New Information on Herpes

Source: Curr Opin Infect Dis. 2014;27(1):75-83.

OK so we all know Herpes is bad news. How bad news? This bad news:

  1. It cannot be cured. Once you have it, you have it for life.
  2. It is highly contagious and spread by skin-to-skin or skin-to-mucosa contact EVEN WHEN a person does not have any symptoms. This is called asymptomatic viral shedding. More on that later.
  3. It increases the risk of contracting HIV 2 to 3 times.
  4. It can infect a baby during delivery and cause the baby to become very sick.
  5. It can cause very painful blisters and ulcers.

Some new information was recently made available on Herpes and I would like to share it with you.

  • Herpes Type 1 infects the mouth and Herpes Type 2 infects the genitals right? WRONG!

HSV 1 (Herpes Simplex Virus Type 1) is found to be twice as commonly found in the genitals compared to HSV 2 (Herpes Simplex Virus Type 2). So if you test positive for HSV 1, it could be because you have had cold sores your whole life. It could also be because you have HSV 1 infection in your genitals. Unfortunately, there is no way for you to know unless you actually develop symptoms in the genitals. How often people who are infected in the genitals with HSV 1 develop symptoms is discussed below.

  • How many people in the world actually carry Herpes?

HSV 1 – 80% to 90%. Oh yes. Scary thought. HSV 2 – 16% (This study is only for people between the ages of 19 and 49. It could be more if the age range was wider.) Yes it is extremely common. Which means universal screening for Herpes might not be too useful. In other words, if you do not have symptoms, you might not want to screen for Herpes as statistically, there is a good chance your test will turn out positive.

  • How many people develop symptoms?

When a person is first infected with HSV 1, 74% of them do NOT develop any symptoms. Same goes for HSV 2 except the number is a little lower at 63%.

As time goes by, 57% of people infected with HSV 1 in the genitals will develop symptoms. The number is much higher for HSV 2 at 89%. Those with HSV 1 infection of the genitals have a median of 1.3 outbreaks per year and those with HSV 2 infections of the genitals have a median of 4 outbreaks per year.

This means there are a good number of people infected with HSV that go through life happily oblivious of the fact.

  • What’s this thing about asymptomatic viral shedding?

That means even when a person does not show any symptoms, he/she is still shedding the virus and can infect someone else. Recent very smart studies using repeat genital sampling and spatial mathematical modelling have demonstrated that reactivations are brief (i.e. <12 h) and occur frequently. More specifically, 80% to 90% of people infected with HSV 2 undergo asymptomatic viral shedding in approximately 20% of days.

This means that many people are spreading Herpes without even realizing it. This makes it very challenging if not impossible to completely protect oneself from getting Herpes.

  • Should I screen for Herpes?

Hmm. No surprise the jury is still out on this one. In Singapore there is no recommendation for universal screening for Herpes. Similarly, in the US, screening is not recommended by the US Preventive Services Task Force. The reason given is that current blood tests are not all that accurate and that is a very fair statement. The other concern is that Herpes screening can lead to ‘detrimental psychological outcomes’. I definitely can relate to that. Many of my patients, completely well and asymptomatic, are driven to near madness because of a positive Herpes test. Of course when there is a clinical need, you should still screen for Herpes. The emotional and psychological aspect of it just has to be dealt with. However, universal screening for Herpes is still not recommended because there are no studies to actually show that people who know that they carry Herpes will change their behaviours to lower transmission rates.

If there is a good reason for you to screen for Herpes, please do it.

  • Any chance of a vaccine in the near future?

Sorry nope. Vaccine trials for Herpes has been nothing short of disappointing. Kinda like vaccine trials for HIV actually. There is a candidate for a Therapeutic Vaccine but it is only in Phase 1. Industry insiders will know to tell you not to hold your breath.

  • Conclusion

Statistically, it is more likely that you are carrying Herpes than not. If you develop symptoms like blisters or ulcers in the genital region, go see your doctor immediately. Swab tests of the blister or ulcers are much more accurate than blood tests for Herpes. There are medicines that you can take that will reduce the number of days you have to suffer with the symptoms. There are also medicines you can take to prevent outbreaks and reduce the risk of passing it on to your partner.

