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    Includes Expert Content
    HSV1 and 2 Transmission
    cmm1964 posted:
    Prospective partner has HSV 1 orally, I have HSV 2 genitally, can you please explain transmitability.
    betsyo1967 responded:
    your partner is vulnerable to your hsv2 infection.

    have you discussed what precautions you plan to take together?
    Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
    cmm1964 replied to betsyo1967's response:
    I have read that his oral HSV 1, gives him some protection against aquiring HSV 2 and visa versa. I have also read that HSV tends to be more prevelant in its site of preference.

    Yes, we have begun STI discussions and I want to have accurate facts to present as we discuss further. I have revealed my HSV status and that is how I learned of his.

    I have had one HSV2 swab culture come back positive in August 2009 (I had gotten ill and went for testing) and the IGM and IGG blood tests soon after was also positive. I have never had a lesion, I went for testing because I was in pain and very sick). Since then, I have never had a positive blood test or swab (I know it sounds odd as the IGG blood should be positive forever but for some reason not with me). I have seen an infectious disease specialist because I was confused and he said based on the positive culture in 2009, I have HSV 2.

    Your feedback on all would be appreciated. Also, if you think I should get additional testing, please advise as to which test. Last, precautions to take would be helpful too.

    Terri Warren, RN, ANP replied to cmm1964's response:
    I would agree that if you had a positive swab test for HSV 2 and a positive IgG at some point, you likely have HSV 2 infection. Why did you have a swab test is you never had a lesion?

    cmm1964 replied to Terri Warren, RN, ANP's response:
    Good morningTerri,

    To answer your question, I had the swab done in August 2009 because I had gotten very ill vomiting, headache, vaginal discomfort and lower extremity pain. I went to my general doctor during this illness as well as my GYN. I was sick for over 2 weeks, although the vomiting only lasted a day or so. I also believe there may have been a fever. It was horrible. There was no vaginal lesion but a red area and lots of vaginal pain. My GYN swabbed and the culture came back HSV positive (it was not typed to be I or II). In September 2009, my partner at the time was HSV II tested with results of positive IGG (3.22), I had positve HSV II IGM (4.47). In October 2009 both our HSV II IGGs were positive his was 3.73, mine was 1.61. In February 2010, I was tested again and IGG was elevated slightly, .94. In April 2011, I was blood tested again, IGM was 1.80, IGG negative. In May 2011, I had a red area/discomfort vaginally and I went to GYN cultured negative and IGG blood tested negative. In October 2011 again red area /discomfort vaginally, cultured negative, no bloodwork done.

    I am taking 500 mg of valtrex daily. I recently saw my GYN again for the red area/discomfort vaginally and am awaiting the results of the bloodwork and culture. The GYN had told me as soon as the symptoms come get in right away and be that is what I do.

    It is difficult because, I had a postive HSV swab in 2009 and based on that, I have HSV (that took quite some time to wrap my brain/heart around). However I keep running to the GYN each time this reddness/discomfort occurs and the culture keeps coming back negative. Another important note is that this vaginal issue occurs approximately every other month around ovulation. Could this possibly be yeast or pre menapause?

    Terri, if you have any feedback/thoughts, anything that could help, I am completely open to hearing. By the way several years ago I printed your handbook and recently ordered your book "the good news about the bad news" which I need to pick-up at bookstore.

    betsyo1967 replied to cmm1964's response:
    Terri's book is terrific

    odds are your lesion cultures will come back negative when you are on daily suppressive therapy. If your partner is negative for hsv2, avoid sex when you have anything going on genitally - including redness and itching.

    have they been testing you for yeast and bacterial infections vaginally when you go to be seen?
    Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
    cmm1964 replied to betsyo1967's response:
    Good morning Terri,

    I began reading your book and had a few questions I hope you can clear up. Before I launch into them, I will tell you that I believe I have been getting mis-information from my OB doctor. That said, here are my questions.

    1. Prospective partner has oral HSV 1, I have genital HSV 2. What are each of our risks of infecting the other orally or genitally? Does his HSV I status provide some immunity to HSV 2?

    2. I am on daily suppresive therapy (Valtrex, 500 daily) but still contending with outbreaks, When this occurs, I run to OB doc for culture and blood work. Doc told me that using daily suppressive and zovarax would not segue results but in your book it seems to say that swabs and blood would be effected by daily suppressive. negative IGM/IGG blood and swabs may not be accurate, due to daily suppressive, correct?

    3. I tried generic Valtrex as it was a much lesser copay but do not think it works, have you heard this from others?

    4. My outbreaks seem to occur around ovulation, and lately along with vagina symptoms, I have been getting anal rashes as well, OB doc said didn't think this was herpes, but cultured it per my request and came back...negative. In reading your book it seems that this may in fact be herpes just traveling via another route, correct?

    5. Recently, I notice when vaginal symptoms occur, I also get a small water blister inside my mouth. I am at wits kissing out too?

    6. Have you heard of folks who are HIV negative benefiting from twice a day Valtrex or another form of suppressive therapy? My general practitioner mentioned a client it works for but whenI asked my OB if I could try that for 3 months and see if outbreaks diminish, he said he has never seem that work. Other than herpes, my health is excellent, eat healthy, exercise like a trooper, do not smoke, drink or do any drugs. Just trying to find a formula to reduce outbreaks.

    7. Do you know of any clinical trials that can participate in and how do i obtain a kit where I can swab at home daily to see how often i am shedding virus (will this be segued by valtrex and zovarax ointment)?

