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Medical Forum / Diseases and Disorders / Herpes / October 2006I/II vs oral/genital
I am getting more and more confused. Can both types I and II be either oral OR genital? For example, but not limited to this, can genital be spread to the oral area of another person? It is my growing understanding that initially it was thought that I (One) was primarily oral but could be transferred to the genital area and that II was only genital. Over time, it seems, it came to be thought that either can be found in either area. Does anyone KNOW about this? One contributing factor to my confusion is the proliferation on newsgroups of what someone "thinks" vs what they KNOW to be true. If you would make a distinction between whether what you express is opinion vs. something more fact-based, I would appreciate it. Thanks. R >I am getting more and more confused. http://yoshi2me.com/hsv1-hsv2.html > Can both types I and II be either oral OR genital? Yes > For example, but not limited to this, can genital be spread to the oral > area of another person? Yes > It is my growing understanding that initially it was thought that I (One) > was primarily oral but could be transferred to the genital area and that > II was only genital. No, they can both pop up in both locations. However, you don't hear too much about oral HSV-2 because it's not that common. Genital HSV-1 is very common. > Over time, it seems, it came to be thought that either can be found in > either area. Does anyone KNOW about this? http://yoshi2me.com/hsv1-hsv2.html > One contributing factor to my confusion is the proliferation on newsgroups > of what someone "thinks" vs what they KNOW to be true. If you would make a > distinction between whether what you express is opinion vs. something more > fact-based, I would appreciate it. Look - this is the Internet. You have to take responsibility for what information you are going to check into and what information you are going to ignore. There are plenty of search tools available so that you can figure out what is accurate and what is inaccurate. What I share with information on the inernet is based on 11 years of having this virus, faciliatating a support group here in my town, and interacting with the medical community. As with all experience-sharing-advice -- you have to check it with your own medical resources -- such as a doctor, etc. Good luck, Angela http://yoshi2me.com -- Yes, that's my site too -- take it or leave it. Im back online now, so I'll jump in on this one > I am getting more and more confused. Can both types I and II be either oral > OR genital? OK the thing to separate is disease agent and location. The oral and genital is the location and the HSV I and II specifies the agent. Part of the problem is that type I and type II have been in use for longer than the ability to discriminate the agents genetically and have had different definitions in the past which did merge location and type. While each type has a classically associated location they can infect both locations. > It is my growing understanding that > initially it was thought that I (One) was primarily oral but could be > transferred to the genital area and that II was only genital. A long time ago the terminology was used differently. As the understanding of the nature fo the viruses themselves has expanded and the tools developed then the understanding of the biology has increased. With that has come the understnadning that the viruses were different and could transfer from location to location. Currently it appears that about 1 in 3 new cases of genital herpes turn out to be HSV1. Data for oral herpes is a lot harder to come by since less people are answering this sort of question. The quick answer typically given that HSV2 seems to transfer less, but that may be a question of visibility to some extent or other. There's one here, which is in a study in men which may shed some light on that... Kim HN, Meier A, Huang ML, Kuntz S, Selke S, Celum C, Corey L, Wald A. Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men. J Infect Dis. 2006 Aug 15;194(4):420-7. The conclusions they came to were; Oral HSV-2 reactivation was common (especially among HIV-positive men), was always asymptomatic, and often occurred on days of genital HSV-2 reactivation. How reprentative of the general population this is would require some dissection of the datasets. It does establish HSV2 infection in the oral area though. One of the authors also published this case report of a symptomatic case Olin L, Wald A. Case report: symptomatic oral herpes simplex virus type 2 and asymptomatic genital shedding. Herpes. 2006 May;13(1):25-6. But yes, HSV1 and HSV2 can each infect both oral and genital locations. How often they do it is much more open to debate - particularly with oral HSV2. Tim -- When playing rugby, its not the winning that counts, but the taking apart ICQ: 5178568 Hi Robert, So, just in case there is any confusion left: Type 1 and type 2 are about types, not location. Both viruses can infect either the genital or oral locations. Type 1 was most commonly thought of as cold sores, but with the increase in oral sex practices, type 1 is becoming quite common in the genital area. Type 1 genital herpes can be spread to someone's mouth through oral sex as well. Type 2 herpes is not often found orally, but that may be because it is not often reported. Let us know if you have any other questions. ar >I am getting more and more