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Background/Facts. I am male; I dated an HSV-2 positive woman (genital). In mid-Oct. 2015, we kissed and had unprotected sex–including intercourse; I did not perform oral sex on her, though she did on me. In early Nov. 2015 I developed one small lesion (red bump) on my upper lip edge (like pimple w/o a head and no fluid/crusting); I had no genital lesions. My lip lesion lasted two weeks. Prior to then, I have never had mouth or genital sores. About a week after the lip lesion appeared, I saw my doctor/got swab test; it tested negative (HSV 1/2 DNA). I was put on Valcyclovir 500 mg for 10 days. In mid-Jan. 2016, took blood test: IgG for HSV-1 = < 0.10; IgG for HSV-2 = 2.31. HSV 1&2 combined IgM = 0.33. In May 2016, I had another similar lip lesion (one week); swab test negative. No oral lesion since, and never any genital lesions. Now dating a woman who believes she is HSV 1&2 negative; I have encouraged a blood test.
Questions – 1. Since I have HSV-2, is it likely that I have oral HSV-2? How likely might it be that I contracted genital HSV-2 concurrently, even though I did not exhibit any genital lesions in Nov. 2015? Is there any reasonable way of determining whether I might have HSV-2 genital herpes? Assuming that I only have oral herpes but not genital herpes, to what extent might that lower my contracting of genital herpes?
2. Does the IgM test (I know you don’t like) provide any evidence of when I may have contracted HSV-2? E.g., does it suggest that I may have had HSV-2 (e.g. genital) prior to Oct.2015?
3. What is the likelihood of transmitting HSV-2 through kissing? I take Valcyclovir daily to lower the risk.
4. The likelihood of transferring HSV-2 to her breasts if I kiss/suck them?
5. Thoughts on transmission regarding other forms of sex? That is, intercourse either with or without a condom? Her performing oral sex on me? Me performing oral sex on her?
6. She had shingles in her 40s; how might that impact potential transmission? -
Questions – 1. Since I have HSV-2, is it likely that I have oral HSV-2? How likely might it be that I contracted genital HSV-2 concurrently, even though I did not exhibit any genital lesions in Nov. 2015? Is there any reasonable way of determining whether I might have HSV-2 genital herpes? Assuming that I only have oral herpes but not genital herpes, to what extent might that lower my contracting of genital herpes?
We do not know that you have HSV 2. IgG test index value is in what we call the low positive range. This range runs from 1.1 to 3.5 and within that range, 50% of the positives are false positives. The Center for disease control recommends that each person who gets an index value in that range obtain a confirmatory test such is the herpes Western blot. I don’t think I would be concerned about this until you obtain a confirmatory test that says you actually have HSV 2.
2. Does the IgM test (I know you don’t like) provide any evidence of when I may have contracted HSV-2? E.g., does it suggest that I may have had HSV-2 (e.g. genital) prior to Oct.2015?
It isn’t just me that doesn’t like this test. The Center for disease control says it should never be used. I cannot comment upon this test any further except to say that it is terrible
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3. What is the likelihood of transmitting HSV-2 through kissing? I take Valcyclovir daily to lower the risk.A person who tests positive for HSV-2 that has been confirmed buy the best test should consider themselves infected genitally, even if they have no symptoms. Not orally. Your repeated negative swab test from the oral area suggest that these are probably pimples and not cold sores.
4. The likelihood of transferring HSV-2 to her breasts if I kiss/suck them?
Very close to zero and zero if the Western blot says you do not have HSV 2
5. Thoughts on transmission regarding other forms of sex? That is, intercourse either with or without a condom? Her performing oral sex on me? Me performing oral sex on her?
Again, it is important that you obtain a confirmatory test. if you are infected genitally, and have sex about twice per week without daily antiviral medicine or condoms the risk of her acquiring infection is about 10% per year. Condoms reduce transmission by 96% an antiviral therapy reduces transmission by 50%. She could acquire this orally by giving you oral sex but that is not common. If she is uninfected with HSV-2 then you giving her oral sex does not present a risk since it is highly unlikely that you have HS V2 on your mouth.