If you truly have been found to have Herpes don’t freak out. I know it sucks to be diagnosed with an STD that will stay with you for life but really things could be worse. At least Herpes is not going to kill you. It may cause you to have painful blisters or ulcers that can be controlled with medicines. It will not be passed to your children. The way infants are infected is if the mother has active Herpes blisters in the genital region at the time of delivery. If that is the case, your doctor can discuss alternatives with you like delivering the baby via a C-Section.

If you have Herpes don’t freak out. Manage the problem.

Click for the old article on Herpes.

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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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170 Comments

  1. What does IGG – “reactive” mean? (No values given)
    IGM – negative
    how ever blood test gone when blisters were there.
    Could it be false positive IGG?

    • You should ask the doctor who did the test for you to interpret the results for you. We cannot given medical consultations online.

  2. Hi Doc,

    So does it really matter if one gets a cold sore, or is HSV positive? Since its so common.

    Thanks

    • It is very common. The only concern is that you can get painful cold sores, and you can transmit the virus to another person.

  3. Hi Doctor,
    I was diagnosed with genital herpes couple of years back. I am married and I was using condoms as a contraceptive. I had an outbreak early this month, and it was controlled by 800mg (2 tablets) of Acyclovir. Now I want to have a baby with my wife and it freaks me out for having unprotected sex with her, because of the obvious reason of infecting her and in turn infecting our baby in the process. From what I know she is not infected. Do you have any advice of how we should be doing this?

  4. Hi Dr. Tan,

    I am confused and scared.
    I am married for the last 11 years and have been completely faithful. I recently started working for a company which runs free routine tests for its employees. These include typical blood tests, urine test etc. All cleared out except HSV 2 with a result of Igm 0.7 and IgG 1.2 (Elisa test – Anything above 1.0 is considered positive).

    I have been reading a lot over the internet and I am trying to educate myself. I ran another test 7 days later at a different lab running an Eclia test. The results are HSV2 – abs IgG 2.7 (where anything above 1.0 is considered positive).

    It may be irrelevant to mention, but in both cases HSV1 results (both IgM and IgG) were negative.

    I am coming to terms that I have the virus, but what I am trying to understand is if there is any indication that this is an old infection (10+ years) with absolutely no outbreak, or a recent one again with no outbreak. I have never had any outbreak symptoms whatsoever, no itching, no blisters, no discharge etc.. If it is a recent infection, then this means I have a serious problem in my marriage. 🙁

    (PS. I live in Europe and the Western Blot test is not available).

    Kind Regards
    Andrew

    • First of all, I personally would only consider an asymptomatic patient to have HSV 2 only if the antibody titre is > 3.50. So in your case, I am still not convinced you carry the virus.
      However, I must say that the rapid rise in antibody titre is very worrying. BUT since you did it at 2 different labs, which may be using 2 different machines, it is not right to make a direct comparison of the titre levels.

      As for the second part of your question, the answer is YES. It is absolutely possible for someone to be infected with HSV 2 for year and even decades and do not show any symptoms.

  5. Hi drtan,

    Got a couple of question.

    1. If I’m positive with hsv1 and not hsv 2 will I transmit the virus to my partner during sex? Presume no kiss and oral sex, will unprotected sex put my partner at risk for Hsv 1 oral?

    2. Will I infect my family member by sharing soup or food without sharing the utensil?

    3. Will hand sanitizer help to prevent spread of the virus From hand contact to other area/ people?

    Thank you in advance

    • 1. I assume that your HSV 1 is oral. You do know it is very possible to have genital HSV 1 infection right? If your HSV 1 is oral, then you can only transmit it if there is direct contact with your are around your mouth.

      2. This is up for debate. Some people believe sharing spoons (not food) is a possible route of transmission of HSV.

      3. Not that I know of.

  6. Hi Doctor. I am currently dating a girl who just told me she has both HSV-1 and HSV-2. We are not physically intimate yet.
    May I seek your advise on the following:
    – how can I be supportive to her?
    – what precautions can I take?
    – regarding sex, my religion prohibits contraception, what measures can I take?

