Hi,

I don’t have herpes (i’ve been tested several times for both HSV-1 and -2, and have been celibate for several years), but i’m encountering more and more folk who do, and i understand that it’s still a rather mysterious disease; hence, since i’m thinking of re-entering the dating scene soon, i’ve been looking over my notes on herpes and checking websites to see how our knowledge of it has progressed.

I have a few questions, and have given up trying to get through on the ASHA hotline (no fault of yours, of course, but i’ve called literally dozens of times, so i’m trying a different route). (By the way: the hotline voice message says that the hotline operates 8–8 when it should say 8–6.)



First: I’d like to know the credentials of whoever answers my questions. As you probably know, there’s a LOT of misinformation about herpes even among health professionals in America. I’m hoping you folk are abreast of the latest info.

Your webpage — http://www.ashastd.org/sexualhealth/ask ... herpes.cfm — raises questions that i’ve been wondering about, so i’ll use it as a reference.



ASHA website: “Once you are both infected with the same type of the virus (HSV-2 presumably in your situation), there is no need to use condoms or any other protection from herpes transmission since you cannot give someone ‘more’ herpes infection.”

This raises a few questions for me.

It’s my understanding that until one’s immune response is fully deployed against HSV-1 or -2, one is at risk of being newly infected with that virus in another part of one’s body either through autoinoculation or through interaction with someone else carrying that virus. Is this correct? I ask because some herpes websites claim that the risk of fresh infection with the same virus by autoinoculation or a partner carrying that virus is zero after that virus’ first lesion outbreak, but that’s an unhelpfully vague rule-of-thumb since many folk are so asymptomatic that they don’t realize they have HSV-1 or -2 till years after they’ve contracted it. I know that for blood-test results to mean much in asymptomatic cases the blood must be drawn six months after possible infection because some people produce detectable quantities of type-specific HSV-1 or -2 antibodies within a few weeks of infection, and others take as long as six months. So, does this also mean that for several weeks to six months after initial infection (with HSV-1 or -2) one is at risk of being infected again with that virus in another part of one’s body either by autoinoculation or by a partner carrying it? (I’m being very careful and redundant with my terminology because i understand that HSV-1 and -2 sometimes birth nearby secondary infections by creeping along nerve paths — which is not the kind of new, fresh, or secondary infection i’m asking about.)

A related question is: What happens when one’s immune system grows chronically compromised due to stress, age, HIV infection, environmental toxins, chemotherapy, etc.? In other words, does a compromised immune system (which eventually happens, one way or another, to everyone) create risk of one’s being infected again with HSV-1 or -2 in another part of one’s body either through autoinoculation or through interaction with someone else carrying that virus? If so, i think it would be helpful for folk to have this possibility in the back of their minds so that they can take precautions against it when their immune systems become compromised. (I know that a compromised immune system tends to increase the frequency and severity of lesion outbreaks — which, i know, is a separate issue, but it does make me wonder about the possibility of multiple infections by the same herpes virus; hence, my question.)



ASHA website: “If you are both infected with genital HSV-2, it is very unlikely that you can acquire HSV-1 genitally from someone else’s mouth during oral sex.”

Why is contracting both HSV-1 and -2 in the same area unlikely? And what if the scenario was reversed, i.e., what if a person already had genital HSV-1; would this mean that contracting genital HSV-2 is unlikely?



ASHA website: “Also, it is difficult to acquire HSV-2 in your mouth from someone else’s genital area that is infected with HSV-2.”

Why is oral HSV-2 so rare when genital HSV-1 is now so common? Traditionally, HSV-1 was always seen in or around the mouth, and HSV-2 in or around the genitals and anus, but the prevalence of oral sex for the last few generations means that we can no longer make this assumption. Our current knowledge of herpes suggests that, in the developed world at least, HSV-1 is now prevalent both orally and genitally; health authorities like the University of Maryland School of Medicine say that HSV-1 causes approximately 50% of genital herpes cases these days. But HSV-2 has not paralleled HSV-1’s migration, i.e., HSV-2 is still primarily found genitally (which is to say, HSV-2 can infect our mouths, but, for some reason unknown to me, rarely does). Which raises the question: Why is oral HSV-2 still so rare? Do we know?



Those are my questions. I’m guessing that others might be interested in the answers, too.

I’m forty years old; hence, i’m meeting (and dating) folk with herpes more often as i age — sadly, i tend to know more about herpes than they do (i mostly fault America’s capitalist health system for that). In any case, i prefer to understand the primary and secondary risks of health choices i’m making (especially when there’s an epidemic). And i’m trying to be an informed sexual citizen for everyone’s sake.

Can you dispel these mysteries for me? Or direct me to someone who can (who won’t charge me a $100)?

