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Zena Dec-28-99, 11:20 PM (CST)

"OK you websearching folks"

I need help finding some info. I have read soooo much about spreading HSV1 to the genitals, but have yet to find more than a blip about transmission of genital HSV2 to the mouth. If you have any info, or a link or two please let me know! Thanks!
Zena

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Table of contents

Oral HSV2, M'sMom, Dec-29-99, (1)
Here it is Sunny!, M'sMom, Apr-09-00, (28)
one more blip, windy, Dec-29-99, (2)
Thank you, Zena, Dec-29-99, (3)
about oral hsv2..., M'sMom, Dec-31-99, (4)
oral hsv2, windy, Dec-31-99, (5)
picking nits again, M'sMom, Dec-31-99, (6)
nits, windy, Dec-31-99, (7)
Nit picking too, Zena, Dec-31-99, (8)
Here's why I think..., windy, Jan-01-00, (9)
philosophy and statistics, M'sMom, Jan-02-00, (10)
Actually....., Zena, Jan-02-00, (11)
I think I understand..., M'sMom, Jan-03-00, (12)
this whole oral thing, yada yada, Jan-09-00, (13)
yada yada.., weed, Jan-09-00, (14)
Flavored concoms.., Rajah, Jan-09-00, (15)
(close, but) NO BANANA, M'sMom, Jan-10-00, (16)
hsv I, J, Jan-10-00, (19)
Really? Thanks..., M'sMom, Jan-10-00, (20)
wald notes a dramatic increase in...., ruby, Jan-11-00, (23)
One more thought...., M'sMom, Jan-10-00, (17)
you are right :), ruby, Jan-10-00, (18)
Gee wiz....., Zena, Jan-11-00, (22)
oral , windy, Jan-10-00, (21)
Quite a controversy I created here!, yada yada, Jan-12-00, (24)
a bone, windy, Jan-13-00, (25)
bones as well , J, Jan-13-00, (26)
Nice bones!, M'sMom, Jan-13-00, (27)
Oral HSV-2 redux , Layla, Dec-24-00, (31)
RE: Oral HSV-2 redux , Rajah, Dec-24-00, (32)
RE: Hi there!, windy, Dec-28-00, (33)
HEY LONGHORN!, M'sMom, Jun-07-00, (29)
Hall of Fame, Rajah, Jun-07-00, (30)

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M'sMom Dec-29-99, 00:54 AM (CST)

1. "Oral HSV2"

Zena-
You are so right - there isn't much readily available data on this, and interestingly, most of it is responses to questions. Here are the most relevant sites I could find, and they aren't much.
What little I could find to read, though, seems to indicate that oral HSV2 is the least common of the possible type/site combinations, and the least likely to recur. I wonder if that info matches with experience?

go to http://www.allhealth.com/conditions/infect/qa/ and search on oral herpes - you will get several relevant responses. I haven't used allhealth.com before, but I don't see anything in these answers that looks suspect. Perhaps others here have some additional commentary on this site.)
http://herpes.com/hsv1-2.html (this is a fairly comprehensive discussion of hsv - 1 and 2, oral and genital. If you read the whole thing, there is a lot of information about oral hsv2)
Luck,
M'sMom

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M'sMom Apr-09-00, 05:59 PM (CST)

28. "Here it is Sunny!"

Hope this helps.
MM

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windy Dec-29-99, 01:16 AM (CST)

2. "one more blip"

Zena,
Here's a response from Dr. Handsfield at UW to a question I asked about the possibility of having oral HSV2 and spreading it to someone else. BTW, the 10-15% figure comes from a 1988 study by Corey.
windy

"Although 10-15% of persons with initial genital herpes due to
HSV-2 have oral HSV-2 symptoms and/or lesions (often in the form of
pharyngitis), chronic recurrent oral HSV-2 disease is extremely rare.
Something about the virus and the host response markedly reduces the
likelihood of recurrences. Therefore, unless the exposure takes place at
or soon (a few weeks) after the acquisition of dual oral/genital
infection, oral sex is extremely unlikely to ever transmit HSV-2 to a
parter--either by kissing or by orogenital contact."

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Zena Dec-29-99, 02:51 PM (CST)

3. "Thank you"

for the responses! From Windy's article, I get the impression that oral HSV2 is usually coupled with a genital and oral ob. Well, the reason I am researching is because my ex has been told he has oral HSV2. He has no genital symtoms, will NOT seek another Dr.s opinion, and does not know what test he was given. He also will not go to another Dr. So, in a last ditched effort to help this stubborn person....got any ideas what I should tell him to do from here? My concern is that either he doesnt have HSV at all or worse has oral and genital.....
Peace~ Zena

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M'sMom Dec-31-99, 02:04 AM (CST)

4. "about oral hsv2..."

Zena,
I'm not sure that I read Windy's info quite the same way that you do. It sounds to me like Dr. Handsfield started out thinking of people who have genital hsv2 and went on to discuss their experience with oral hsv 2. *I* think that what he's saying is that about 10-15 percent of people who have genital hsv2 contract oral hsv2 at the same time, but that the oral symptoms of hsv2 are not likely to recur at all. I think he is implying that because the symptoms of oral hsv2 are rarely chronic, we can assume that very little oral shedding of hsv2 is going on, and so a person who has oral hsv2 to is very unlikely to pass it on except during their initial outbreak.
What I don't think Dr. Handsfield is talking about at all is a person who has an ORAL ONLY hsv2 infection, which could happen, although it doesn't appear very likely based on the data I've seen. Seems to me that the most likely scenario for getting oral hsv2 without also being infected genitally would be an instance an hsv- person had only oral sex with someone who was hsv and shedding, or by (only) kissing soneone who was having a primary outbreak of oral hsv2. Don't know if either of these scenarios could apply to your friend.
One question: how was it determined that he had oral hsv2? The only way I can think of to figure that our would be to culture a lesion. If he had a blood test, it won't tell him a darn thing about the site of infection. I can believe he wouldn't know what kind of tests were done on the samples they took from him, but he should be able to recall whether he was swabbed or stuck.
I'm really not sure there is anything else you can do for the guy. You could present him with the data you have and point out the holes in his current diagnosis, but it kinda sounds to me like he doesn't want to know. If there's any chance of you two hooking up again, I'd certainly behave as if he has hsv2 genitally as well as orally.
MM
DISCLAIMER: The preceding opinion is free, and comes without a warranty, express or implied.

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windy Dec-31-99, 08:55 AM (CST)

5. "oral hsv2"

Mom,
The original question I asked was if someone with hsv2 could transmit from their mouth to someone's genitals or mouth (assuming that the H person is one of the 10-15% that had oroopharyngeal symptoms during their initial infection).

>think that what he's saying is
>that about 10-15 percent of people
>who have genital hsv2 contract oral
>hsv2 at the same time, but
That number is from a study (Corey 1988)

>that the oral symptoms of hsv2
>are not likely to recur at
>all. I think he is implying
>that because the symptoms of oral
>hsv2 are rarely chronic, we can
>assume that very little oral shedding
>of hsv2 is going on, and
>so a person who has oral
>hsv2 to is very unlikely to
>pass it on except during their
>initial outbreak.
That is exactly what he meant.
>What I don't think Dr. Handsfield is
>talking about at all is a
>person who has an ORAL ONLY
>hsv2 infection, which could happen, although
>it doesn't appear very likely based
>on the data I've seen.
We didn't get into the 'oral only' discussion, but I'd assume that H2 would act the same orally regardless of whether there is concurrent genital infection or not. Now that I think about it, there are probably a number of these cases that go completely undiagnosed. How many people go to the doctor to get checked for STD when they have a sore throat and a fever with no genital symptoms? And even if they did, they're likely to be told that they have a sore throat and fever, and might get a prescription for antibiotics.
Seems
>to me that the most likely
>scenario for getting oral hsv2 without
>also being infected genitally would be
>an instance an hsv- person had
>only oral sex with someone who
>was hsv and shedding, or by
>(only) kissing soneone who was having
>a primary outbreak of oral hsv2.
Yes. You understand this biology stuff better than you think you do.

windy

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M'sMom Dec-31-99, 12:22 PM (CST)

6. "picking nits again"

Hey, windy,
Thanks for the clarification. One more boneheaded questsion, if you don't mind.
Both your question and Dr. Handsfield's response-