    • 1. HSV especially HSV-1 is very common. You can start by accepting her condition.
      2. Use a condom. It can reduce the risk but not 100% because HSV can be transmitted by skin to skin contact.
      3. You can bring her to speak to a doctor regarding HSV suppression therapy – taking oral anti-viral tablets to reduce risk of transmission.

      http://www.drtanandpartners.com/where-to-find-us/

  7. Hi there,

    I been reading that people with herpes could exhibit flu-like symptoms and i am worried. I have been coughing out phlegm recently, and wondering if i could have gotten herpes, or am i just overly paranoid and have just gotten flu since it has been rather cold in singapore recently.I do not experience any pain passing urine.

  8. Hi doctor i had a unprotected oral sex amd protectd sex with a girl whom i barely know.the next day i had flu for the whole day.the second second day i woke up with pain in tight knee and leg.third day i am having burning sensation on skin of my leg and hands.can this be herpes or any other stds.

    • There are no STDs in this world that can produce symptoms less than 24 hours after infection. I am not saying that you did not catch anything. I am saying that your symptoms are not due to STDs.

    • Hi doc today is exactly two week since my incident.today i woke with heavy sneezing with slight flu,now having nausea knida feeling.are this symptoms of any std or hiv?

      • Plus i had feeling vomitting.pls do help me doc.feeling very worried

  9. Depressed

    Will I pass herpes to my baby if I kiss him on the cheeks or share the same food as him? I’m very worried that my baby will be infected because of me…

    • If you have Herpes infection of your lips like most people in this world do, and you kiss your child or anyone else, you can pass the herpes to that person. That is in fact the most common way people get herpes type 1 i.e. kissing.

      • Depressed

        If i have no cold sores around my lips? Would i still be contagious when i kiss my baby?

        • Assuming that you are infected with Herpes on your lips, you still will be contagious even when you do not have symptoms. This is caused by asymptomatic viral shedding.

  10. I have an crack both side where lips meet..I was told it was exima. A week after I had red indication above by lip.
    I was told it’s herpes. so I went to hospital and got two blood test hsv 1 and 2. hsv tgg was borderline 0.93. And the other test was hvs test negative. The indication like small pimple right where lips meet it’s back..I don’t what borderline means.. can you please help out? Thank you

    .

    • It means nothing. The HSV IgG test is very difficult to interpret. The best way to know if your symptoms are caused by HSV or not is to get your lesions swabbed and sent for a HSV PCR test.

      • Thanks for your replay.. I am traveling and it’s hard to find a professional

    • Hi doc

      I am taking antiviral suppressive therapy , still will I get a outbreak, is it possible.

  11. 1)Do i need to test for herpes for applying school or job in singapore?
    2)Will having herpes deny me from attending school or job?
    3)how abt the rest of the world?
    Thanks you doctor for all the information you guys are providing!

    • 1. Herpes testing is not a requirement for getting a work or employment visa in Singapore. I have also never heard of any company requesting Herpes testing as part of a pre-employment screening. 2. Not that I have heard of. 3. I don’t know.

  12. Hi doctor I recently got tested for everything under the book everything came back fine but said that blood test came back borderline for herpes I’m scared out of my mind I have to go back to see a gyno but I don’t have bumps or rashes I was just getting the tests to be on the safe side n then I hear that please help

    • Borderline test result for herpes can either mean 2 things:
      1) False positive
      2) Early infection
      You can get yourself re-tested for herpes in about 2-3 months time just to be sure.

  13. So basically herpes is not dangerous bcuz 80-90% of people have herpes..the only bad thing about herpes is the blasters and uclers?..i think i have harped since i was young cuz i had several uclres on my buttlock till now ..it just went on and off. Is herpes consider common diease? that mean i can live normal life and wife and have children with C section?