6. She had shingles in her 40s; how might that impact potential transmission?
If this was indeed shingles it has no impact on transmission
Terri
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6) Any reasonable way to determine that I have genital HSV2 (though never any lesions)? PCR swabs daily over a period of several weeks? If that is not positive, does oral HSV2 lower likelihood of getting genital HSV2. What likelihood of concurrent oral/genital? Why wouldn’t I have had genital lesions if I got HSV2 in October 2015. Could I have gotten earlier?
If you did not give her oral sex, there is no way for you to get HSV 2 on your mouth unless you got it from some previous partner. You could have genital infection without lesions or you could have gotten this years ago and not recognized subtle symptoms. I can’t tell you for certain that the oral sores are not herpes but with a negative PCR, it suggests that they are not herpes.
7) She has concerns about kissing. Likelihood of transmission through kissing, including deep kissing? I am taking daily valacyclovir. Transmission for kissing/sucking her breasts? Kissing eyelids? Any % likelihood over a year?
I am not really concerned about kissing (assuming you are HSV 1 negative).
8) Back to question 5, above. Transmission genitally with sexual intercourse while on daily valacyclovir, with and w/o condom? Your earlier comments say condoms reduce by 96%. Seems high; is that a typo (48%)? Her performing oral sex (assuming I have genital HSV2). Would a lot of sexual intercourse that may break skin on penis affect transmission? Transmission by oral to her?
No, it is not a typo. It is in the literature. There is a small risk of transmission to her mouth if she gives you oral sex but only a small risk. Breaking the skin isn’t any different than unbroken skin on your penis
9) She is concerned about her immune system- got shingles at 34 (not 40s), w/ painful periodic outbreaks; a palmer wart, still present, is being difficult to remove. To what extent might her immune system, if compromised in some way, affect likelihood of transmission? Can she be tested or work with immunologist? Any way of predicting how her body may react were she to get HSV2 genital.
Shingle in the healthy adult rarely recurs even once – only 4% of people who get shingles once ever recurs. So recurrent painful recurrences – hope. Sounds like it could be herpes to me.I am assuming she has had an IgG test for herpes and had the shingles recurrences swab tested for VzV?
10) For moment we are abstaining from any sexual intercourse. If she got oral HSV2, might that actually lower risk later of getting HSV2 genital?
Yes, it would serve essentially as a vaccine for genital HSV 2.
Clin Infect Dis. 2016 Feb 15;62(4):456-61. 2015 Nov 17.
Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples.Terri
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post-herpetic neuralgia (PHN) from shingles). Questions follow:
(1) What is your diagnosis about what is going on – the facial tingling in particular? Oral HSV?
So a swab test was negative for herpes? I guess I don’t know what the tingling would be then.
(2) She is likely only to have HSV-2 orally – don’t you agree? She seems clear case for only having oral HSV-2, right?
I don’t know if she has HSV 2 orally if her swab test was negative. With only a few pecks on the lips transmission to me seems very unlikely, especially if your lesions are HSV 2 – and we don’t know that because you don’t have a positive swab from a lip lesion, correct? I am assuming your blot was negative for HSV `1?
(3) The Shingles Foundation says that symptoms of PHN on face are likely HSV oral. Do you agree?
I would agree that shingles is not a recurring disease in the vast majority of people. And you said she has painful recurrent outbreaks. That just doesn’t fit with shingles. Where are her painful recurrent outbreaks of “shingles”?
(4) If she has oral HSV2, and doesn’t now have HSV2 genitally now, will she be essentially inoculated from HSV2, or is transmission (or auto transmission) genitally still possible?Yes, oral infection with HSV 2 essentially protects against genital HSV 2, but you have made some huge leaps here to come to that place.
(5) Your thoughts on likelihood of continued recurrence orally?Recurrence? Is there any evidence that we know these oral lesions are HSV 2? There is a lot of material here and perhaps I missed the statement of a positive swab from a lesion from either of you.
(6) What are your recommendations going forward?
I don’t have enough information to make a recommendation except to say if she is HSV 2 negative and you are HSV 2 positive, you should be on daily antiviral therapy and use condoms with intercourse.(7) She will get blood test again for HSV 1/2 soon; but what are your thoughts on other possible reasons for her lip and mouth lesions?
all sorts of things from pimples to other viral infections of the mouth could cause her symptoms. And I still don’t know the location of her “recurrent shingles”
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