The original question I asked was if someone with hsv2 could transmit from their mouth to someone's genitals or mouth (assuming that the H person is one of the 10-15% that had oroopharyngeal symptoms during their initial infection).
"Although 10-15% of persons with initial genital herpes due to HSV-2 have oral HSV-2 symptoms and/or lesions ....."
- could be read to imply that 10 to 15 percent of people get both oral and genital hsv2 FROM THE SAME INFECTION. I didn't think that happened - my understanding was that if there was genital contact, you would have outbreaks in the genital region (or somewhere close by) and that if there was oral contact, your outbreaks would be around your mouth or throat. I think that the true situation is that you can get hsv both orally and genitally FROM THE SAME ENCOUNTER, but that there does have to be inital skin contact in both areas for this to occur. No?
Thanks
MM

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windy Dec-31-99, 03:11 PM (CST)

7. "nits"

The virus doesn't care how many place it infects. If it meets a host with no antibodies, there's not much to stop it. It'll go in any way it can - eyes, nose, mouth, genitals, anus, open cuts. So one could get multiple infection sites from multiple initial contact sites, or from one initial site and then autoinoculate or re-inoculate (in another encounter) other sites before there is time to make antibodies.
I assume that many people do have both oral sex and intercourse in the same encounters. I mean, it sure sounds like a good idea. It's probably safe to assume that all of the 10-15% who got both oral and genital infections got them at the same time this way. I know someone who got both oral and genital hsv1 this way.
windy
Here's the abstract -
Corey L
First-episode, recurrent, and asymptomatic herpes simplex infections.
In: J Am Acad Dermatol (1988 Jan) 18(1 Pt 2):169-72
ISSN: 0190-9622
Genital herpes simplex virus infections should be classified into
first-episode and recurrent infections. First-episode infections
include true primary infections in patients with seronegative results
who have never been infected with any type of herpes and nonprimary
first-episode infections in patients who have been infected before
and have serum antibody and humoral immunity, an example being
genital infection with type 2 in adolescence after orolabial
infection with type 1 in childhood. First-episode infections show
more extensive disease, more systemic symptoms, and greater viral
shedding than do recurrent infections. Ten percent to 15% of patients
with first-episode primary genital herpes have oropharyngeal
infections with the same virus strain. Herpesvirus can be isolated
from the urethra in about 30% of male patients with first-episode
infections. In recurrent vulvar herpes, virus can be isolated from
the cervix in 10% to 15% of patients. Many genital lesions that
clinically suggest something else turn out to be herpes; herpes may
be diagnosed 5% of the time clinically but cultures are positive 14%
of the time. Primary genital herpes type 2 infections recur about 95%
of the time whereas type 1 infections recur about 50% of the time.
Recurrences are highly unpredictable from patient to patient and time
to time. The role of asymptomatic shedding in the spread of herpes is
a major area for future study. Antiviral treatment is probably going
to change the epidemiology of herpetic infections very little.
Institutional address:
Department of Laboratory Medicine
University of Washington
Seattle.

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Zena Dec-31-99, 07:52 PM (CST)

8. "Nit picking too"

> "Although 10-15% of persons with initial
>genital herpes due to HSV-2 have
>oral HSV-2 symptoms and/or lesions (often
>in the form of pharyngitis), chronic
>recurrent oral HSV-2 disease is extremely
>rare.
OKay, this seems to be based on someone with initial genital HSV2 and the likelyhood of having oral HSV2 along with it.

Therefore, unless
>the exposure takes place at or
>soon (a few weeks) after the
>acquisition of dual oral/genital infection, oral
>sex is extremely unlikely to ever
>transmit HSV-2 to a parter--either by
>kissing or by orogenital contact."
So, this seems to say that very rarely does someone have only oral HSV2, yes? I want to clarify becuase that is the official diagnosis that I am seeking info on. From the info I have gathered, the numbers are very small for this to happen without also having genital HSV2.
Am I just dense?
Zena

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windy Jan-01-00, 11:12 AM (CST)

9. "Here's why I think..."

there's so little information on oral-only hsv2.
The study I cited, and the question and answer, all dealt with oral and genital infections that were acquired at or about the same time. They say nothing at all about oral-only hsv2.
The most likely way to find people who have hsv2 orally but not genitally would be if they have a visible outbreak that is recognized as herpes and cultured. Most likely, that person would have gone down on someone who was shedding, with or without symptoms, and they didn't have intercourse.
Since most genital infections go unnoticed, and since hsv2 tends not to affect the mouth as much, then it's likely to assume that most oral-only hsv2 infections go unnoticed or undiagnosed. Someone gets the flu and sore throat and doesn't connect it to the oral sex they performed last week on the partner who didn't know they had herpes. How many sore throats is that?
I'm not sure, but I don't think a herpes culture is a standard part of a throat culture. That might make a good study - h culture and typing on every sexually active person who comes into the clinic with the flu.
Below is the only paper I could find by searching Pub Med for "hsv2 pharyngitis", and I think it highlights my point about missing the hsv2 oral-only diagnosis (even though we don't know for sure if the father got it genitally or not).
I found more by searching "herpes genitalis AND (pharyn* OR orophar* OR nasophar* OR ocular)". Curious to note that Pub Med considers HSV-1 as a medical subject heading, but not HSV-2.

And to clarify:
>Therefore, unless
>>the exposure takes place at or
>>soon (a few weeks) after the
>>acquisition of dual oral/genital infection, oral
>>sex is extremely unlikely to ever
>>transmit HSV-2 to a parter--either by
>>kissing or by orogenital contact."
>So, this seems to say that very
>rarely does someone have only oral
>HSV2, yes?
No, this says that someone with genital and oral hsv2 is unlikely to give it to someone by kissing them on the mouth or by perfoming oral sex on the h- person. Only exception is during or right after the primary episode, when they are certain to be shedding virus from the mouth. I see no reason to assume that it would be different if the person had oral-only hsv2 (that MY assumption).
>genital HSV2. Am I just dense?
>
>Zena
>
Nope. Not at all. Tricky virus, tricky subject.

I hope this helps. I'll filter through the other stuff I found and share what's relevant.
windy

----------------------------------------------
Am J Perinatol 1999;16(1):43-5 Related Articles, Books

Sequential peripartum herpes simplex virus type 2 disease in parents and their newborn mimicking intrafamily spread of common viruses.
Klauber EV, Thirumoorthi MC, Khatib R
Scottsdale Medical Specialty, Inc., Arizona, USA.
Herpes simplex type 2 (HSV2) disease developed sequentially among two parents and their newborn. The father first became ill with upper-respiratory symptoms and fever. Then, 5 days later, shortly after delivery, the mother had fever, pharyngitis, and diarrhea. Subsequently, the infant developed undifferentiated febrile illness at the age of 3 days. HSV etiology was recognized by incidental isolation of HSV2 from the newborn naospharynx. The father never developed genital lesions and the mother's symptoms remained nonspecific for several days prior to the onset of genital manifestations. The sequential emergence and manifestations of these infections could have been misconstrued for an intrafamily spread of respiratory or enteric viruses. This cluster illustrates that HSV2 may cause sequential symptomatic disease in susceptible individuals mimicking other viruses.
PMID: 10362081, UI: 99288927

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M'sMom Jan-02-00, 12:11 PM (CST)

10. "philosophy and statistics"

Zena-
I suspect you are trying to decide just how reasonable your friend's "oral hsv2" diagnosis is. Here's some thoughts on that, based on the info provided thus far on this forum, along with the random firing of the neurons in my brain.
There are at least two major factors that play into the the frequency of oral only hsv2.
The first is the behavior of the virus. Oral HSV2 is probably significantly less frequent than genital HSV2 because the mouth and throat just aren't the site of preference for this strain of hsv. Give the opportunity to infect at any site, I'll bet the odds are highest that hsv2 wil infect the genitals. It may or may not infect some other sites, but I can't really think of any circumstances in which a person is likely to acquire hsv2 orally but not genitally if there has been contact in both places.
The second is the behaviour of humans. Think about the behaviours that allow the transmission of hsv.
Kissing: the most common "transmission act", and the reason that hsv1 is ubiquitous. However, in the case of oral hsv2, not much of a transmission threat since there is not likely to be viral shedding except during primary infection.
Intercourse: The way that most hsv2 infections occur, but this would result in a genital-only infection unless the person auto-innoculates their mouth or some other site. Question: how likely is a guy to do this? It would require that he touch an area of shedding and then his mouth. Not sure on this, probably depends on his personal habits.
Oral sex: This is the most likely way to acquire oral hsv2, but in order to get oral ONLY hsv2, you would likely have to have mouth to genital contact without genital to genital contact. (Going on the theory here that if circumstances allow oral hsv2 infection, they are probably even more encouraging to genital infection. I am not sure this is true, but it seems likely to me.) So: in what circumstances is this likely to occur? I can think of a few: Prostitutes (male or female) selling bj's; women using oral sex as a contraceptive measure or to avoid sex during menses; some instances of lesbian sex; anonymous "quickie" encounters (in this case I would bet that the recipient is more likely to be male, although the "giver" could be either.); men using oral sex as an alternative means of sexual expression (I may catch some flack for this, but I suspect this is kind of rare. It is my observation that the male of the species generally prefers to get socketed at some time during the encounter unless there are compelling reasons not to.)
I guess my point is that the likelyhood of acquiring oral only hsv2 may depend more on a persons sex habits than anything else. Might want to think that through in relation to your friend.
MM

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Zena Jan-02-00, 07:44 PM (CST)

11. "Actually....."

