First HSV1 OB, mild but for weeks – worries on resistance and self-innoculation

[merpalertParticipant]

So I got recently infected with oral HSV1 and after nearly 2 weeks with several rounds of valtrex, I am still getting bumps from lack of sleep

Day 1: I had a single white bump at outside corner of my lip white and fluidy. Doc looks and prescribes Valtrex

Day 2: Nicked it while shaving, put rubbing alcohol over the entire area and took Valtrex a few days. It dried to a hard nub. Appears to be another hard nub next to it though it has never swelled. I also took an IGG and IGM test this day: LAB #1

Day 3: Took IGM/ IGG from LAB #2

Day 5: Lab #2 returns negative IGG and IGM results for HSV1. My IGG/IGM values are unchanged from my last negative test in August.

Day 6: Some burning pain while eating. Check fleshy part of inside lip and see a couple white bumps and red healed dots. They pop when I prod and white fluid comes out. Take more Valtrex

Day 8: LAB #1 comes in: Negative IGM, POSITIVE IGG 3.2 for HSV1

Day 9: Lips chapped and look like a many white bumps when moistened. No pain. I take Valtrex because I haven’t been sleeping well. Bumps gone next day.

Day 12: More white bumps inside my lips after another night of poor sleep. I prod them with q-tip, one hurts, but pops. I douse area with rubbing alcohol and topical acovlir. However, later while eating taco, I bite finger. No blood/deep cut, but definite scratch on skin.

1) Why won’t this end? Is it lack of sleep? If so I feel immunocompromised, or that I’ll have an OB so long the virus mutates, I typically sleep somewhat poorly.

2)How can the two IGG results be so different? I know IGGs miss HSV1 but I thought they would either all miss an infection or none would. The lab that missed my infection has shown positives on that test for other people before so I trust them.

3) There’s basically no way to tell when I got infected right?

4) I am so worried about whitlow. Biting during OB puts me at solid risk right?

My mouth feels like an enemy. Can’t rub my eyes, scratch nose or eat freely

[Terri WarrenKeymaster]

You are making the assumption that all of this is related to HSV but I think that is an error. This may well not be HSV. If you want to know for sure you should have these swab tested.
If you had a positive IgG at>3 at 8 days out, this suggests that you have been infected for longer than 8 days. Your immune response is solid now.

1) Why won’t this end? Is it lack of sleep? If so I feel immunocompromised, or that I’ll have an OB so long the virus mutates, I typically sleep somewhat poorly.

See above.

2)How can the two IGG results be so different? I know IGGs miss HSV1 but I thought they would either all miss an infection or none would. The lab that missed my infection has shown positives on that test for other people before so I trust them.

Some BRANDS of IgG tests appear to miss infection more often than others. What lab missed the infection?

3) There’s basically no way to tell when I got infected right?

No, there is not

4) I am so worried about whitlow. Biting during OB puts me at solid risk right?

With an index value of >3 on your Igg test, I would not worry about whitlow now.

Terri

[merpalertParticipant]

Hi Terri,

Thank you so much for a response. These labs were done in Asia, so I’m not sure the company names can tell you much.

You reassurance about Whitlow was very helpful. I was feeling afraid of my own mouth and very vulnerable. I’m left wondering though: where I do have to be careful with and without visible outbreak?

I know the risk of infecting other parts of you goes down after a few months (you seem to indicate I am there already), but it’s not 0 right? It seems like your immune system is on guard once you get IGG, but you can still overwhelm it, like if you touch an open cold sore then immediately touch your genitals or rub your eyes. When have you heard of this later stage self-innoculation happening in people (other than those with serious diseases like HIV)? Is a cold or fatigue enough to lower your defenses to do so?

There’s a lot of conflicting information out there. For example, this link (https://www.uhs.wisc.edu/medical/common-student-concerns/cold-sores/) and more state that during OB, the following could spread cold sore:

– Shaving
– Sucking on your fingers, even after first outbreak
– Touching your eye (at least on first OB)
– Sharing utensils or towels
– Not replacing bedsheets/towels
– Reusing Lip balm post OB

On other posts in this forum, I think you have mentioned some of these are not viable and that once you get oral herpes you can’t really “reinfect” another part of your face, but there’s many health websites that seem to believe you can spread it even within your face, so I’m left a bit confused.

It does seem to be true that the virus can live outside the body for several hours ( https://www.ncbi.nlm.nih.gov/pubmed/2172749), and sometimes skin to skin contact is avoidable. What precautions are necessary(if any) to take during an outbreak with:

– Shaving around sore
– Eating w/ hands (finger foods)
– Sleeping facedown on pillow (helps me relax)
– Lip balm
– Rubbing eye or putting in contacts

How do I keep from becoming OCD?