    • my blaster or uclres look like a big pimple ..always one pimple

      • Herpes type 1 is more common than herpes type 2. Yes, the only problem with herpes is that it causes blisters and ulcers. You can live a normal life with herpes.

  14. sir ,

    I tested hSV 1&2 IGG-2.81 and hsv 1&2 IGM-0.11 please advise . any impact to personal and sexual life.

    Thanks
    swarupa

  15. Hi Doctor,

    I will like to know if it’s possible to get HSV-2 even though I had not have unprotected sex for more than a year. Yesterday I went to doctor and was diagnose with HSV-2 by visual inspection from specialist but the blister and tingling pain are limited only to the scrotum (not on the penis).

    Thank you.
    Jim

    • Yes of course. You could have caught it more than a year ago and it is only showing symptoms now.

  16. Paranoid

    Hi, I am still very confused how Herpes Type 2 is being spread.

    1. Is it spread through exchange of secretion or it will spread by just touching each other? If this is the case Herpes Type 2 can actually spread with almost 100% chance? When I am having sex with my wife I would 100% pass it to her too even with no symptoms?

    2. Recently, I have protected sex with a sex worker. There are no kissing or oral sex involved just penetration with condom. She then fondled my penis & testicles using hands no ejaculation though. I fingered her & suck her dry nipples. She has a blister inside her lips but I do not know if it is cold sore or normal blister.

    3. It has been 1 week since the exposure, I experienced itchiness around my buttocks now & then but there are no blisters or redness. I am very worried I have an outbreak overseas as I am leaving Singapore in 2 weeks time. What do you think are the chances I am infected with the virus.

    4. What can I do to prevent the outbreak overseas?So sorry for the lengthy questions !!!

    • 1. It can be spread by touching because of virus shedding, but not 100%. No STD can be 100% transmitted. If this is the case, almost every person on the street has some sort of STD.
      2. Penetrative sex (even with condom) can put you at risk of STD/HIV.
      3. Itchiness is not a typical sign of HSV infection. If you have itchiness around the buttock, you may want to see a doctor to get yourself checked of parasitic infection instead.
      4. You don’t even know if you have herpes. If you do, you can take anti-viral tablet daily to prevent outbreak.
      http://www.drtanandpartners.com/where-to-find-us/

      • Paranoid

        Thank you very much for the valuable information Dr Sii !!!

  17. Hi doctor
    I have decide to take valaclyclovir 1 mg everyday & l lysine 1 mg
    Will that prevent from giving me recurrence.
    I had 3 outbreaks this year , one in Jan 15 .. Then I started taking antivirals & vitamins for 2 months , the outbreak stopped till September 15 , then I got one again in start of October & one again in end of October ..
    So now I m taking antivirals & lysine everyday …what can be the effect on my kidney & frequency of outbreak if I keep continuing the medicine life long .
    I m only having outbreak on my lip .. Primary infection was in 2010 … Then virus was atent till 2014 December … Then there onwards recurrence have started.

    • I hope you meant 1000mg, not 1mg. Taking valacyclovir as suppressive therapy may reduce the outbreaks and transmission rates. It may potentially harm your liver if you take a high dose for a long period of time. You may want to consider cutting it down to 500mg.

      • Thankyou doc
        Yes I mean 1000 mg .
        Ok I will reduce it to 500 mg , every day.
        But doc , what do you think about the frequency of outbreaks I am having, is it too serious doc.
        If I am taking 500 mg everyday , still That would not prevent from outbreaks.
        Sir 1 important question .. Now this virus active from latent state ,,is there a chance it can again go in the latent stage , or now once active from latent stage it would keep on giving recurrences.
        Thanks
        Sir

        • Frequency of outbreaks differs from person to person. It does not directly indicate the severity of the disease.
          As long as you have the virus, it will stay with you. You may still experience outbreak in the future.

          • I am now really very very tired of this herpes ,,
            Don’t know how to deal with it , suddenly it pops out from nowhere … I am loosing my mind..
            How do U live with this stuff , unable to figure out .

          • Hi doc
            If I m taking antiviral suppressive therapy now , still will I get outbreak , is it possible.