>I suspect you are trying to decide
>just how reasonable your friend's "oral
>hsv2" diagnosis is.
That was exactly what I am trying to figure out. Searching is soooo time consuming, either due to my ISP or my computer itself...I appreciate all the info I have recieved.

>The first is the behavior of the
>virus. Oral HSV2 is probably significantly
>less frequent than genital HSV2 because
>the mouth and throat just aren't
>the site of preference for this
>strain of hsv. Give the opportunity
>to infect at any site, I'll
>bet the odds are highest that
>hsv2 wil infect the genitals.
My theory as well.
>a person is likely to acquire
>hsv2 orally but not genitally if
>there has been contact in both
>places.
Also my theory.

>Oral sex: This is the most likely
>way to acquire oral hsv2, but
>in order to get oral ONLY
>hsv2, you would likely have
>to have mouth to genital contact
>without genital to genital contact. (Going
>on the theory here that if
>circumstances allow oral hsv2 infection, they
>are probably even more encouraging to
>genital infection.
Seemed likely to me as well.
men using oral sex
>as an alternative means of sexual
>expression
I guess that is why it still seems possible...
It was strictly oral for many months, with only a few geintal encounters. Even with that though, it still seems unlikely to me that he would have oral and not genital. There is of course that little bit of doubt that keeps me wondering....I will never know for sure and neither will he unless he gets some type specific tests done.
To answer a previous question, he was swabbed and stuck. By his own admission though, the Doc was not helpful, nor gave him any info. Well, thank you again!
Zena

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M'sMom Jan-03-00, 00:56 AM (CST)

12. "I think I understand..."

... your dilema now. Lots of opportunities for oral infection, just a few for genital. Oral symptoms, no genital symptoms, and (we think) a positive hsv culture orally and a positive blood test. The evidence points to oral only, but the odds go the other way.
Well, I have no solution, but I certainly admire the problem.
I don't see a way to ever be sure short of a genital lesion to be tested.
Luck,
MM

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yada yada Jan-09-00, 09:03 PM (CST)

13. "this whole oral thing"

Not much time to talk - I've recently been around this tree with some doctors I trust and the ASHA hotline. Their unanimous decision was to say that transmission genital to oral of HSV-II is possible, but highly improbable with very few consequences. Bottom line, the moral aspect for me (a male) is (according to them) if I have a random sexual encounter which entails oral sex only, it is not necessary to divulge my positivity for H-II genitally. So, my current girlfriend is mulling the whole issue over. I am really hoping to get a blow-job anyway soon. This may be our sex-substitute for the duration. This disease blows (pun intended/
The better, more interesting question: If my girlfriend gets the H-II infection on the mouth through oral sex, does she not become almost vaccinated against the disease genitally? Why not administer a "poor mans oral vaccine" to everyone who is worried about genital to genital transmission? Food for thought.
-yada yada out.

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weed Jan-09-00, 10:01 PM (CST)

14. "yada yada.."

Was that a theory or a fantasy?
/herpes/images2/coolsmil.gif

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Rajah Jan-09-00, 10:16 PM (CST)

15. "Flavored concoms.."

I can testify that HSV2 above the belt can be quite unpleasant. I got it on my left thumb at the edge of the nail and it caused severe discomfort and resulted in the nail having to be removed, a major ouchie. (It grew back.)
I suggest that you consider using flavored condoms if they cover your "hotspot"
Rajah

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M'sMom Jan-10-00, 01:16 AM (CST)

16. "(close, but) NO BANANA"

I can't find the post, but this has been discussed before.... having either hsv (1 or 2) in a given location does not *prevent* you from getting it elsewhere. If it did, 30% of new genital herpes infections would not be HSV 1, since close to 90% of the population is already infected with it orally. Having a given hsv at one location may REDUCE YOUR CHANCES of contracting it elsewhere,
but nowhere nearly enough to call it immunity.
What a disappointment to all those selfless herpsters who were doubtless lining up to act as vaccine donors!
On a more serious note, however, it does appear that contracting HSV 2 orally, while possible, is lower risk and lower impact than most other ways to join the club.
MM

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J Jan-10-00, 10:10 PM (CST)

19. "hsv I"

"I can't find the post, but this has been discussed before....
having either hsv (1 or 2) in a given location does not
*prevent* you from getting it elsewhere. If it did, 30% of
new genital herpes infections would not be HSV 1, since
close to 90% of the population is already infected with it
orally. Having a given hsv at one location may REDUCE YOUR
CHANCES of contracting it elsewhere,
but nowhere nearly enough to call it immunity."
M's mom, 1/3 of all new genital cases are HSV I due to the declining incidence of HSV oral-hence, first exposure is genital.
You can transfer the virus to other locations but it is difficult (assuming the body has developed a full immune response.) Ideal condition include recent infection, large viral load, and a compromised immune system. Yada Yada has a good idea but there are a lot of people that have bad cases of Oral HSV II-despite what is commonly said. Although most cases are mild and most don't recur, there are exceptions (a few on this board.)
J

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M'sMom Jan-10-00, 11:06 PM (CST)

20. "Really? Thanks..."

...for straightening me out on that.
Has the percentage of people with oral hsv1 declided dramatically in the last ten years or so? Are most folks with hsv 1 genitally gen-x'rs or younger? How many people currently contract hsv each year?
I got out my calculator and tried to figure this out, but I don't think I have enough data. Is there a web site that has some of the demographics?
Thanks
MM

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ruby Jan-11-00, 10:04 AM (CST)

23. "wald notes a dramatic increase in...."

LAST EDITED ON Jan-11-00 AT 04:49 PM (EST)
genital hsv 1 over time - but i'm not sure about oral hsv 1 and 2.
concern about oral hsv is just starting - you may want to try to search grateful med - go to medline on the left whe the site comes up and search recent articles on hsv1.
good luck http://www.racoon.com/dcforum/Images/happy.gif";>
/
TITLE:
Seroprevalence of herpes simplex virus infections in a family medicine
clinic
AUTHORS:
Oliver L; Wald A; Kim M; Zeh J; Selke S; Ashley R; Corey L
AUTHOR AFFILIATION:
Department of Family Medicine, University of Washington, Seattle.
SOURCE:
Arch Fam Med 1995 Mar;4(3):228-32
CITATION IDS:
PMID: 7881604 UI: 95187360
COMMENT:
Comment in: Arch Fam Med 1995 Mar;4(3):207
ABSTRACT:
OBJECTIVES: To determine the prevalence of herpes simplex virus
(HSV) antibody in a general medical practice setting and to assess the
frequency of subclinical infection. DESIGN: Prevalence study.
SETTING: A family practice clinic at the University of Washington
Medical Center, Seattle. PARTICIPANTS: Five hundred randomly
selected patients between the ages of 18 and 45 years. MAIN
OUTCOME MEASURES: Serum samples were tested by Western
blot assay to detect the presence of antibody to HSV type 1 (HSV-1)
and HSV-2. Demographic information and clinical history of oral and
genital herpes were obtained. RESULTS: One hundred fourteen
patients (23%) were seropositive for HSV-2 antibody, 277 patients
(56%) were seropositive for HSV-1 antibody, 59 patients (12%) were
seropositive for both HSV-2 and HSV-1 antibodies, and 163 patients
(33%) were seronegative for both. Women were almost twice as likely
as men to be seropositive for HSV-2 antibody (28% vs 15%, P < .001).
Blacks had the highest rates of HSV-2 antibody seropositivity (60%)
compared with whites (20%) and Asians (6%) (P < .001). Other
demographic correlates of seropositivity included being older, having
fewer years of education, and having public insurance. The specificity
of a clinical history of genital herpes or sores for HSV-2 infection was
high (99%), but the sensitivity was low (27%). CONCLUSIONS:
Herpes simplex virus infection is common among patients seeking
primary care. Women, blacks, and patients of lower socioeconomic
status are most likely to be seropositive for HSV-2 antibody. The high
frequency of unrecognized HSV infection has implications for primary
care physicians in counseling patients regarding HSV infection and
transmission.

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M'sMom Jan-10-00, 06:25 AM (CST)

17. "One more thought...."