• This reply was modified 2 months, 2 weeks ago by  merpalert.

[Terri WarrenKeymaster]

There is a huge difference between the virus being able to survive and being infectious to someone else. They are definitely not the same.

I am not concerned about any of the activities that you describe above. I would not share lip balm with others when someone has an active cold sore. The virus is living in the trigeminal ganglia already so the nerve that supplies the eye is included in that group so the virus can travel on that branch of the nerve without you doing anything.

I think you already have passed into the realm of OCD. I hope you will work on that.

Terri

[merpalertParticipant]

Hi Terri,

You are not wrong about OCD. HSV1 is so common but it ticks off several anxieties. I’m working on it.

I guess I have 2 different concerns:
– spreading it to myself
– spreading it to others

1) I’m just confused about why there’s varying info on if I can actively spread HSV on my face. Here and elsewhere I’ve heard that HSV can spread anywhere else the nerves goes – like you said, it can go to the eye by itself. But reputable sources like the UHS.wisc link above and the Scottish Health Service (https://www.nhsinform.scot/illnesses-and-conditions/mouth/cold-sore) say to be careful with shaving or contact lens usage as they can spread the sore – no mention even of risk during first OB only. My sense is that I can ‘encourage’ spread on my face if I accidentally shave over a sore or somehow touch my sore and put in contact lenses – or even touch my saliva during an OB. Is this wrong? Are the sites above and people reporting situations like this just misinformed or overcautious?

1a) In terms of spreading to my genitals or fingers, are all those cases during first OB only? Would only HIV or immune system cancer put me back at risk?

1b) Part of my anxiety is it’s my first OB -even if I have IGG. The lab that reported positive IGG gave me a negative in August 2018, so I caught this in the last 6 months. My IGG of 3.2 seems low compared to other 15+ IGG values. Does that mean my immune response is not ‘fully established’ yet?

2) The other anxiety I have is about even kissing a new partner. In reality, I was lucky enough to have a single pimple-like OB, one with no noticeable pain or clear prodorme. But that leaves me wondering whether an itch near that OB spot or elsewhere is prodorme. What signs should I look for -will it always be near that first OB spot? What cautions should I take with kissing a new partner? I don’t want to avoid a first date makeout session, but I’d feel bad for that to spread it.

3) Thoughts on taking VZV vaccine for HSV 1?

Thank you!

[Terri WarrenKeymaster]

1) I’m just confused about why there’s varying info on if I can actively spread HSV on my face. Here and elsewhere I’ve heard that HSV can spread anywhere else the nerves goes – like you said, it can go to the eye by itself. But reputable sources like the UHS.wisc link above and the Scottish Health Service (https://www.nhsinform.scot/illnesses-and-conditions/mouth/cold-sore) say to be careful with shaving or contact lens usage as they can spread the sore – no mention even of risk during first OB only. My sense is that I can ‘encourage’ spread on my face if I accidentally shave over a sore or somehow touch my sore and put in contact lenses – or even touch my saliva during an OB. Is this wrong? Are the sites above and people reporting situations like this just misinformed or overcautious?

It is wrong. The virus is in the entire nerve ganglia and once the infection is well established, the virus can move on it’s own but you personally are not going to move it. I cannot account for the errors in advice on line.

1a) In terms of spreading to my genitals or fingers, are all those cases during first OB only? Would only HIV or immune system cancer put me back at risk?

Autoinoculation almost always with first infection. I suppose there is a possibility if you are majorly immunocompromised that this could happen at another time – not certain.

1b) Part of my anxiety is it’s my first OB -even if I have IGG. The lab that reported positive IGG gave me a negative in August 2018, so I caught this in the last 6 months. My IGG of 3.2 seems low compared to other 15+ IGG values. Does that mean my immune response is not ‘fully established’ yet?

No. You cannot compare your value to others as different brands of tests have different ranges for positive – some go up only to 16 while others go up to 80.

2) The other anxiety I have is about even kissing a new partner. In reality, I was lucky enough to have a single pimple-like OB, one with no noticeable pain or clear prodorme. But that leaves me wondering whether an itch near that OB spot or elsewhere is prodorme. What signs should I look for -will it always be near that first OB spot? What cautions should I take with kissing a new partner? I don’t want to avoid a first date makeout session, but I’d feel bad for that to spread it.

Prodrome consists of tingling and a feeling of crawling under the skin. Outbreaks may come in the same location or at a different location – hard to say.

3) Thoughts on taking VZV vaccine for HSV 1?

NO!

BTW, you cannot know for certain if the bump that you experienced was herpes or not as no actual testing was done. You know you are infected yes, but you can’t know if that bump was herpes.