    Any insight would be greatly appreciate and I will continue reading your book.
    betsyo1967 replied to cmm1964's response:
    hsv1 doesn't provide any significant protection against contracting hsv2. hsv2 does however seem to protect against contracting hsv1 significantly though probably not 100%.

    correct, being on suppressive therapy would make it more likely you'd have false negatives on lesion cultures. if you are having recurrences more than 2-3x/year while on 500mg valtrex, discuss with your provider increasing to the 500mg 2x/day dose or the 1gm daily dose to see if that helps.

    generic valtrex works the exact same. it's the same medication.

    odds are your anal rashes aren't due to herpes. continue to be seen when you have them. make sure they are testing you for yeast and bacterial infections vaginally as well as considering external yeast around the anal area as a cause.

    symptoms inside the mouth typically are not oral herpes. be seen when you have this - it might be a mucocele.

    if you have 9 or more ob's a year of hsv2, you need the higher doses of valtrex even if you don't have hiv. the prescribing info is very clear about this. to see if any herpes related trials going on in your area to participate in.

    you can't afford daily swabbing to see when you are shedding the virus

    zovirax ointment is ineffective for herpes recurrences genitally. don't waste time or money on it!!
    Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
    betsyo1967 replied to betsyo1967's response:
    also usually if recurrences aren't reduced significantly with suppressive therapy in the right doses, it's not a herpes related issue causing your symptoms. continue to follow up every time you have genital symptoms for further work up with your gyn. if you aren't happy with your current gyn, consult a different one.
    Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
    cmm1964 replied to betsyo1967's response:
    Thank you for both your replies. I will say that zovirax ointment does provide relief for me. I know you said don't waste time or money but...on that one I have to disagree. It really relieves discomfort (maybe of bacterial or yeast that I think is HSV, who knows at thsi point).

    I want to try 1000mg once daily and will press OB about that again. If he doen't go for it, my primary care doc would write appropriate script for me. I just need to make appointment and ask.

    I was diagnosed with HSV in August 2009. This year since January 2011, I have been trying to track my outbreaks - I think I am currently coming out of outbreak 6 for the year. It seems outbreaks are around ovulation and probably last about 10 days however one in August 2011 lasted 2 - 3 weeks (but may not have been hsv as there were many anal syptoms) Cultures (vaginal, oral and anal) keep coming back negative but as you said suppressive therapy may be seguing results. Yes, I will ask that bacterial infections and yeast be looked for as well.

    Will IGG blood work also be negative to due to suppressive therapy?

    All that said, if I lived on the opposite coast I would make an appointment with Terri. I have thought about flying out there or requesting a phone appointment. It just seems that medical professionals don't know too much about this. I am trying to be a trooper but the outbreaks do bring me down a bit, but despite them, I keep plugging . I was hopeful that suppressive therapy would rid me of them....

    Thanks again, and please let me know your thoughts on suppresive therapy and its effects on bloodwork results.

    I will not worry about mouth issue being HSV and will kiss with glee - lol.

    Be well and have a wonderful day
    betsyo1967 replied to cmm1964's response:
    how were you originally diagnosed as having genital herpes? what testing was done?

    sounds like the ointment part of the xovirax ointment is what is giving you comfort. it has nothing in it for pain relief.
    Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
    cmm1964 replied to betsyo1967's response:
    I had a vaginal culture in August 2009, no lesion was present. It came back HSV positive, it was not typed to be 1 or 2. In September 2009, my partner at the time was HSV II tested IGG (3.22) and I had positve HSV II IGM (4.47). In October 2009 both our HSV II IGGs were positive his 3.73, mine 1.61. In February 2010, I was tested again and IGG was .94. In April 2011, I was tested again, IGM was 1.80, IGG negative. And now blood always comes back negative for me. I am no longer with this partner.

    I am so confused but I go with the fact that since the culture came back positive, I have HSV. Even though current my bloodwork does not seem to support that.
    betsyo1967 replied to cmm1964's response:
    you can always stop suppressive therapy completely and be seen every time you have symptoms for repeat lesion cultures and typing to confirm to know for sure. it would be worth increased ob's to get the answers you are seeking don't you think?
    Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
    cmm1964 replied to betsyo1967's response:
    Okay so here's the update: I thought I was having an outbreak, went to OB doctor and had swab done and asked to have blood work done as well. Swab came back negative but blood came back positive 6.00. Unfortunately, the lab messed up the test and did not type the blood. I went back to lab to have bloodwork redone but by that time I had doubled up on Valtrex to treat the outbreak.

    Can suppressive therapy seque the blood test result?

    Also, my doctor did agree to let me try valtrex 1 gram daily. I had started taking 500 mg daily in August but continue to have symptoms. Very frustrating....hoping that 1 gram daily will reduce outbreaks. Have you encountered folks for whom valtrex does not work. If yes, can you provide feedback on what did work for them.

    Thank you.
    Lookingforanswers replied to Terri Warren, RN, ANP's response:
    Hello Terry,
    I have two questions. I have HSV 1 genitally and my ex is negative for all STDs...he gets tested every few months with his most recent negative HIV and HSV titers negative this past week.
    1. Do you know of any point of care rapid swabs that can be performed at home to check for viral shedding? I am taking valtrex but he is still concerned about shedding. I know someone else asked about the daily swabbing to check for shedding but plan is to only do the swab if we plan to be intimate, and I am pretty sure he will purchase the swabs.
    2. Is there an literature on the HSV negative person taking daily valtrex prophylactially against getting HSV?

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