How do the Dr.'s at ASHA get to make moral decisons for you? (eg. when to tell, what to tell) I think the rules are, they provide the data, you make the call.
And if it were me, I'd tell, even for oral sex only. The reason is that while it is statistally likely that HSV 2 orally will be relatively mild and non-recurrent, that does NOT guarantee that any one particular woman won't develop a mean bastard of an infection. You don't know how much trauma getting herpes would be for her, so I don't see why you should get to decide that it is an acceptable risk.
Your life, your decision, but in my opinion, nice guys tell.
MM

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ruby Jan-10-00, 09:50 AM (CST)

18. "you are right :)"

i don't think any of the sites with H information dictate when to tell - they just give you guidelines and encouragement.
i fully agree that if ANY risk is involved - telling is paramount.

the viriadae site has a good section on telling -
http://www.viridae.com
see info&publications section (Dr. Sacks is the author of this site) - there is a section on telling.
we have had forum talks on when to tell - the issue seems to teeter on issues of trust and mutual respect and plain ole personal preference on timing and content of the telling chat.....some people still chose not to tell....
- in my other post i suggested that you don't have to tell every possible suitor or consort as soon as you meet them - you can decide who can be trusted and who you should be wary of trusting....
i tell my friends, but as far as "boyfriends" go - there has to be a strong feeling of trust i.e. don't rush into a relationship - take your time to get to know someone......follow your gut feeling. but i strongly believe intelling BEFORE and telling over time so that your partner can make a non-rushed, informed decision. and it's understandable that some people won't want to take on the risk of H.
we've even had forum discussion on one-night stands and how responsible people felt about telling someone who seemed to be silently accepting the risk of exposure to any kind of STD.....
it's a complicated issue to say the least!

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Zena Jan-11-00, 00:15 AM (CST)

22. "Gee wiz....."

I have to tell for just oral sex too????? Darn it!
(stomping feet and clenching fists)

Oh....okay
Zena

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windy Jan-10-00, 11:22 PM (CST)

21. "oral "

yada yada,
I think what the ASHA people were telling you is that if you have genital herpes, then it's safe for you to PERFORM oral sex. If they told you that someone can't get oral herpes from performing oral sex on you, then they need to wake up. Sorry about that. I'd be real hesitant to take a blow job without telling. I already know what it feels like to give it to someone without telling and don't ever want to go through feeling like that again.
Recurrence of hsv2 orally is rare. Infection of the mouth/throat by hsv2 is rather common.
windy

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yada yada Jan-12-00, 10:37 PM (CST)

24. "Quite a controversy I created here!"

To all ye concerned-
Yeah, I'd probably tell. I haven't been put in the random blow job situation much anyway. However, I am quite sure that the ASHA person told me that it wasn't really necessary for me to.... And I quote- OK, I paraphrase "So, I don't have to tell for Oral(with no active sores?) " ASHA-girl "No, this is not considered high risk activity. Further, no subclinical shedding is possible in the mouth, so, in the rare case of a recurrence the person need only not perform oral sex on someone until the signs are gone, which they ought not to do anyway." ME "Really?" ASHA girl "Yep" ME "You Sure?" ASHA girl "Yep" REALLY????.........
The doctor I went to, who is really super up on the research, (he recruited patients for the recent vaccine trial and is looking for people for the new Glaxo Valtrex trial,) said basically the same thing. No, he didn't come right out and say (nor did I really ask.....him) whether it was a morally necessary thing to do. Never-the-less, he did say the oral -II was a non-issue. Some on this thread (sorry, I'm bad with names) claim that there have been some really bad, repetitive cases. That doesn't sound good, nor is it consistent with what "the experts" tend to say- Any published evidence of this, or is this anecdotal/experiential? I mean, it's not the easiest thing to know what particular type of Herpes is flaring up unless each and every time the area is swabbed. Just curious.
As far as the immunity issue, we can all probably agree that SOME genital resistance would be imparted on an individual whose body had already been exposed to the same strain of the virus, particularly if, like me, the viral load is likely low (I've not had a visible outbreak (since the first initial mini outbreak) in the 9 months I've had this damn thing.) I'm not saying that I WANT to give the virus to someone ANYWHERE, just that it may not be the end of the world for them to get it orally. To tell, yeah, I would, but I could really see that spoiling a spontaneous moment Come on guys, throw me a bone here, I'm dyin'
On a different note, our fearless leader Rajah has actually acquired Herpes on the hand, something that is supposed to be extremely rare as well. Are we saying no hand jobs either? Does it recur there? Hell, could I even give it to myself?
Yada Yada out

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windy Jan-13-00, 00:46 AM (CST)

25. "a bone"

>I paraphrase "So, I don't have
>to tell for Oral(with no active
>sores?) " ASHA-girl "No, this is
>not considered high risk activity.
>Further, no subclinical shedding is possible
>in the mouth,
Well, I can't say that I've seen this or the opposite in any studies, but I would think that if recurrent outbreak is possible, then subclinical shedding is possible.
so, in the
>rare case of a recurrence the
>person need only not perform oral
>sex on someone until the signs
>are gone, which they ought not
>to do anyway."
Frequency of shedding is proportional to frequency of outbreaks, and when you see the frequency numbers in the abstract below, you'll see that it is indeed very rare. This means it is low risk for someone if you perform oral sex on them (as long as it's not during your primary or a recurrence).

> Some on this thread (sorry,
>I'm bad with names) claim that
>there have been some really bad,
>repetitive cases. That doesn't sound good,
>nor is it consistent with what
>"the experts" tend to say-
I don't know of any, but yes, someone here said that they do know of it happening. Whoever it was is talking about specific cases. The experts are speaking from information gained from studies of large numbers of people. Statistically speaking, it's a non-issue. For those few who do have bad recurrences, it's likely to be an issue.

>As far as the immunity issue, we
>can all probably agree that SOME
>genital resistance would be imparted on
>an individual whose body had already
>been exposed to the same strain
>of the virus,
Yes, having antibodies will help reduce the chance of infection in a new place, and if it does occur, it would be milder than if there were no antibodies.
particularly if, like
>me, the viral load is likely
>low (I've not had a visible
>outbreak (since the first initial mini
>outbreak) in the 9 months I've
>had this damn thing.)
That's a good sign. Does sound like you were infected with a smaller viral load, and your ob frequency is low, so there should be less frequent shedding.
>I'm dyin'
>On a different note, our fearless leader
>Rajah has actually acquired Herpes on
>the hand, something that is supposed
>to be extremely rare as well.
I've forgotten the timing on that - Rajah? Did your hand get infected shortly after genital infection? Or was it long after - something I've heard from an expert that doesn't happen. (i.e. autoinocculation only occurs soon after the primary, befor full immune response is developed)
> Are we saying no hand
>jobs either? Does it recur there?
> Hell, could I even give
>it to myself?
Not likely after 9 months.
One more bone - I was in a relationship for a few years with a woman who had genital herpes. She was good about knowing when an ob was coming. We had unprotected sex many times, and I'm quite sure I didn't get it from her. Much more likely that I got it from the woman who wasn't as clear about her ob, and it came up less than a week after we had unprotected sex (and a few days before that, she said she sort of felt something, but wasn't sure). A little ignorance can go a long way.
Here's a study of recurrence rates of both oral and genital HSV1 and HSV2 -
N Engl J Med 1987 Jun 4;316(23):1444-9 Related Articles, Books

Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type.
Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L
We prospectively followed 39 adults with concurrent primary herpes simplex virus (HSV) infection (12 with HSV type 1 and 27 with HSV type 2) of the oropharynx and genitalia, caused by the same virus in each person, to evaluate the influence of viral type (HSV-1 vs. HSV-2) and site of infection (oropharyngeal vs. genital) on the frequency of recurrence. The subsequent recurrence patterns of HSV infection differed markedly according to viral type and anatomical site. Oral-labial recurrences developed in 5 of 12 patients with HSV-1 and 1 of 27 patients with HSV-2 (P less than 0.001). Conversely, genital recurrences developed in 24 of 27 patients with HSV-2 and 3 of 12 patients with HSV-1 (P less than 0.01). The mean rate of subsequent genital recurrences (due to HSV-1 and HSV-2) was 0.23 per month, whereas the mean rate of oral-labial recurrences was only 0.04 per month (P less than 0.001). The mean monthly frequencies of recurrence were, in order, genital HSV-2 infections, 0.33 per month; oral-labial HSV-1 infections, 0.12 per month; genital HSV-1 infections, 0.020 per month; and oral HSV-2 infections, 0.001 per month (P less than 0.01 for each comparison). We conclude that the likelihood of reactivation of HSV infection differs between HSV-1 and HSV-2 infections and between the sacral and trigeminal anatomical sites. The sixfold more frequent clinical recurrence rate of genital HSV infections as compared with oral-labial HSV infections may account for the relatively rapid increase in the prevalence of clinically recognized genital herpes in recent years.
PMID: 3033506, UI: 87201808