          • Yes it is possible albeit unlikely. In some patients, they need to increase the dose of their suppressive medicine to achieve complete control i.e zero outbreaks.

          • Samit

            Hi doc
            Sep Oct Nov Dec & Jan is when I get recurrence outbreaks oral, from last 2 years when the virus got active from latent state.
            Now I m waiting this year what will happen.intresting.
            been reading a lot on Internet , came across hydrogen peroxide treatment oral or external , thus it really works .
            Might be a stupid question but wanna really know because atleast what I read lot of people r doing this method .

          • I cannot really comment on the use of hydrogen peroxide for herpes because we do not use this in our clinics.

          • Sorry troubling again , what is looks like for vaccine in future for oral herpes will it be out by 2017 .

  18. Hi doc, i was tested for both > 3.5 for both hsv 1 and 2. Was it a 100% cases for me that i hv infected with both hsv 1 and 2. Must i seek for another test by other clinic to confirm.

    • HSV antibody of >3.5 means that you definitely have been infected with HSV. I do not think you need to repeat the test. It will most likely show the same results.

      • hi doctor, I got my result at HSV 1 at 2.0 and HSV 2 at 1.20
        is it mean confirm I have infected?
        or I should retest again.
        please advise.

  19. Dear Dr Tan,
    My lips have been dry, itchy and burning for a month or so, of which later blisters developed and was told by the doctor that i have herpes.
    However, my ex was tested negative for herpes and i do not have other sexual partner.
    I’m wondering if it is possible for the virus to be transmitted through sharing of lipsticks?
    Also, could it be just fungal infection on my lips?
    I do not have anything on my genitals but i’m not sure if it is because the outbreak has yet to develop.
    Thanks in advance for your kind reply.

    • It is possible. Sharing of food utensils is possible as well. Fungal infection on the lips is rare and it is usually itchy. Having herpes on the lips does not mean that you have herpes on your genitals. These are two separate problems.

  20. Hi Dr Tan,

    Will Influenza Vaccine affect hsv1 igg test. I had a reading of >3.5.
    Vaccine taken in March. Hsv 1 test in September.

  21. Dear dr tan, recently i have uclers like blister n red spot on the outer n inner virginia. It hurts to walk or sit. When burst it hurts. There are spot on the anus.and some is individual some is in cluster. This happened to be 3 rd time it occured. Previously the spot is nt painful nor itchy. These happened after i shaved. At first it was itch so i went to shave because my virginia hair some time make me itch . I scratch the part that itch and the next day i saw white bumps which are painful. Could you advise on whether is it herpes or ingrowth hair.after i shave i was wearing panty liner which irritates it. After that the bumps came out. When burst it looks like uclers. Its on top of my cunt and 1 or 2 on the inner left side of the virgina.the cunt area is worse as there is one small cluster n it becoming large. Could you advise me on what to do or what is it i dnt want to see a doctor. It hurts when i pee n there is some burning sensation.

    • Hi, your symptoms sounds like it could be herpes. However, it is difficult to tell exactly if it could be herpes, folliculitis, etc without examining and doing further testing. Would advice that you see a doctor or feel free to visit us as it is definitely causing you discomfort and needs to be treated.

  22. helpless

    Dear doctor, bf and I were first sexual partner. today Went doctor after 2 days fever with bodyache and burning when pee. was told i had genital herpes. could i have got it when bf use his saliva on me and he was also having ulcers in his mouth then? How much will it cost for me to come your clinic for a test and treat it. Thank you

  23. Dear Dr. Tan,

    Many thanks for the great website that you have created and the fact that you take out time yourself to answer reader’s questions is amazing. I just wanted to ask your opinion about the following symptoms which I have been having on and off over the past four years:

    – red rash around parts of the corona of my penis, parts of glans and parts of the foreskin but only those which, when the penis is flaccid touch directly the rash on the corona or glans (as if the rash was somehow transferred from corona/glans to foreskin)