Terri

[merpalertParticipant]

(I purchased another round of 3 questions)

Speaking of what is and isn’t HSV, there is a new wrinkle in the IGG results.

I had a blood test on March 13th from Lab #1 (the one that gave me a positive igg result earlier) and my HSV1 igg came back negative – very low, like .02 where the value had been 3.1 before. The clinic said they retested several times but have no idea what happened. The doc suggested that sometimes igg goes down when symptoms fade, but he seemed to be quite uncertain.

So basically, my test history for HSV1 igg is:

August 15, 2018: Lab #1 negative at .02

Feb 15, 2019: Lab #1 positive at 3.2

Feb 16, 2019: Lab #2 negative at .02

March 13,2019: Lab # 1 negative at .02, same as August 15, 2018

I think it’s still likely that I have HSV1. It’s too coincidental for me to have a positive test when there’s a bump near the edge of my lip that a doc said looked more like a blister than an in grown hair – even if it wasn’t a grouping of blisters or burn or hurt much.

(I actually did a scrape test about 12 hours after I accidentally popped the blister that came out negative, but I don’t think that proves anything cause it seems to have dried out and there was no liquid at the time.)

1) Does the doctor’s explanation of positive igg vanishing cause my symptoms have gone make sense? I mean antibody levels would be elevated during OB, but it’s odd that they go down to basically a 0. Also IgM was never positive.

2) A lot of my anxiety is that this was a recent infection and I wasn’t past the safe period. What does this new negative test indicate? I’m inclined to believe it means that I have been infected for much longer since I didn’t really have a large OB or fever or sore lymph nodes. I was undergoing a period of intense stress and weeks of poor sleep when what could have been a blister occurred, so it might have just been extreme circumstances triggering something long dormant.

Thanks, Terry.

[Terri WarrenKeymaster]

What a confusing situation.
The doctor’s explanation does not make sense to me, no. I suspect that the two labs using different brands of tests. It is unusual for anyone with an index value of >3 on HSV 1 to then be negative, but the IgG tests are notoriously poor for HSV 1. If you want to know for sure if you have HSV 1, you should get a western blot
If the 3.2 is correct, it is not brand new infection but it would be just several weeks old. Or it could be very old infection. First, find out if you really have HSV 1.

Terri

[merpalertParticipant]

Hi Terri,

You’re right, it’s very confusing. It’s one thing if different testing facilities were giving me different results, but it’s the same lab using the same brand of test (I just confirmed with them) giving me very different results 1 month apart.

– Would you still say it’s most likely that I have HSV1?

– I should either (A) not have HSV1 or (B) have HSV1 but have it be mostly undetectable right? Either way, I shouldn’t be at risk of self-innoculation if my IGG was >3.0 at some point?

– I’m unclear about your comment on infection timing: “If the 3.2 is correct, it is not brand new infection but it would be just several weeks old. Or it could be very old infection.” It seems like you’re saying there’s no way to tell when the infection was given these confusing results?

– Do I really need a western blot? It’s quite a bit of money for a HSV1 test ($400 right?), and I’m not sure I’d be relieved to see a negative there when most of my future partners will likely have HSV1. It’s the idea of frequent active OBs and recent infection that made me feel very anxious. A positive, dormant HSV1 infection seems like the best outcome given current state of medicine.

– If I did do a western blot, I should wait longer to do it right? My symptoms were in mid-Feb and last time I kissed someone would probably be early February.

thank you

[Terri WarrenKeymaster]

– Would you still say it’s most likely that I have HSV1?

I honestly have no idea based on this. It’s too wacky

– I should either (A) not have HSV1 or (B) have HSV1 but have it be mostly undetectable right? Either way, I shouldn’t be at risk of self-innoculation if my IGG was >3.0 at some point?

If the >3 is correct, yes, you should not fear autoinoculation

– I’m unclear about your comment on infection timing: “If the 3.2 is correct, it is not brand new infection but it would be just several weeks old. Or it could be very old infection.” It seems like you’re saying there’s no way to tell when the infection was given these confusing results?

I am saying that correct

– Do I really need a western blot? It’s quite a bit of money for a HSV1 test ($400 right?), and I’m not sure I’d be relieved to see a negative there when most of my future partners will likely have HSV1. It’s the idea of frequent active OBs and recent infection that made me feel very anxious. A positive, dormant HSV1 infection seems like the best outcome given current state of medicine.

If you don’t care so much about transmission and you are OK going with the positive result, then I don’t think you do need a blot. Or if you decide that it’s bugging you, then you could obtain it at a later time

– If I did do a western blot, I should wait longer to do it right? My symptoms were in mid-Feb and last time I kissed someone would probably be early February.

Yes, 12 weeks from then.

Terri

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