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J Jan-13-00, 01:53 AM (CST)

26. "bones as well "

I'd first like to state that there is still a lot to be learned about HSV-in the three years I've had the virus, information on this board has shifted and changed based on emerging evidence. What is thought as absolute today, may not be tomorrow.
We commonly think of HSV as 2 sister viruses that prefer one of 2 areas, but, we tend to find the virus through out the body (heart muscles, brain, baldder, intestines, etc.) I'm sure there are many more. Only recently was HSV I identified as the cause of Bell's palsy. There is probably more to follow. Another recently reviewed article identified HSV as having the capability to cause cellular changes-we're waiting on supporting evidence but the association is certaily indirectly there already.
Shedding, subclinical or clinical is associated with the frequency and severity of infection which in turn is associated with the amount of "initial" viral load someone is exposed to (excluding prior exposure/immune function.) What this means is that most people have unrecognized, minor infections, but giving the relative percentage of infections, a HUGE % have serious infection-meningitis, more than 6 obs a year, etc. In fac

Zena	Dec-28-99, 11:20 PM (CST)
"OK you websearching folks"
I need help finding some info. I have read soooo much about spreading HSV1 to the genitals, but have yet to find more than a blip about transmission of genital HSV2 to the mouth. If you have any info, or a link or two please let me know! Thanks! Zena
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M'sMom	Dec-29-99, 00:54 AM (CST)
1. "Oral HSV2"
Zena- You are so right - there isn't much readily available data on this, and interestingly, most of it is responses to questions. Here are the most relevant sites I could find, and they aren't much. What little I could find to read, though, seems to indicate that oral HSV2 is the least common of the possible type/site combinations, and the least likely to recur. I wonder if that info matches with experience? go to http://www.allhealth.com/conditions/infect/qa/ and search on oral herpes - you will get several relevant responses. I haven't used allhealth.com before, but I don't see anything in these answers that looks suspect. Perhaps others here have some additional commentary on this site.) http://herpes.com/hsv1-2.html (this is a fairly comprehensive discussion of hsv - 1 and 2, oral and genital. If you read the whole thing, there is a lot of information about oral hsv2) Luck, M'sMom
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	M'sMom	Apr-09-00, 05:59 PM (CST)
	28. "Here it is Sunny!"
	Hope this helps. MM
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windy	Dec-29-99, 01:16 AM (CST)
2. "one more blip"
Zena, Here's a response from Dr. Handsfield at UW to a question I asked about the possibility of having oral HSV2 and spreading it to someone else. BTW, the 10-15% figure comes from a 1988 study by Corey. windy "Although 10-15% of persons with initial genital herpes due to HSV-2 have oral HSV-2 symptoms and/or lesions (often in the form of pharyngitis), chronic recurrent oral HSV-2 disease is extremely rare. Something about the virus and the host response markedly reduces the likelihood of recurrences. Therefore, unless the exposure takes place at or soon (a few weeks) after the acquisition of dual oral/genital infection, oral sex is extremely unlikely to ever transmit HSV-2 to a parter--either by kissing or by orogenital contact."
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	Zena	Dec-29-99, 02:51 PM (CST)
	3. "Thank you"
	for the responses! From Windy's article, I get the impression that oral HSV2 is usually coupled with a genital and oral ob. Well, the reason I am researching is because my ex has been told he has oral HSV2. He has no genital symtoms, will NOT seek another Dr.s opinion, and does not know what test he was given. He also will not go to another Dr. So, in a last ditched effort to help this stubborn person....got any ideas what I should tell him to do from here? My concern is that either he doesnt have HSV at all or worse has oral and genital..... Peace~ Zena
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	M'sMom	Dec-31-99, 02:04 AM (CST)
	4. "about oral hsv2..."
	Zena, I'm not sure that I read Windy's info quite the same way that you do. It sounds to me like Dr. Handsfield started out thinking of people who have genital hsv2 and went on to discuss their experience with oral hsv 2. I think that what he's saying is that about 10-15 percent of people who have genital hsv2 contract oral hsv2 at the same time, but that the oral symptoms of hsv2 are not likely to recur at all. I think he is implying that because the symptoms of oral hsv2 are rarely chronic, we can assume that very little oral shedding of hsv2 is going on, and so a person who has oral hsv2 to is very unlikely to pass it on except during their initial outbreak. What I don't think Dr. Handsfield is talking about at all is a person who has an ORAL ONLY hsv2 infection, which could happen, although it doesn't appear very likely based on the data I've seen. Seems to me that the most likely scenario for getting oral hsv2 without also being infected genitally would be an instance an hsv- person had only oral sex with someone who was hsv and shedding, or by (only) kissing soneone who was having a primary outbreak of oral hsv2. Don't know if either of these scenarios could apply to your friend. One question: how was it determined that he had oral hsv2? The only way I can think of to figure that our would be to culture a lesion. If he had a blood test, it won't tell him a darn thing about the site of infection. I can believe he wouldn't know what kind of tests were done on the samples they took from him, but he should be able to recall whether he was swabbed or stuck. I'm really not sure there is anything else you can do for the guy. You could present him with the data you have and point out the holes in his current diagnosis, but it kinda sounds to me like he doesn't want to know. If there's any chance of you two hooking up again, I'd certainly behave as if he has hsv2 genitally as well as orally. MM DISCLAIMER: The preceding opinion is free, and comes without a warranty, express or implied.
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	windy	Dec-31-99, 08:55 AM (CST)
	5. "oral hsv2"
	Mom, The original question I asked was if someone with hsv2 could transmit from their mouth to someone's genitals or mouth (assuming that the H person is one of the 10-15% that had oroopharyngeal symptoms during their initial infection). >think that what he's saying is >that about 10-15 percent of people >who have genital hsv2 contract oral >hsv2 at the same time, but That number is from a study (Corey 1988) >that the oral symptoms of hsv2 >are not likely to recur at >all. I think he is implying >that because the symptoms of oral >hsv2 are rarely chronic, we can >assume that very little oral shedding >of hsv2 is going on, and >so a person who has oral >hsv2 to is very unlikely to >pass it on except during their >initial outbreak. That is exactly what he meant. >What I don't think Dr. Handsfield is >talking about at all is a >person who has an ORAL ONLY >hsv2 infection, which could happen, although >it doesn't appear very likely based >on the data I've seen. We didn't get into the 'oral only' discussion, but I'd assume that H2 would act the same orally regardless of whether there is concurrent genital infection or not. Now that I think about it, there are probably a number of these cases that go completely undiagnosed. How many people go to the doctor to get checked for STD when they have a sore throat and a fever with no genital symptoms? And even if they did, they're likely to be told that they have a sore throat and fever, and might get a prescription for antibiotics. Seems >to me that the most likely >scenario for getting oral hsv2 without >also being infected genitally would be >an instance an hsv- person had >only oral sex with someone who >was hsv and shedding, or by >(only) kissing soneone who was having >a primary outbreak of oral hsv2. Yes. You understand this biology stuff better than you think you do. windy
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	M'sMom	Dec-31-99, 12:22 PM (CST)
	6. "picking nits again"
	Hey, windy, Thanks for the clarification. One more boneheaded questsion, if you don't mind. Both your question and Dr. Handsfield's response- The original question I asked was if someone with hsv2 could transmit from their mouth to someone's genitals or mouth (assuming that the H person is one of the 10-15% that had oroopharyngeal symptoms during their initial infection). "Although 10-15% of persons with initial genital herpes due to HSV-2 have oral HSV-2 symptoms and/or lesions ....." - could be read to imply that 10 to 15 percent of people get both oral and genital hsv2 FROM THE SAME INFECTION. I didn't think that happened - my understanding was that if there was genital contact, you would have outbreaks in the genital region (or somewhere close by) and that if there was oral contact, your outbreaks would be around your mouth or throat. I think that the true situation is that you can get hsv both orally and genitally FROM THE SAME ENCOUNTER, but that there does have to be inital skin contact in both areas for this to occur. No? Thanks MM
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	windy	Dec-31-99, 03:11 PM (CST)
	7. "nits"