    – apart from that nothing else, no bumps, no chancres, no sores and no pain when urinating. Rash is not painful to the touch, no itching and no burning sensation

    – first time this developed was circa one month after having unprotected oral sex

    – since then it comes and goes (2 or 3 times per year)…sometimes a rash develops one day and is gone the following day. Sometimes it stays for as long as two weeks (never longer)

    – whenever symptoms appear it all happens very quickly so in the evening there is nothing visible and by next morning the rash is clearly visible (it always seems to appear overnight)

    Over the years I have had regular tests including syphilis, hiv, hep B, gonorrhea, chlamydia, all neg, but the one tests that i haven’t done is HSV2 hence my posting here.

    Do you think it could be herpes or an unrelated skin condition (balanities, psoriasis etc)?

    Sorry for the rather long post but I really appreciate and value your comments.

    Many thanks,

    Harry

    • Does not sound like Herpes at all. However not all herpes infections follow textbook symptoms. If you really want to know if this is herpes or not, you should get a HSV PCR swab.

  24. Hello Dr. Tran,

    I am aged 30 yrs. I have taken vaccination on 25th Feb for Swine flu.In my child hood I had been vaccinated for Chicken pox.

    My Risk is I involved in Sex with a sex worker 4 months back, 6 months back and a year back.

    can the vaccination Vaxigrip makes HSV 1 & 2 IgG – give false positive ?

    I got a values as below for tests done on 5th March
    HSV 1 & 2 IgG – 2.1
    HSV 1 & 2 IgM – 0.4

    Till today I never had any cold sores either on face or on genitals.

    But when I consume more alcohol, i see some warts on bumps that’s go within a week. I have skin problem where I get small pimple kind of sores on left hand and fade away with a normal tropical cream.

    Do I need to get more tests done for herpes ? Do I need to worry on
    my current test results ? I saw in many blogs <3.5 value there is a 50% chance of false positives.

    Thanks,
    Kiran

    • The blogs you read were absolutely right. When the HSV IgG levels are < 3.5, we cannot be really sure of the diagnosis as the chance of false positives are high. This is especially so if you do not have any symptoms of Herpes. You may want to do a HSV TSST to find out which of the 2 types are causing the high IgG levels. The Chicken Pox vaccine you had as a child can cause the HSV 1 to be false positive.

      • Many Thanks Doc. your Blogs are accurate and one can get relief just by reading your blogs and contributions. Great work from you and your team.

        1 last question.

        As far as I know all the tests are done over blood they will detect antibodies for the virus.

        Can the Influenza Vaccine can also contribute to the false positive for both the types ? Since I had a vaccine Vaxigrip 2 week’s back just want to make sure when is the rite time to get tested again.

        previous tests I got it done was ELISA.

        composition:
        15 μg HA A/California/7/2009 (H1N1) – like strain [A/California/7/2009 (H1N1) (NYMC X-
        179A)]
        15 μg HA A/Perth/16/2009 (H3N2) – like strain [A/Victoria/210/2009 (NYMC X-187)]
        15 µg HA B/Brisbane/60/2008.
        Other Ingredients
        2 μg thimerosal*, up to 0.5 mL sodium phosphate buffered isotonic sodium chloride solution,
        formaldehyde (≤30 μg), Triton® X-100, and trace amounts of sucrose and neomycin
        * added as a preservative in multidose presentation only
        For the 2010-2011 season, each 0.25 mL dose of VAXIGRIP® contains:
        7.5 μg HA A/California/7/2009 (H1N1) – like strain [A/California/7/2009 (H1N1) (NYMC X-
        179A)]

        7.5 μg HA A/Perth/16/2009 (H3N2) – like strain [A/Victoria/210/2009 (NYMC X-187)]
        7.5 µg HA B/Brisbane/60/2008.
        Other Ingredients
        1 μg thimerosal*, up to 0.25 mL sodium phosphate buffered isotonic sodium chloride solution,
        formaldehyde (≤15 μg), Triton® X-100, and trace amounts of sucrose and neomycin

  25. Just curious

    Hi drtan,

    May I know around how long does herpes take after infection to be contagious?

    thank you in advance 🙂

  26. Feeling Anxiety

    Hi DrTan,

    I have visited a sex worker in early November 2014. I would like to know if I am infected with herpes. After how long of the exposure will herpes have outbreaks (period)? If there is no sign of herpes for 6 months will this prove I do not have herpes if otherwise may you let me know how long will it take me to confirm I do not been infected with herpes.

    thank you DrTan.

