[Question #7392] Hsv 1 question

3 months ago
Hi I am a returning user and Terry was very helpful before. I have genital HSV 1 and my boyfriend has oral hSV 1. I have confirmed this. I seem to be getting frequent, but very mild like one tiny dot outbreaks. We do not use condoms because we both have the same virus but just wanted to see if we needed to refrain from having sex if I am having a potential outbreak.  Or if since he already has the virus it’s ok? Also my daughter gets cold sores and whenever she has one. I seem to get one little genital ulcer.  Is it possible there is a correlation.? Thanks.! 
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Welcome back to the Forum and thanks for your question.  I'll do my best to help, first by agreeing entirely with Terri's comments.  Once a person has genital HSV-1, they typically will not get it again and will not spread it to other parts of the body though normal actions such as scratching, rubbing, etc.  You and your BF certainly not need to use condoms to protect you form each other's HSV-1, no matter what the variety of exposure.  I do not mean to disparage or question your comment but if you have not done so, it may be helpful to conform that the "tiny dot outbreaks" that you describe are actually HSV and not some other dermatologic process.  After all, recurrences of genital HSV-1 are relatively rare, particularly for longstanding infections. This would be best done with a PCR test performed ASAP after the lesions appear. 

Your recurrences when your daughter has cold sore outbreaks in coincidence or perhaps a manifestation of any stress that you might have over her illness. 

I hope these comments are helpful. EWH. 

---
3 months ago
Thank you. So even if I have one sore it’s ok to have intercourse without a condom? He and I both have confirmed HSV 1. His orally and mine genitally. I really am not sure this is/or every time they are actual herpes sores since they look nothing like my initial outbreak or like a typical herpes lesion but I do get itching many times when it occurs. I don’t want to damper our  sex life By bringing this up every time I have a question  as he is fully aware of both of our HSV-1 but I don’t want to re-infect him generally. (He’s has cold sores for years)... so I don’t meant to sound redundant but just making sure its ok to have intercourse whenever even if I am concerned about a possible lesion.  Unfortunately, I did get a culture and at glance my gyno said there was no way that it was a recurrence. He said he never saw herpes that looked that minimal and laughed.  He thought it was folliculitis but he said that the culture came back positive for HSV-1. He was in shock as was I.  I never had something that looked like a sore or an ulcer after twenty years. I also got a blood test which confirmed hsv 1 but I knew that already.  Is a PCR test the culture? I honestly was shocked because I never had a standard “herpes lesion” and did a ton of research knowing genital HSV-1 doesn’t come back a ton especially a long standing infection. I do have a low white blood count and maybe I could be one of the unlucky people that get reoccurrences. Also my hsv 2 test is negative.  Any advice you have would be great.  Your right the coincidence could be stress. 
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Correct, Even with a sore, you are most unlikely to transmit your HSV to him.  No need to constrain your sex life. 

i also think that, given your concerns about possible HSV, a PCR of these lesions the next time they appear would be helpful and, I suspect, reassure you that this is not recurrent HSV.  EWH

---
3 months ago
Hi! Sorry to be a pain but I have a few follow up questions and you both have been more helpful than anyone I have met in 20 years. So my doctor said he did culture the lesion and that he couldn’t believe the culture actually was herpes -could a culture come back false positive because I have the virus in my cells and what I am having isn’t an actual outbreak or is a culture pretty definitive? Should I still get a pcr test done? I just want to know if these small bumps are actually recurrent outbreaks. Do either of you do phone consults I am out of state but can’t seem to find a good OB/GYN that even knows what a PCR test is. Would that be more accurate than the culture? I do have one little bump now and wondering if I should get the PCR test done or wait until I have something more substantial for the test. I would truly value your opinion.  Also, I am not sure if I should just put this all to rest as my boyfriend has oral HSV1 and I have genital. Just wondering about what to do/say if I ever had to disclose in the future about my herpes status it would be nice to know if I am actually having outbreaks or if I’m more the norm with genital hsv 1 that doesn’t have recurrent outbreaks. These small bumps/itching occur quite frequently. . Thank you. I would love to someone be a patient of one of yours. 
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Your asking good questions. 

Cultures are never falsely positive for herpes unless someone else's specimen is mislabeled.  You should believe your culture.

The reason I suggested the PCR is that it is more sensitive than a culture test (i.e. less chance of a false negative test) and my sense was that the somewhat atypical sounding lesions you described as "tiny dot outbreaks" may not be HSV.  I sensed it would be a relief to you if that was not the case and they really do not sound typical for herpes. 

PCR is more sensitive than culture.  The test is widely available.  I suggest you mention the "new test" for herpes that you have heard about which is more sensitive than culture for detection of herpes.  At the very least that will get the conversation started. 

Once again, with you having genital HSV-1 and him having oral HSV-1, you can be confident that you are not a risk to him and he is not a risk to you.  Terri and I have both told you this. 

Hope this information  has been helpful.  I'm afraid that it is about time for this thread to be closed without further responses.  Our guidelines provide for three responses for each client's questions.

Take care.  Please don't worry. EWH. 


---
3 months ago
Hi! Thank you I actually paid for a new question because I thought I needed to :). So basically if the culture says the atypical lesions are herpes than I should trust that they are? I guess there would be no need for a PCR test then? Thanks! 
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
Correct.  EWH---