	The virus doesn't care how many place it infects. If it meets a host with no antibodies, there's not much to stop it. It'll go in any way it can - eyes, nose, mouth, genitals, anus, open cuts. So one could get multiple infection sites from multiple initial contact sites, or from one initial site and then autoinoculate or re-inoculate (in another encounter) other sites before there is time to make antibodies. I assume that many people do have both oral sex and intercourse in the same encounters. I mean, it sure sounds like a good idea. It's probably safe to assume that all of the 10-15% who got both oral and genital infections got them at the same time this way. I know someone who got both oral and genital hsv1 this way. windy Here's the abstract - Corey L First-episode, recurrent, and asymptomatic herpes simplex infections. In: J Am Acad Dermatol (1988 Jan) 18(1 Pt 2):169-72 ISSN: 0190-9622 Genital herpes simplex virus infections should be classified into first-episode and recurrent infections. First-episode infections include true primary infections in patients with seronegative results who have never been infected with any type of herpes and nonprimary first-episode infections in patients who have been infected before and have serum antibody and humoral immunity, an example being genital infection with type 2 in adolescence after orolabial infection with type 1 in childhood. First-episode infections show more extensive disease, more systemic symptoms, and greater viral shedding than do recurrent infections. Ten percent to 15% of patients with first-episode primary genital herpes have oropharyngeal infections with the same virus strain. Herpesvirus can be isolated from the urethra in about 30% of male patients with first-episode infections. In recurrent vulvar herpes, virus can be isolated from the cervix in 10% to 15% of patients. Many genital lesions that clinically suggest something else turn out to be herpes; herpes may be diagnosed 5% of the time clinically but cultures are positive 14% of the time. Primary genital herpes type 2 infections recur about 95% of the time whereas type 1 infections recur about 50% of the time. Recurrences are highly unpredictable from patient to patient and time to time. The role of asymptomatic shedding in the spread of herpes is a major area for future study. Antiviral treatment is probably going to change the epidemiology of herpetic infections very little. Institutional address: Department of Laboratory Medicine University of Washington Seattle.
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	Zena	Dec-31-99, 07:52 PM (CST)
	8. "Nit picking too"
	> "Although 10-15% of persons with initial >genital herpes due to HSV-2 have >oral HSV-2 symptoms and/or lesions (often >in the form of pharyngitis), chronic >recurrent oral HSV-2 disease is extremely >rare. OKay, this seems to be based on someone with initial genital HSV2 and the likelyhood of having oral HSV2 along with it. Therefore, unless >the exposure takes place at or >soon (a few weeks) after the >acquisition of dual oral/genital infection, oral >sex is extremely unlikely to ever >transmit HSV-2 to a parter--either by >kissing or by orogenital contact." So, this seems to say that very rarely does someone have only oral HSV2, yes? I want to clarify becuase that is the official diagnosis that I am seeking info on. From the info I have gathered, the numbers are very small for this to happen without also having genital HSV2. Am I just dense? Zena
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	windy	Jan-01-00, 11:12 AM (CST)
	9. "Here's why I think..."
	there's so little information on oral-only hsv2. The study I cited, and the question and answer, all dealt with oral and genital infections that were acquired at or about the same time. They say nothing at all about oral-only hsv2. The most likely way to find people who have hsv2 orally but not genitally would be if they have a visible outbreak that is recognized as herpes and cultured. Most likely, that person would have gone down on someone who was shedding, with or without symptoms, and they didn't have intercourse. Since most genital infections go unnoticed, and since hsv2 tends not to affect the mouth as much, then it's likely to assume that most oral-only hsv2 infections go unnoticed or undiagnosed. Someone gets the flu and sore throat and doesn't connect it to the oral sex they performed last week on the partner who didn't know they had herpes. How many sore throats is that? I'm not sure, but I don't think a herpes culture is a standard part of a throat culture. That might make a good study - h culture and typing on every sexually active person who comes into the clinic with the flu. Below is the only paper I could find by searching Pub Med for "hsv2 pharyngitis", and I think it highlights my point about missing the hsv2 oral-only diagnosis (even though we don't know for sure if the father got it genitally or not). I found more by searching "herpes genitalis AND (pharyn* OR orophar* OR nasophar* OR ocular)". Curious to note that Pub Med considers HSV-1 as a medical subject heading, but not HSV-2. And to clarify: >Therefore, unless >>the exposure takes place at or >>soon (a few weeks) after the >>acquisition of dual oral/genital infection, oral >>sex is extremely unlikely to ever >>transmit HSV-2 to a parter--either by >>kissing or by orogenital contact." >So, this seems to say that very >rarely does someone have only oral >HSV2, yes? No, this says that someone with genital and oral hsv2 is unlikely to give it to someone by kissing them on the mouth or by perfoming oral sex on the h- person. Only exception is during or right after the primary episode, when they are certain to be shedding virus from the mouth. I see no reason to assume that it would be different if the person had oral-only hsv2 (that MY assumption). >genital HSV2. Am I just dense? > >Zena > Nope. Not at all. Tricky virus, tricky subject. I hope this helps. I'll filter through the other stuff I found and share what's relevant. windy ---------------------------------------------- Am J Perinatol 1999;16(1):43-5 Related Articles, Books Sequential peripartum herpes simplex virus type 2 disease in parents and their newborn mimicking intrafamily spread of common viruses. Klauber EV, Thirumoorthi MC, Khatib R Scottsdale Medical Specialty, Inc., Arizona, USA. Herpes simplex type 2 (HSV2) disease developed sequentially among two parents and their newborn. The father first became ill with upper-respiratory symptoms and fever. Then, 5 days later, shortly after delivery, the mother had fever, pharyngitis, and diarrhea. Subsequently, the infant developed undifferentiated febrile illness at the age of 3 days. HSV etiology was recognized by incidental isolation of HSV2 from the newborn naospharynx. The father never developed genital lesions and the mother's symptoms remained nonspecific for several days prior to the onset of genital manifestations. The sequential emergence and manifestations of these infections could have been misconstrued for an intrafamily spread of respiratory or enteric viruses. This cluster illustrates that HSV2 may cause sequential symptomatic disease in susceptible individuals mimicking other viruses. PMID: 10362081, UI: 99288927
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	M'sMom	Jan-02-00, 12:11 PM (CST)
	10. "philosophy and statistics"
	Zena- I suspect you are trying to decide just how reasonable your friend's "oral hsv2" diagnosis is. Here's some thoughts on that, based on the info provided thus far on this forum, along with the random firing of the neurons in my brain. There are at least two major factors that play into the the frequency of oral only hsv2. The first is the behavior of the virus. Oral HSV2 is probably significantly less frequent than genital HSV2 because the mouth and throat just aren't the site of preference for this strain of hsv. Give the opportunity to infect at any site, I'll bet the odds are highest that hsv2 wil infect the genitals. It may or may not infect some other sites, but I can't really think of any circumstances in which a person is likely to acquire hsv2 orally but not genitally if there has been contact in both places. The second is the behaviour of humans. Think about the behaviours that allow the transmission of hsv. Kissing: the most common "transmission act", and the reason that hsv1 is ubiquitous. However, in the case of oral hsv2, not much of a transmission threat since there is not likely to be viral shedding except during primary infection. Intercourse: The way that most hsv2 infections occur, but this would result in a genital-only infection unless the person auto-innoculates their mouth or some other site. Question: how likely is a guy to do this? It would require that he touch an area of shedding and then his mouth. Not sure on this, probably depends on his personal habits. Oral sex: This is the most likely way to acquire oral hsv2, but in order to get oral ONLY hsv2, you would likely have to have mouth to genital contact without genital to genital contact. (Going on the theory here that if circumstances allow oral hsv2 infection, they are probably even more encouraging to genital infection. I am not sure this is true, but it seems likely to me.) So: in what circumstances is this likely to occur? I can think of a few: Prostitutes (male or female) selling bj's; women using oral sex as a contraceptive measure or to avoid sex during menses; some instances of lesbian sex; anonymous "quickie" encounters (in this case I would bet that the recipient is more likely to be male, although the "giver" could be either.); men using oral sex as an alternative means of sexual expression (I may catch some flack for this, but I suspect this is kind of rare. It is my observation that the male of the species generally prefers to get socketed at some time during the encounter unless there are compelling reasons not to.) I guess my point is that the likelyhood of acquiring oral only hsv2 may depend more on a persons sex habits than anything else. Might want to think that through in relation to your friend. MM
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	Zena	Jan-02-00, 07:44 PM (CST)
	11. "Actually....."
