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Can HSV1 diagnosis be made on mere visual examination of lesion?

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Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3562 Questions

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Posted on Tue, 26 Aug 2014 in Skin Hair and Nails
Question: Hi, I have HSV1 orally. Recently my boyfriend had a lesion on his penis that was unable to be cultured by the time he saw his doctor. His initial IGG done at that time came back HSV1 positive and HSV2 negative. His doctor told him he has HSV1 genitally. I would like to convince my boyfriend that it's possible he does not have HSV1 genitally based on the tests done by the doctor and I need a doctor to agree with me. First, only a swab culture of the actual lesion can tell him 100% if that lesion was HSV1, correct? Since that test was not performed then his doctor cannot be 100% sure it was HSV1. You cannot make a definitive diagnosis by visual examination of a healed lesion, correct? Second, his positive IGG means only that his body/blood has developed a response to a prior infection with HSV1. Therefore, the test only shows that he has had it for at least several weeks and most likely he has had it since childhood. And no one can say for sure at this point if he has it orally or genitally based on a positive blood test result alone. We have been together for 4 years and he has never had a lesion orally or genitally before. He did not get sick with this current lesion on his penis. He barely noticed it until he picked at it and then he thought it looked like a cold sore and remembered that I get cold sores and we had oral/genital contact a few weeks prior. I did not have a cold sore at the time, and not even for many months. He also believes that oral to oral contact can transmit the disease and the virus can travel to anywhere in the body and manifest itself. Basically, you don't necessarily develop the lesion at the point of contact. So his penis did not have to come in contact with the virus in order for him to get it there. I believe this is false. Can you clarify? His doctor is a microbiologist, or was, so my boyfriend thinks he is an expert. Also, I am aware based on his negative HSV2 result that retesting in several weeks is needed to make sure he doesn't have HSV2 that he got from me recently. I am a known HSV2 negative so that is expected to be negative as well. Lastly, can you please agree with me that if he should develop a future lesion he should see his doctor immediately for a swab culture so that he can be sure if it is HSV or something else. Thank you for your time doctor!
doctor
Answered by Dr. Suresh Heijebu 2 hours later
Brief Answer:
PRESUMTIVE VALCYCLOVIR SHOULD BE INITIATED.

Detailed Answer:
Hi

I have read your query and understand your concern.

I can agree with you totally only in the first half of your query.

Hsv 1 diagnoses cannot be made on mere visual examination of lesion.

Swab and smear testing is needed for 100% accurate hsv confirmation.

Positive IgG only represents infection in the remote past and it has not much significance.

Tzanck smear test of lesion with IgM anti hsv assay can accurately confirm the active/recent onset infection in your boyfriend.

Hsv 1 can be acquired both orally as well as genitally.

Since you are currently positive for hsv 1 ,there is every chance that your boyfriend can acquire it from you genitally and develop a lesion on his penis as in this scenario.

Your boyfriend is exactly right as far as the mode of transmission of disease is concerned.virus can travel all the way and manifest elsewhere.

A single negative test for hsv 2 will virtually rule out its presence.in all most of all cases,retesting is not needed.

In case if he develops a future lesion he should certainly see a doctor immediately and get tested for swab/smear to know if its hsv or not.

I do agree with you here.

For all safety purposes presumptive treatment with tab Valcyclovir 1gm twice a day for 1 week can be started in both of you,to eliminate the infection and risk of possible future complications.

I hope this info is helpful to you,
Post your further queries on http://bit.ly/drsureshheijebu
Thank you
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Suresh Heijebu 2 hours later
Thank you that is very helpful! As a follow up, I would like to clarify so I don't misunderstand. I understand I can give him HSV1 genitally with oral/genital contact. Are you also saying that I can give him HSV1 genitally with only oral/oral contact? I know the point is moot in our case since we are both HSV1 positive, but I would still appreciate the answer. Specifically, if I kiss an HSV1 negative person other than my boyfriend, is there any risk of them developing HSV1 genitally? Is that what you mean by it travels all the way and manifests elsewhere?

doctor
Answered by Dr. Suresh Heijebu 11 hours later
Brief Answer:
Mere oral to oral kissing will not result in genital lesions

Detailed Answer:
Hi Madam,

You can transmit your hsv1 to your boyfriend by both oral route (oral sex) and genital route(vaginal or anal sex).okay.

Your boyfriend can have penile lesions with hsv1 in case if he participates in any one of the three routes namely vaginal ,oral or anal sex,which brings his penile mucosa in contact with your hsv1 infected mucosal areas(of oral,vaginal or anal orifices) .

Genital herpes lesions ,ie,penile lesions in your partner(other than your boyfriend) can be acquired only if his penis comes in contact with your mucosal areas(of oral,vaginal or anal orifies) similar to what i mentioned above.

In case of only mouth -mouth kissing with your other partner(other than your boyfriend),you can transmit infection,which results only in oral lesions and not penile lesions by definition

infection travelling all the way implies male partner with genital herpes transmitting infection to the entire body of female partner by having either vaginal or oral or anal sex and vice versa.

I hope this will be clear now,
Thank you
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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