 1 and 2, but we do have shedding data on both HSV 1 orally and genitally.  Do you get recurrent cold sores? 

Kissing anyone one the cheek when there is no cold sore present is NOT a risk for transmission.  Neither is drinking from the same glass.

Terri


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7 months ago
My labs are as follows:

HSV 1/2 IGG, HERPESELECT TYPE SPECIFIC AB
     HSV 1 IGG, TYPE SPECIFIC AB 57.90
     HSV 2 IGG, TYPE SPECIFIC AB 13.40

What is your data on shedding for both hsv 1 orally and genitally? I have never had a cold sore and have yet to have any questionable outbreaks on my genitals or oral mucosa. The outbreak on my thigh was the only questionable outbreak and it was closer to my knee than genital area.

Since I have yet to have a painful outbreak and I am now on acyclovir BID will I not have a painful outbreak? Do you have data on this?
    

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
We have data on shedding of oral herpes for people who have about 6 or more outbreaks per year.  That number is about 25% of days measured.  We do not have data on people who are HSV 1 positive but have no symptoms.  Our shedding data for HSV 1 genital infection is that after having it for 2 years, people shed virus on about 4 days out of the year, on average.
If you have something that you think might be an outbreak, you should see someone to swab test it as soon as it appears to you can sort out if what you are experiencing is herpes or not. 
I think if you are taking acyclovir, it is quite unlikely that you will experience a painful outbreak, but it's possible.  If you notice herpes symptoms coming, you can increase your dose to try to stop the outbreak - you should talk to your prescriber about what dose to use.

Terri
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