	>I suspect you are trying to decide >just how reasonable your friend's "oral >hsv2" diagnosis is. That was exactly what I am trying to figure out. Searching is soooo time consuming, either due to my ISP or my computer itself...I appreciate all the info I have recieved. >The first is the behavior of the >virus. Oral HSV2 is probably significantly >less frequent than genital HSV2 because >the mouth and throat just aren't >the site of preference for this >strain of hsv. Give the opportunity >to infect at any site, I'll >bet the odds are highest that >hsv2 wil infect the genitals. My theory as well. >a person is likely to acquire >hsv2 orally but not genitally if >there has been contact in both >places. Also my theory. >Oral sex: This is the most likely >way to acquire oral hsv2, but >in order to get oral ONLY >hsv2, you would likely have >to have mouth to genital contact >without genital to genital contact. (Going >on the theory here that if >circumstances allow oral hsv2 infection, they >are probably even more encouraging to >genital infection. Seemed likely to me as well. men using oral sex >as an alternative means of sexual >expression I guess that is why it still seems possible... It was strictly oral for many months, with only a few geintal encounters. Even with that though, it still seems unlikely to me that he would have oral and not genital. There is of course that little bit of doubt that keeps me wondering....I will never know for sure and neither will he unless he gets some type specific tests done. To answer a previous question, he was swabbed and stuck. By his own admission though, the Doc was not helpful, nor gave him any info. Well, thank you again! Zena
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	M'sMom	Jan-03-00, 00:56 AM (CST)
	12. "I think I understand..."
	... your dilema now. Lots of opportunities for oral infection, just a few for genital. Oral symptoms, no genital symptoms, and (we think) a positive hsv culture orally and a positive blood test. The evidence points to oral only, but the odds go the other way. Well, I have no solution, but I certainly admire the problem. I don't see a way to ever be sure short of a genital lesion to be tested. Luck, MM
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	yada yada	Jan-09-00, 09:03 PM (CST)
	13. "this whole oral thing"
	Not much time to talk - I've recently been around this tree with some doctors I trust and the ASHA hotline. Their unanimous decision was to say that transmission genital to oral of HSV-II is possible, but highly improbable with very few consequences. Bottom line, the moral aspect for me (a male) is (according to them) if I have a random sexual encounter which entails oral sex only, it is not necessary to divulge my positivity for H-II genitally. So, my current girlfriend is mulling the whole issue over. I am really hoping to get a blow-job anyway soon. This may be our sex-substitute for the duration. This disease blows (pun intended/ The better, more interesting question: If my girlfriend gets the H-II infection on the mouth through oral sex, does she not become almost vaccinated against the disease genitally? Why not administer a "poor mans oral vaccine" to everyone who is worried about genital to genital transmission? Food for thought. -yada yada out.
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	weed	Jan-09-00, 10:01 PM (CST)
	14. "yada yada.."
	Was that a theory or a fantasy? /herpes/images2/coolsmil.gif
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	Rajah	Jan-09-00, 10:16 PM (CST)
	15. "Flavored concoms.."
	I can testify that HSV2 above the belt can be quite unpleasant. I got it on my left thumb at the edge of the nail and it caused severe discomfort and resulted in the nail having to be removed, a major ouchie. (It grew back.) I suggest that you consider using flavored condoms if they cover your "hotspot" Rajah
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	M'sMom	Jan-10-00, 01:16 AM (CST)
	16. "(close, but) NO BANANA"
	I can't find the post, but this has been discussed before.... having either hsv (1 or 2) in a given location does not prevent you from getting it elsewhere. If it did, 30% of new genital herpes infections would not be HSV 1, since close to 90% of the population is already infected with it orally. Having a given hsv at one location may REDUCE YOUR CHANCES of contracting it elsewhere, but nowhere nearly enough to call it immunity. What a disappointment to all those selfless herpsters who were doubtless lining up to act as vaccine donors! On a more serious note, however, it does appear that contracting HSV 2 orally, while possible, is lower risk and lower impact than most other ways to join the club. MM
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	J	Jan-10-00, 10:10 PM (CST)
	19. "hsv I"
	"I can't find the post, but this has been discussed before.... having either hsv (1 or 2) in a given location does not prevent you from getting it elsewhere. If it did, 30% of new genital herpes infections would not be HSV 1, since close to 90% of the population is already infected with it orally. Having a given hsv at one location may REDUCE YOUR CHANCES of contracting it elsewhere, but nowhere nearly enough to call it immunity." M's mom, 1/3 of all new genital cases are HSV I due to the declining incidence of HSV oral-hence, first exposure is genital. You can transfer the virus to other locations but it is difficult (assuming the body has developed a full immune response.) Ideal condition include recent infection, large viral load, and a compromised immune system. Yada Yada has a good idea but there are a lot of people that have bad cases of Oral HSV II-despite what is commonly said. Although most cases are mild and most don't recur, there are exceptions (a few on this board.) J
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	M'sMom	Jan-10-00, 11:06 PM (CST)
	20. "Really? Thanks..."
	...for straightening me out on that. Has the percentage of people with oral hsv1 declided dramatically in the last ten years or so? Are most folks with hsv 1 genitally gen-x'rs or younger? How many people currently contract hsv each year? I got out my calculator and tried to figure this out, but I don't think I have enough data. Is there a web site that has some of the demographics? Thanks MM
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	ruby	Jan-11-00, 10:04 AM (CST)
	23. "wald notes a dramatic increase in...."
	LAST EDITED ON Jan-11-00 AT 04:49 PM (EST) genital hsv 1 over time - but i'm not sure about oral hsv 1 and 2. concern about oral hsv is just starting - you may want to try to search grateful med - go to medline on the left whe the site comes up and search recent articles on hsv1. good luck http://www.racoon.com/dcforum/Images/happy.gif";> / TITLE: Seroprevalence of herpes simplex virus infections in a family medicine clinic AUTHORS: Oliver L; Wald A; Kim M; Zeh J; Selke S; Ashley R; Corey L AUTHOR AFFILIATION: Department of Family Medicine, University of Washington, Seattle. SOURCE: Arch Fam Med 1995 Mar;4(3):228-32 CITATION IDS: PMID: 7881604 UI: 95187360 COMMENT: Comment in: Arch Fam Med 1995 Mar;4(3):207 ABSTRACT: OBJECTIVES: To determine the prevalence of herpes simplex virus (HSV) antibody in a general medical practice setting and to assess the frequency of subclinical infection. DESIGN: Prevalence study. SETTING: A family practice clinic at the University of Washington Medical Center, Seattle. PARTICIPANTS: Five hundred randomly selected patients between the ages of 18 and 45 years. MAIN OUTCOME MEASURES: Serum samples were tested by Western blot assay to detect the presence of antibody to HSV type 1 (HSV-1) and HSV-2. Demographic information and clinical history of oral and genital herpes were obtained. RESULTS: One hundred fourteen patients (23%) were seropositive for HSV-2 antibody, 277 patients (56%) were seropositive for HSV-1 antibody, 59 patients (12%) were seropositive for both HSV-2 and HSV-1 antibodies, and 163 patients (33%) were seronegative for both. Women were almost twice as likely as men to be seropositive for HSV-2 antibody (28% vs 15%, P < .001). Blacks had the highest rates of HSV-2 antibody seropositivity (60%) compared with whites (20%) and Asians (6%) (P < .001). Other demographic correlates of seropositivity included being older, having fewer years of education, and having public insurance. The specificity of a clinical history of genital herpes or sores for HSV-2 infection was high (99%), but the sensitivity was low (27%). CONCLUSIONS: Herpes simplex virus infection is common among patients seeking primary care. Women, blacks, and patients of lower socioeconomic status are most likely to be seropositive for HSV-2 antibody. The high frequency of unrecognized HSV infection has implications for primary care physicians in counseling patients regarding HSV infection and transmission.
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	M'sMom	Jan-10-00, 06:25 AM (CST)
	17. "One more thought...."
	How do the Dr.'s at ASHA get to make moral decisons for you? (eg. when to tell, what to tell) I think the rules are, they provide the data, you make the call. And if it were me, I'd tell, even for oral sex only. The reason is that while it is statistally likely that HSV 2 orally will be relatively mild and non-recurrent, that does NOT guarantee that any one particular woman won't develop a mean bastard of an infection. You don't know how much trauma getting herpes would be for her, so I don't see why you should get to decide that it is an acceptable risk. Your life, your decision, but in my opinion, nice guys tell. MM
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	ruby	Jan-10-00, 09:50 AM (CST)
	18. "you are right :)"
	i don't think any of the sites with H information dictate when to tell - they just give you guidelines and encouragement. i fully agree that if ANY risk is involved - telling is paramount. the viriadae site has a good section on telling - http://www.viridae.com see info&publications section (Dr. Sacks is the author of this site) - there is a section on telling. we have had forum talks on when to tell - the issue seems to teeter on issues of trust and mutual respect and plain ole personal preference on timing and content of the telling chat.....some people still chose not to tell.... - in my other post i suggested that you don't have to tell every possible suitor or consort as soon as you meet them - you can decide who can be trusted and who you should be wary of trusting.... i tell my friends, but as far as "boyfriends" go - there has to be a strong feeling of trust i.e. don't rush into a relationship - take your time to get to know someone......follow your gut feeling. but i strongly believe intelling BEFORE and telling over time so that your partner can make a non-rushed, informed decision. and it's understandable that some people won't want to take on the risk of H. we've even had forum discussion on one-night stands and how responsible people felt about telling someone who seemed to be silently accepting the risk of exposure to any kind of STD..... it's a complicated issue to say the least!
