[Question #7539] HSV 2

1 months ago
Hi Terri,
I spoke with Dr Hook recently about a potential exposure. Girl gave a me a massage, she did sit on my face but with underwear on. I did not have access to vagina directly.
We may have briefly kissed. Like a peck on the lips. I sucked her fingers briefly too at one point.
This is around 13 days ago.
I contacted dr hook and was reassured. But the next day started feeling a tingling. On my upper lip there now appears a small cold sore. There has been a temperature drop where I am recently and I have been under a lot of stress. Not eating properly and drinking and smoking too much.
Finally, the girl claims they are a legitimatr SPA and the do not give favors. She also claims she is disease free.
Although dr hook’s words helped, I asked her to test which she did, but she too the IGM test. Apparently this indicated a normal-low positive. I am aware this test does not differentiate between simplex 1 and 2.
Speaking to a another doctor, he told me not to worry, but now I have had the lip cold sore.
I have had hsv 1 cold sores from a child but this may be in a different location. Normally corner of mouth. This is top of lip.
Could this be hsv2? I have read it is very rare and does not shed. We did not engage in deep kissing, and we did not engage in oral - just the  face sitting. What do you think Terri? 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
I completely agree with Dr. Hook that this is a no-risk experience.  Nothing that you did with this partner presents a risk of acquiring a sexually transmitted infection, period.  Good job for being so careful.
You've had cold sores in the past, as you mentioned.  It's completely normal to have cold sores moves around on the lips. I get them also or used to before starting daily antiviral medicine to prevent them, but when they were coming, they would show up in various places on my lips.  So there is no worry there at all. 
No, this could not be HSV 2 as you did nothing to expose yourself in any way to HSV 2. 
I understand that you have worries about this encounter still, but I hope between Dr. Hook and me, you can feel reassured that there is simply no risk with this experience, thanks to your caution with your activities.  What you did is the ultimate description of safe sex!

Terri 
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1 months ago
Hi Terri. I will use your words and move on. Again, only reason I resubmitted after conversation with Dr Edward was due to the cold sore formation. But under normal circumstances would thought nothing of this.
If I may, for educational purposes use my follow ups for HSV2 via kissing. I trust you entirely but a couple of things I do not understand.
I have read several times that hsv 1 has little (maybe none) protection for hsv 2. Also, if not inpossible, hsv 2 is very rare and difficult to acquire orally, if it does, it hardly ever sheds 0.01 percent according to one online article.  In addition, I have read your blogs where you write that when it does occur it is virtually always when somebody has it genitally also. Also, the amount of kissing that happens on a typical Friday/Saturday night amongst young people in bars - and the casual attitude many have to oral sex, is it fair to say that kissing and hsv 2 is virtually non existent? Would it not make sense that increased instance of oral sex and casual night club kissing with multiple partners would see potentially lots of hsv 2 lip infections? At least a number to take note of in what your field? I would  have thought we would see significant numbers if it were easily transmissible. When I was younger, our target was to kiss as many girls at the nightclub as possible - I wasn’t overly successful btw - but never did it ever occur to any of us then young guys or our parents that this was a risk of anything. So to summarize, would you say casual night club kissing is virtually zero risk for hsv 2 acquisition and could you explain why? This is not anxiety just academic curiosity. Thanks again Terri, I can sleep tonight. You are a saint.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
We have no way of knowing exactly how much HSV 2 there is out there, but it is NOT easily transmissible.  And it isn't because it is so rarely shed from the oral area. 
We know that at least 95% of the time, people who test positive for HSV 2 by an accurate antibody test shed virus from the genital tract.  We know that by asking people who test positive for HSV 2 to do daily home swabbing of the genital area, using the most sensitive test, PCR.  And within a few months time, 95% of them will recover virus from the genital tract.   So thinking of your response to that statement, "what about the other 5%?"  We don't know for sure, but we know if these people were only swabbing once a day, they recover less virus shedding than people who swab four times a day, for example.  And what if they swabbed for a longer period of time?   So I suppose that one could worry about the small possibility that someone who acquire HSV 2 by kissing, but for me?  Life is way too short now to worry about the remote possibility of anything!

Terri
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1 months ago
Hi Terri,
Just using my follow up. I understand your analysis and plan to move on. As I stated, worry was the time frame, and found this troublesome, especially as I was worrying anyway. 
Final questions, have you ever seen a case of oral hsv 2 without genital symptoms? When websites and advice state rare, is it vanishingly rare? Also, dr hook states hsv 1 may provide some partial immunity, but I guess not much. Would hsv 1 infection on the lips give any protection against an oral infection with hsv 2? I will leave it there. Thanks again Terrri.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
I personally have not seen a case of oral HSV 2 without genital infection as well, no. Never.  Can I say it never happens?  No.  We don't have good data on if HSV 1 oral infection protects against HSV 2 infection but the only way to know if a cold sore is HSV 1 or HSV 2 would be to have it swab tested each time.  That might be overkill for most people.

Terri
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