Sexually Transmitted Diseases/Herpes? (HSV-1)

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Question
Mr. Behar,
     
     I am a twenty five year old male and my girlfriend is twenty one years old. We have been dating slightly over a year now. Recently what she thinks was a cold sore broke out on her upper lip. We did not take a picture but it sort of sagged her lip down some. This is the fourth day now and it is barley noticeable.

     Anyway she said she has been getting them since she was very little on and off. She said that she has never had anything around her pelvic region as far as she knows. She also is not even sure if they are cold sores but is just what she has been calling them. I have never had anything like that in my life and would like to do what I can to avoid them if I can.

     I was wondering if you could clear up as much as possible for me. Is it possible for us to still have a meaningful relationship without me catching the Herpes? Can I contract this from sexual contact, kissing, or touch? I am not sure what to do and we are afraid to kiss right now much less have sex right now.

     I tried reading through some of your past responses, but did not find anything exactly like that I am talking about. Also is there anyway to have a test done for for this virus? I heard that there are a lot of different tests, but they sometimes are not accurate due to when the virus is active.

     Basically how can I figure out if this is HSV-1 or even HSV-2? Then if we figure out it is say HSV-1 what can I do to avoid it if anything? Right now we are trying to avoid contact which is making us both feel terrible. It is making me feel sorry for her and I am guessing she is feeling embarrassed, "dirty", or something along those lines.

Any aid you could give would be greatly appreciated.

Answer
Hello Jordan,
You may wish to readjust your attitude about herpes. Nothing to feel dirty, embarrassed or anything else.

It is just a virus that infects the peripheral nerves usually around the nose and mouth and or anogenital area, and when it is active (or activated), blisters will appear where the virus may have been initially implanted (usually when an infant or child from a playmate or adult who kissed the child). There are 8 different viruses that comprise the family of herpesviruses, including herpes types 1 & 2, chickenpox (varicella zoster), infectious mononucleosis (Epstein Barr), and a few others.  They all share the common attribute of "once infected, always infected" and capable of reactivation.  Herpes 1 & 2 may reactivate in response to unusually stressful physical, psychological, or environmental stressors. About 80% of all American adults have been exposed to and infected with either herpes 1 and/or herpes 2.

Herpes (either 1 or 2) is best diagnosed with a swab and a DNA test that is commonly available, if a suspected lesion is present. Blood tests are more difficult to interpret, but can sample blood for immediate antibody (IgM) or chronic (convalescent) antibody (IgG) for either HSV 1 and/or HSV 2.  The health care provider ordering the test usually orders something that they can't well interpret, leading to confusion.  

So if girlfriend had the correct blood antibody tests when she had a cold sore, the IgM would be positive; since she's had multiple episodes, the IgG would also be positive.  If it was a first episode, only IgM would be pos; IgG would be negative and wouldn't become positive until perhaps a month after it healed.

Some people confuse "cold sores" (herpes) with "canker sores" (stress induced ulcers without viral cause), or mouth ulcers caused by other viruses (such as coxsackie virus).

So if any sex partner or other friend or relative kissed you on chapped lips, and they were actively shedding herpes virus, then you too would probably become infected, develop a fever blister/cold sore/herpes ulceration, and then have the possibility of having recurrences as well. Such viral shedding may occur up to a day or so before an active blister actually appears. Spread of the virus can occur from whereever the virus is (mouth, penis, vagina, anus, etc) to a similar area in the other person. The virus must get into the body through a break in the skin, not from just touching.

Hope this is helpful, and if it generates more questions, write back.

Good luck!
--mark  

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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