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	Zena	Jan-11-00, 00:15 AM (CST)
	22. "Gee wiz....."
	I have to tell for just oral sex too????? Darn it! (stomping feet and clenching fists) Oh....okay Zena
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	windy	Jan-10-00, 11:22 PM (CST)
	21. "oral "
	yada yada, I think what the ASHA people were telling you is that if you have genital herpes, then it's safe for you to PERFORM oral sex. If they told you that someone can't get oral herpes from performing oral sex on you, then they need to wake up. Sorry about that. I'd be real hesitant to take a blow job without telling. I already know what it feels like to give it to someone without telling and don't ever want to go through feeling like that again. Recurrence of hsv2 orally is rare. Infection of the mouth/throat by hsv2 is rather common. windy
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	yada yada	Jan-12-00, 10:37 PM (CST)
	24. "Quite a controversy I created here!"
	To all ye concerned- Yeah, I'd probably tell. I haven't been put in the random blow job situation much anyway. However, I am quite sure that the ASHA person told me that it wasn't really necessary for me to.... And I quote- OK, I paraphrase "So, I don't have to tell for Oral(with no active sores?) " ASHA-girl "No, this is not considered high risk activity. Further, no subclinical shedding is possible in the mouth, so, in the rare case of a recurrence the person need only not perform oral sex on someone until the signs are gone, which they ought not to do anyway." ME "Really?" ASHA girl "Yep" ME "You Sure?" ASHA girl "Yep" REALLY????......... The doctor I went to, who is really super up on the research, (he recruited patients for the recent vaccine trial and is looking for people for the new Glaxo Valtrex trial,) said basically the same thing. No, he didn't come right out and say (nor did I really ask.....him) whether it was a morally necessary thing to do. Never-the-less, he did say the oral -II was a non-issue. Some on this thread (sorry, I'm bad with names) claim that there have been some really bad, repetitive cases. That doesn't sound good, nor is it consistent with what "the experts" tend to say- Any published evidence of this, or is this anecdotal/experiential? I mean, it's not the easiest thing to know what particular type of Herpes is flaring up unless each and every time the area is swabbed. Just curious. As far as the immunity issue, we can all probably agree that SOME genital resistance would be imparted on an individual whose body had already been exposed to the same strain of the virus, particularly if, like me, the viral load is likely low (I've not had a visible outbreak (since the first initial mini outbreak) in the 9 months I've had this damn thing.) I'm not saying that I WANT to give the virus to someone ANYWHERE, just that it may not be the end of the world for them to get it orally. To tell, yeah, I would, but I could really see that spoiling a spontaneous moment Come on guys, throw me a bone here, I'm dyin' On a different note, our fearless leader Rajah has actually acquired Herpes on the hand, something that is supposed to be extremely rare as well. Are we saying no hand jobs either? Does it recur there? Hell, could I even give it to myself? Yada Yada out
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	windy	Jan-13-00, 00:46 AM (CST)
	25. "a bone"
	>I paraphrase "So, I don't have >to tell for Oral(with no active >sores?) " ASHA-girl "No, this is >not considered high risk activity. >Further, no subclinical shedding is possible >in the mouth, Well, I can't say that I've seen this or the opposite in any studies, but I would think that if recurrent outbreak is possible, then subclinical shedding is possible. so, in the >rare case of a recurrence the >person need only not perform oral >sex on someone until the signs >are gone, which they ought not >to do anyway." Frequency of shedding is proportional to frequency of outbreaks, and when you see the frequency numbers in the abstract below, you'll see that it is indeed very rare. This means it is low risk for someone if you perform oral sex on them (as long as it's not during your primary or a recurrence). > Some on this thread (sorry, >I'm bad with names) claim that >there have been some really bad, >repetitive cases. That doesn't sound good, >nor is it consistent with what >"the experts" tend to say- I don't know of any, but yes, someone here said that they do know of it happening. Whoever it was is talking about specific cases. The experts are speaking from information gained from studies of large numbers of people. Statistically speaking, it's a non-issue. For those few who do have bad recurrences, it's likely to be an issue. >As far as the immunity issue, we >can all probably agree that SOME >genital resistance would be imparted on >an individual whose body had already >been exposed to the same strain >of the virus, Yes, having antibodies will help reduce the chance of infection in a new place, and if it does occur, it would be milder than if there were no antibodies. particularly if, like >me, the viral load is likely >low (I've not had a visible >outbreak (since the first initial mini >outbreak) in the 9 months I've >had this damn thing.) That's a good sign. Does sound like you were infected with a smaller viral load, and your ob frequency is low, so there should be less frequent shedding. >I'm dyin' >On a different note, our fearless leader >Rajah has actually acquired Herpes on >the hand, something that is supposed >to be extremely rare as well. I've forgotten the timing on that - Rajah? Did your hand get infected shortly after genital infection? Or was it long after - something I've heard from an expert that doesn't happen. (i.e. autoinocculation only occurs soon after the primary, befor full immune response is developed) > Are we saying no hand >jobs either? Does it recur there? > Hell, could I even give >it to myself? Not likely after 9 months. One more bone - I was in a relationship for a few years with a woman who had genital herpes. She was good about knowing when an ob was coming. We had unprotected sex many times, and I'm quite sure I didn't get it from her. Much more likely that I got it from the woman who wasn't as clear about her ob, and it came up less than a week after we had unprotected sex (and a few days before that, she said she sort of felt something, but wasn't sure). A little ignorance can go a long way. Here's a study of recurrence rates of both oral and genital HSV1 and HSV2 - N Engl J Med 1987 Jun 4;316(23):1444-9 Related Articles, Books Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type. Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L We prospectively followed 39 adults with concurrent primary herpes simplex virus (HSV) infection (12 with HSV type 1 and 27 with HSV type 2) of the oropharynx and genitalia, caused by the same virus in each person, to evaluate the influence of viral type (HSV-1 vs. HSV-2) and site of infection (oropharyngeal vs. genital) on the frequency of recurrence. The subsequent recurrence patterns of HSV infection differed markedly according to viral type and anatomical site. Oral-labial recurrences developed in 5 of 12 patients with HSV-1 and 1 of 27 patients with HSV-2 (P less than 0.001). Conversely, genital recurrences developed in 24 of 27 patients with HSV-2 and 3 of 12 patients with HSV-1 (P less than 0.01). The mean rate of subsequent genital recurrences (due to HSV-1 and HSV-2) was 0.23 per month, whereas the mean rate of oral-labial recurrences was only 0.04 per month (P less than 0.001). The mean monthly frequencies of recurrence were, in order, genital HSV-2 infections, 0.33 per month; oral-labial HSV-1 infections, 0.12 per month; genital HSV-1 infections, 0.020 per month; and oral HSV-2 infections, 0.001 per month (P less than 0.01 for each comparison). We conclude that the likelihood of reactivation of HSV infection differs between HSV-1 and HSV-2 infections and between the sacral and trigeminal anatomical sites. The sixfold more frequent clinical recurrence rate of genital HSV infections as compared with oral-labial HSV infections may account for the relatively rapid increase in the prevalence of clinically recognized genital herpes in recent years. PMID: 3033506, UI: 87201808
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	J	Jan-13-00, 01:53 AM (CST)
	26. "bones as well "
	I'd first like to state that there is still a lot to be learned about HSV-in the three years I've had the virus, information on this board has shifted and changed based on emerging evidence. What is thought as absolute today, may not be tomorrow. We commonly think of HSV as 2 sister viruses that prefer one of 2 areas, but, we tend to find the virus through out the body (heart muscles, brain, baldder, intestines, etc.) I'm sure there are many more. Only recently was HSV I identified as the cause of Bell's palsy. There is probably more to follow. Another recently reviewed article identified HSV as having the capability to cause cellular changes-we're waiting on supporting evidence but the association is certaily indirectly there already. Shedding, subclinical or clinical is associated with the frequency and severity of infection which in turn is associated with the amount of "initial" viral load someone is exposed to (excluding prior exposure/immune function.) What this means is that most people have unrecognized, minor infections, but giving the relative percentage of infections, a HUGE % have serious infection-meningitis, more than 6 obs a year, etc. In fac