Thanks so much for your time and attention,

Ben

the length of time it takes for the body to produce detectable igg antibodies has nothing to do with your body mounting a protective response to being infected further with herpes. The first few weeks you are vulnerable but after that, no longer an issue. I always recommend when both partners are infected, you wait until the newly infected partner's initial ob has completely cleared up before resuming sex. if both partners have hsv2 going into the relationship, just avoiding performing oral sex on obvious genital symptoms is recommended to err on the side of caution even though the risk of contracting hsv2 orally later on is incredibly low. Normal mouth flora isn't so normal in an open genital lesion so it's best overall to avoid it.

hsv2 appears to protect against hsv1 infection but not vice versa. we don't know how much hsv1 genitally would protect against hsv2 genitally because it's hard to study that but it's assumed that it doesn't provide any significant protection against contracting hsv2 genitally which is why both partners knowing for sure what type they have genitally is important.

to greatly simplify it, hsv2 just doesn't "like" the oral area. It's not its site of preference and it just doesn't seem to like to infect there. so why did hsv1 seem to adapt better to infecting the genital area but hsv2 hasn't to infecting the oral area? well we don't really know. Forget which study it was that looked at old cultures that were frozen from the 80's ( or some point ) and found that hsv1 genitally was actually a significant cause of infections genitally just no one was typing cultures and just assuming that they were all hsv2 since they were genitally. It's not really that hsv1 has adapted recently to infect the genital area easier, it's that we are typing cultures more often to know as well as less teenagers /20somethings aren't contracting hsv1 orally as children so that they are more vulnerable to hsv1 genital infections once they are sexually active. Our grandparents had rates of oral hsv1 infection around 50% by the time they graduated from high school and now the rates of hsv1 oral infection are closer to 30% at that age.

As a male, if you had a hsv2+ female partner, you avoided sex anytime she had anything going on genitally, used condoms properly and she was on daily suppressive therapy with valtrex, you would be 99% likely each year NOT to contract hsv2 from her over the course of each year. Very low risk in general as long as your partner is aware of their infection.

As to my qualifications, I am an RN and a herpes patient advocate.

hope that helped with your questions you had

betsy

_________________
ASHA Moderator

Thanks so much for your reply, Betsy. I appreciate your candor, I feel better having a more accurate understanding of HSV-1 and -2, I’ll pass this info onto my friends, the science of this stuff is fascinating, and, as I mentioned in my prior post, I’ve been unable to get answers elsewhere — so I’m quite grateful to you and ASHA.

When I’m more regularly employed, I’ll definitely make a donation.

If I may, I have a few follow-up questions …



I’m lost in the syntax of your sentence: “Normal mouth flora isn’t so normal in an open genital lesion so it’s best overall to avoid it.”

Since I assume there’s no mouth flora in a genital lesion, I’m further assuming you were distracted when you wrote that. In any case, I don’t understand it. Do you mean that a genital HSV-2 lesion brings with it more virus shedding than during asymptomatic shedding — an amount that might be too much for normal oral flora to neutralize, or crowd out, during oral sex?



And I’m still confused about details regarding the immune response pertaining to HSV-1 and -2:

As I understand you: On one hand, you’re saying that every person is immune to autoinoculation (and further infection by a partner) within a few weeks (i.e., less than a month) after initial infection — it’s “no longer an issue”. This is true even when they’ve, at that point, produced too few antibodies to be detected by our most sensitive blood tests. On the other hand, you’re saying that HSV-2-positive partners should always abstain from performing oral sex on genital HSV-2 symptoms, even years after their initial infection, due to something about oral flora.

I’m confused. If one’s body has adequate numbers of antibodies (against HSV-2, in this case) in the blood stream, then the nature of oral flora, rectal flora, or any other flora is irrelevant, yes?

I’m keen on having a clear understanding of these details since one’s immune system is a matter of antibody production (as i understand it). If we have inadequate quantities of the relevant antibodies, then we’re susceptible to an infection. Conversely, if we have adequate quantities of the relevant antibodies, then we’re immune to an infection. Correct?

Which brings me back to a question i asked earlier:

What happens when one’s immune system grows chronically compromised due to stress, age, HIV infection, environmental toxins, chemotherapy, etc.? Which is to say, what happens when one’s production of antibodies plummets? Does a compromised immune system (which eventually happens, one way or another, to everyone) create risk of one’s being infected again with HSV-1 or -2 in another part of one’s body either through autoinoculation or through interaction with someone else carrying that virus? If so, i think it would be helpful for folk to have this possibility in the back of their minds so that they can take precautions against it when their immune systems become compromised. (I know that a compromised immune system tends to increase the frequency and severity of lesion outbreaks — which, i know, is a separate issue, but it does make me wonder about the possibility of multiple infections by the same herpes virus; hence, my question.)



Thanks in advance for your patience with me,

Ben

no I didn't make a mistake when I typed about normal mouth flora not being normal in an open lesion when I was discussing why not to perform oral on active genital lesions when both partners have hsv2 genitally. A herpes lesion is an open portal into the body. the normal germs in our mouth that don't cause us any issues day to day, can be an issue and cause us infections when they are introduced into an open wound anywhere on the body so overall, no one should be performing oral sex on active genital lesions. same goes with if someone has an active cold sore, they should never perform oral on a partner because what are normal germs in the genital area, aren't so normal when introduced into an open wound on the mouth. make more sense?

General immune system compromise still isn't much of an issue if you have a well established herpes infection. It's more of an issue if you contract herpes when you are undergoing chemotherapy or have hiv etc. Herpes recurrences can be difficult to treat in those situations also but in general it's still not a risk of the virus ending up on other body parts.

betsy

_________________
ASHA Moderator

Thanks, Betsy.

- Ben