    • Unfortunately Herpes can remain symptom free for years. In fact, the majority of people infected with Herpes do NOT get the primary outbreak.

      • Feeling Anxiety

        Thank you for your reply drtan. In this case, how could I know whether I am infected with herpes or not. As I have read your article saying herpes will easily be transmitted even kissing will get us exposed to herpes. If there is no outbreak of herpes, will I still infect people around me? Will a simple kiss on the cheek expose us to potential herpes infection? Sorry for asking too much question, I am very worried right now. Have problem sleeping thinking of it and might spread to my love one if I have contacted the virus. Hope you may help. Thank you once again.

  27. Hi doctors,

    Thanks for your kind efforts in helping us clear our doubts through your site. I’ve a few questions about herpes that hopefully you can please help me answer. Thanks!

    1) What’s is the possibility of herpes transmission (either from the guy to the gal, or gal to the guy) if a guy and gal engage in dry humping, with the guy wearing nothing below but the gal wearing full length pants and underwear, and halfway through the process the guy proceeds to give himself a hand until ejaculation?

    2) Unrelated to the event above, how conclusive is a hsv2 igg result of 0.35 at 6weeks? Will it become positive at 12 weeks?

    3) After how many weeks will hsv1&2 igg tests results be conclusive?

    4) Is it possible to have a hsv2 igg of 0.35 at 6 weeks and yet develop hsv2 blisters in the groin area?

    Thanks so much for your help. Appreciate it

    • 1. So no direct skin to skin contact? No risk. 2. Very indicative. In very rare cases it takes up to 16 weeks for IgG to turn conclusively positive. IgG is not a binary result. It is a continuum. 3. Mostly 4 weeks. Rarely 16 weeks. 4. Yes of course. Swab the blisters for a HSV PCR test.

  28. Recently my wife developed some blister like infection inside skin of lips, and some black shade on outer skin of lips. Besides that some reddish color itchy patch on 1 thumb and 1 toe. She had this similar out break 6 months ago and also 12 months ago. Initially we didn’t suspect anything and it will cure within 2 weeks with antibiotic treatments. After reading on internet I suspect she nay have hpv1.
    Should we go HPV1 test? I am also worried this cause unnecessary stress as it seems HPV1 is common.

    • I do not quite understand your question. She has symptoms so to me the logical thing is to get to the bottom of the cause of her symptoms so that we can give a proper prognosis and treatment.

  29. Hi Doctor, I received unprotected oral sex only from a sex worker about six days ago. I experienced anxiety,and loss of appetite thinking about what I have done and risk of stds.No urinal pain or itching as of now.I went to dsc clinic to screen for std 3 days after exposure but results will take 2 weeks. Now I’m in dubai for some work assignment.2 days ago I notice 3 to 4 warts appear on my genital skin and went to a doctor here and he says it’s warts and prescribe me with aldara cream. Is it a symptoms of herpes? I’m worried as I will be here for at least 2 more weeks. Please advise Dr Tan..

    • Warts are a symptom of HPV infection. The symptoms of Herpes are usually painful blisters and ulcers. If you develop any of these, please see the doctor asap. The sooner you start on anti-viral medicines for Herpes, the quicker the symptoms go away.

      • Thank you doctor. But is it possible warts to appear as early as 1 or 2 days after exposure? From what I know warts will only appear at least 1 or 3 months after exposure. Will visit your clinic once I’m back.

        • You are right. It is not possible for warts to appear so soon after an infection.

  30. Unknown 1

    How much cost for screening hepatitis b? and will i get immediate result?

    • $24 before GST. It takes about a day or 2 to get results.

