new HSV I infection

[really]

Hello Terri,

I’m a senior female and one of the 20% that never had a cold sore! Until now!

About 3 days after a sexual session with a new lover of about 3 months, I had a large outbreak of sores (about 10 visible) in my genital area (on the outside of my vagina – beginning of thigh area, as well as on my labia and inside my vagina). I also had a low-grade fever. I went to the GYN ASAP, which was about 5 days after symptoms appeared. She visually identified the outbreak as herpes and performed a culture/swab test that came back showing HSV-1 as positive and HSV-2 as negative. At this first office visit I was started on Valtrex (500 mg 2x/day for 10 days and then just 1x /day. Total time on Valtrex was 5 weeks). One week after my initial visit, my GYN gave me the IgG blood test –Type I and Type II were both negative. My lover’s Herpeselect IgG blood test was Type I -positive and Type II- negative (4.73 for I, less than.90 for II). He had never noted an obvious cold sore or anything else to indicate herpes. In retrospect, he did have a sore and crusting on the interior end of one nostril during the lovemaking session in question, but he had equated that with the dry interior air that comes with the winter heating season. I also spotted blood vaginally after the session in question. He performed oral sex on me with nasal involvement. We are assuming this was how the infection was transmitted and that he has HSV 1 orofacially because he reports no sores have ever shown up on his penis or in his genital area. After the 5 weeks of Valtrex therapy and elimination of sores and symptoms, my GYN and I have decided to stop Valtrex to see what will happen. One of the main reasons I want to do this is because I understand that Valtrex can delay the formation of antibodies if taken at the beginning of a primary infection.

How long should I wait to have another IgG test while off the Valtrex to allow time for my body to create antibodies? Can my lover and I kiss, have intercourse, and oral sex now since I “have it” or do we wait until I have antibodies so that I don’t contract it orally. Is there also a risk of autoinnoculation before antibodies are formed? Does having antibodies and an HSV 1 infection in one location mean it is impossible or just unlikely that you will get it in another location? What are the odds? When he performs oral sex on me, depending on our positioning, my vaginal secretions and genital area involves his mouth, but peripherally might involve his whole face (nose, eyes…) How dangerous is this going forward if he already has the antibodies?

[Terri Warren]

I don’t think you need to stop Valtrex and get another IgG antibody test. Why would you? You had a positive HSV 1 swab test which is totally an adequate diagnosis. The test isn’t great for HSV 1 to start with and the antiviral therapy can keep antibody development at bay for months, maybe years! Having HSV 1 infection that is well established (read that as four months without antiviral therapy) will keep you from getting it at a new location on your body. He has no risk of giving you oral sex – he already has well established HSV 1 infection. You can kiss, have intercourse, and have oral sex. You can fly over the moon! You are all set. HSV 1 is unlikely to recur frequently if at all. You guys are all set together as far as HSV 1 infection is concerned.

Please ask more questions as you have them.

Terri

[really]

Sorry.I posted my response below as a new topic (new HSV I infection part 2) not knowing how to continue on this thread. I just figured it out and am reposting so my response has continuity.

Thank you for your response Terri. However, I am confused by some of it.

First, you say “I don’t think you need to stop Valtrex and get another IgG antibody test. Why would you?” Then you say “The test isn’t great for HSV 1 to start with and the antiviral therapy can keep antibody development at bay for months, maybe years! Having HSV 1 infection that is well established (read that as four months without antiviral therapy) will keep you from getting it at a new location on your body.” I don’t want to get it on another part of my body, which as you say, I can if I haven’t developed antibodies. In order to develop those antibodies, you say I have to be four months without antiviral therapy. That is primarily why I want to get off the Valtrex, so that I can develop the antibodies and be resistant to getting an infection orofacially. Being on Valtrex doesn’t offer immunity to getting it in another location if I haven’t yet developed antibodies right?

Secondly, your saying the IgG test isn’t great for HSV 1 antibody detection confuses me. When you say “The test isn’t great for HSV 1 to start with” are you saying it isn’t as accurate for HSV 1 as it is for HSV 2? If so, how does my lover know that his test is accurately positive? Because his value is so high? Because I had a primary infection without antibodies? That is the second reason I want to get off Valtrex, to measure the fact that I have antibodies and am afforded protection by them.

Finally, I don’t want to take any more medication than I have to, so I thought I would just take it with this lover if I had another outbreak. I understand that if I have a seronegative lover in the future that I might consider going back on it.

Related to all of this, I don’t understand how the virus is prohibited from reinfecting an already infected individual in a different location on their body because they have antibodies circulating in their blood, yet the virus can repeatedly come out of dormancy and manifest itself as visible sores and/or if not that, shed invisibly. My understanding is that the only reason the virus isn’t eradicated from your body is because it takes up residence in the nerve ganglion corresponding to the original infection location. But doesn’t it have to come out of dormancy to manifest a sore or shed? And if so, once the virus leaves the ganglion and begins traveling down the nerve pathway to daylight at skin eruption or invisible shedding, isn’t it no longer protected from the antibodies and wouldn’t it be exposed to the antibodies and killed before day lighting on the skin surface? Or does the entire nerve pathway offer protection from antibodies and a potentially new infection hasn’t yet entered the nerve pathway and is therefore, somehow stopped in its tracks and killed by circulating antibodies? In other words, a primary infection occurs outside of the nerves and nerve pathway, where it can be killed by antibodies, but, after a time, enters the nerve pathway and from then on it is protected from being eradicated by antibodies whether it is dormant in the nerve ganglion or not.

[Terri Warren]

You don’t need an antibody test because you have a positive HSV 1 swab test. If you take antiviral medicine, the medicine will kind of take the place of the immune response that keeps the virus in check and eventually you will develop antibody though it can take a while while on medicine. If you want to stop Valtrex that’s fine, no problem. Transferring herpes to another part of your body is really uncommon and not something that I worry about very often thus my response. Also you could be infected orally already and just not have any symptoms there, hard to know for sure. but really, you may be worrying about this perhaps more than you need to (getting it in a new place)

The problem with the HSV 1 test is with false negatives – it misses about 1-2 out of 10 infections. There is NOT a problem with false positives.

There are many parts to the human immune response, not just antibody. That’s just one “side” of the immune response – the other kinds of immune response are also important. If people easily got infected a new locations on their bodies, we would see people with herpes all over the place, particularly children who touch cold sores and their genitals all the time. but we don’t see that in children and we don’t see it adults very often at all, and when we do, the most likely explanation is that they acquired infection at two locations at the same sexual encounter.

Does that help?

Terri

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