[Question #7189] Genital Herpes

6 months ago
My girlfriend got tested for herpes simplex virus via a culture swab (Pap, thin prep, cervical) when she was having what we think was her first genital herpes outbreak. The lab results came back and said "culture positive for herpes simplex virus", but didn't specify the type.  She said she experienced lesions inside her vagina and around her labia. From your knowledge, is this not enough information not tell us whether it is type 1 or type 2? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
No, they both look the same on exam.  If this was recent, she should ask her provider to call the lab and ask for typing.  The provider should have asked for it originally, per the CDC guidelines.  Error. If that cannot be done, she will have to wait for several weeks and have an IgG antibody test done to determine the type of HSV that she has. This is highly unfortunate as these two types act very differently in the genital area. Have you been tested? Have you ever had a cold sore on your lip? Do you give her oral sex? Terri---
6 months ago
This all happened almost two years ago so it's too late to ask for typing; I think getting an antibodies test is a good idea. I'd had lesions on my genital area around the same time which went away pretty quickly after I was on valaciclovir. We still don't 100% know if it came from me or from her since I had my first outbreak a few days prior (it's more likely it came from me, right?).

What do you mean the two types act very differently in the genital area? Does this mean that the lesions or time of recovery are quite different? Could we determine whether it was type1 or type2 based on our symptoms?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
You cannot know if this was HSV 1 or 2 based on your symptoms, no. 
HSV 1 genitally rarely recurs and is rarely transmitted to someone else through intercourse.

Terri
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6 months ago
Does that mean that most people with genital HSV1 get it through oral sex? I just don't understand how we could both have genital HSV1 but not oral.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
Yes, most people who acquire HSV 1 genitally do so from receiving oral sex. 
I'm confused - how do you know that you have both have genital HSV 1?  I thought you didn't know the type?

Terri
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6 months ago
Yes, I meant to share that I did get an antibodies test 2 months after the first outbreak and the Igg type-specific test said I tested positive for HSV1 ("H - 1.03 (index)");  my girlfriend only got the viral swab. She and I are just trying to figure out: 1. what type we both definitely have, and 2. who got it from who. She says she hasn't gotten an antibodies test yet but by the looks of it she probably also has HSV1. 

An important note is that right after I had my first outbreak she had hers 2-3 days later. It is confusing though because neither of us got it orally; we both have it genitally. Is it possible for HSV1 to be shed and spread from your genitals during the incubation period? Or, is it possible to get HSV1 through intercourse if you're not immunocompromised? Neither of us are immunocompromised, so how is it that we could both have gotten genital HSV1 through sex? Could the Igg antibodies test have gotten the type wrong (since it was taken only two months after)? I'm pretty certain, however, I have HSV1 (and not HSV2) because I haven't (as you mentioned is a common sign) had any recurrent outbreaks. Maybe it's worth getting a second Igg antibodies test.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
I don't know when the last time was that you had sex with anyone else or when she did so hard to know what's going on here.  Your value on the HSV 1 test is not positive - it is equivocal but could indicate new infection OR a negative.  We know she has herpes, we just don't know which type.  Has she had an antibody test?  Has either of you had a cold sore on your mouth ever?  I think an antibody test for her and a repeat test for you would be helpful.

Terri
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