      • thanks Dr !!! and i have question . Kissing can pass the hepatitis b??

        • Theoretically possible especially if there is poor dental hygiene and blood in the mouth.

  31. Hi Dr Tan,
    My last exposure was on 17 Aug 14.
    I had protected but came into contact with menses blood. Had a panic attack then.
    Current symtomps include:
    1) white spots under the lips skin (both sides connecting to face)
    2) several 4-5 small red spots on penis shaft, not cluster and not itchy
    3) white spots on foreskin of penis when retracted (not circumcised)
    4) watery excrete but not diahrea

    I suspect is herpes. Would like to seek your advice doctor.
    And should I visit the clinic immediately or wait till 28 days? Thanks!
    Will really appreciate your reply.

  32. last year 2012, i was able to acquire the genital warts and herpes viruses. and then my doctor required me to have a vaccine against Cervical cancer. Currently I am 5 months pregnant.. does the virus affects my child?

    • Herpes and Genital warts will not affect your child unless you have skin lesions along your birth canal during delivery. Im other words, if you have herpes blisters on your labia during delivery, your baby’s face will rub against these blisters on the way out. He/She can then get a very bad herpes infection of the face.

  33. Unknown 1

    Doctor,
    I have been told that I have hsv1=1.86.
    No symptoms Nothing. CAn it be false positive.And Am a foreigner affected with hsv1..may I know it will affect my employment pass..am to worried doctor.
    Thanks

    • Hi Unknown 1,

      HSV has no bearing on your employment pass in Singapore. Without clinical signs, it’s hard to state if your test results are false positive or otherwise. In any case, HSV 1 is very prevalent and is thought to affect 80% of the world’s population. Despite its widespread prevalence, it is a fairly benign disease and will cause you irritation rather than harm. Rest assured.

  34. Unknown 1

    Doctor,
    I have been told that I have herpes type 1.86.
    No symptoms Nothing. CAn it be false positive.And Am a foreigner affected with hsv1..may I know it will affect my employment pass..am to worried doctor.

    Thanks

  35. unknown

    Doctor,

    Am a foreigner affected with hsv1..may I know it will affect my employment pass..am to worried doctor..Pls advise sir..

  36. Hi Dr tan
    I have been told that I have herpes type 1 + and it is borderline.
    No symptoms just tingling feeling. Border line results means I have type1?
    .

    • You need to go ask your doctor what exactly he means by ‘borderline’. If the IgG antibody titre is just about enough to be higher than the lab’s reference range for positive and you do not have any symptoms, in my view that is most likely a false positive.

  37. Freak out

    I was tested positive for herpes type 1 recently, what can I do to prevent or minimise the contagious.
    IgG test show 34 .but herpes type 2 shows igG 2.5
    I am also prone to cold and fever and sore throat. However I do no have blister or sore mouth etc from the symptom type 1 should have.
    How can I controll for this ? Would supplements helps?

    Thanks
    Worried

    • drtan

      The only way to 100% not spread Herpes to anyone is to not kiss or engage in sexual contact with anyone for the rest of your life. Obviously this is impractical. When you have an outbreak you are very contagious and should avoid sexual contact. Condoms give about only 30% protection. Supplements like Lysine and Vitamin C reduces the frequency of outbreaks but does not reduce the risk of contagion per se.

  38. Horatio

    Any chance at all we can procure a Western Blot at all locally, or by expediting blood overseas?

    • drtan

      You mean Western Blot for Herpes? I do not know of any local lab that does it. I am not sure of sending the sample overseas.

  39. Lim yong

    thanks for the reply. Anyway I had seen a few doctors. some how they each give me a different answer. 🙁

    • That is a shame. My personal opinion, for what it’s worth, is that you do not. The test is more likely to be a false positive.

  40. Lim yong

    Hi I had a herpes type 2 IGG test with a reading of 1.2 from path lab Singapore. I got no symptoms at all. Please kindly advise do I have herpes type 2 or not? What should I do now?

    • Most likely not. Please see the doctor who did the test for you for more advice.

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