confused. Can both types I and II be either oral >OR genital? For example, but not limited to this, can genital be spread to [quoted text clipped - 12 lines] > > R Robert, Either type can be found in either location. That said, HSV-1 very much prefers the oral area while HSV-2 very much prefers the genital area. Outside of its preferred area, each virus loses much of its "punch", in that of those people with a genital HSV-1 infection, 40% have 1-2 outbreaks over the next 1-2 years and then none. 50% never have another outbreak after their primary. And only 10% have any that are slightly more frequent than 1-2. Oral type-2 has a recurrence rate of like 1/30 years or something very small like that. It virtually never recurs. Since viral shedding is proportional to frequency and severity, there is very little if any shedding of the viruses outside of their area of preference. These are all facts which can be verified by peer-reviewed journal articles. Now in my opinion, oral type-1 sucks. Just like genital hsv-2, the virus is in its "home territory" and can cause all of the symptoms or even be worse than genital hsv-2. Finally, type-2 is an STD, which causes primarily genital herpes. Since there is no sex necessary to get type-1 orally, it is NOT an STD. > I am getting more and more confused. Can both types I and II be either oral > OR genital? For example, but not limited to this, can genital be spread to [quoted text clipped - 12 lines] > > R > Since there is no sex necessary to get type-1 orally, it is NOT an STD. Not quite, type 1 herpes is an std. Whether it occurs on the mouth or the genitals, it is still a sexually transmitted disease. http://vanderbiltowc.wellsource.com/dh/content.asp?ID=301 HSV-1, also known as oral herpes, usually causes cold sores or fever blisters around the mouth. It can be transmitted to another through kissing or oral sex while the cold sore or fever blisters are present and sometimes even when no symptoms are apparent. Oral herpes is the most common of all sexually transmitted diseases (STDs). http://www.stanford.edu/group/SHPRC/ch4_ora.html a.. Herpes is probably the biggest STD risk during oral sex. Both strains of herpes can live in the mouth or the genitals, and particularly during outbreaks (cold sores, herpes lesions) can be passed from one place to the other. Many people have oral herpes, more than 50% of a random group of people will have antibodies to the virus (indicating some level of infection). Having oral herpes for most people is no big deal, a cold sore during times of stress or illness is usually little more than an annoyance. Genital herpes can be more complicated and uncomfortable, but there are treatments (see Herpes Fact Sheet for more info). Care should be taken so that oral herpes are not passed to anyone's genitals. In general it is not a good idea to have unprotected oral sex while any lesions are present. > Not quite, type 1 herpes is an std. Whether it occurs on the mouth or the > genitals, it is still a sexually transmitted disease. This is an editorial. I am going by Harrison's Internal Medicine which is peer-reviewed by herpes experts such as Corey and Handsfield. I'll send an excerpt where HSV-1 is described as "not a true STD" in that the vast majority is "not sexually transmitted". The article will clarify. So you would say that a 2 year old child with a coldsore has an STD? Tell that to the parents, LOL. I'm a virgin and you would say that I have an STD? > So you would say that a 2 year old child with a coldsore has an STD? > Tell that to the parents, LOL. I'm a virgin and you would say that I > have an STD? And you would say that I don't? ar > > So you would say that a 2 year old child with a coldsore has an STD? > > Tell that to the parents, LOL. I'm a virgin and you would say that I > > have an STD? > > And you would say that I don't? That you don't what? HSV-1 is predominantly not an STD because it spreads predominantly through non-sexual means, e.g. kissing. So, you're saying I don't have an std. ar >> > So you would say that a 2 year old child with a coldsore has an STD? >> > Tell that to the parents, LOL. I'm a virgin and you would say that I [quoted text clipped - 4 lines] > That you don't what? HSV-1 is predominantly not an STD because it > spreads predominantly through non-sexual means, e.g. kissing. > So, you're saying I don't have an std. I'd say HSV-1 is in a gray area. I found a posting on this very topic on another forum. http://www.medhelp.org/forums/STD/messages/2811.html That didn't actually clear up anything. And I really don't like that doctor's advice: "You probably don't need to worry about transmitting the infection to anyone, sexually or by any other contact, unless you develop symptomatic outbreaks, such as cold sores " That's not true due to asymptomatic shedding. And for this, I discount pretty much everything he says. He apparently has no problem perpetuating myths about herpes and therefore, continues to allow people to infect others out of ignorance. You can't have one virus and call it an std in one location and not an std in another location. That simply doesn't make sense. How can someone with genital type 1 catch an std from someone who doesn't have an std? Unfortunately, no matter the mode of transference, herpes is a sexually transmitted disease. Perhaps the definition of std needs to be refined to take in to account changing sexual practices. If someone has oral herpes, they need to modify sexual behavior to keep their partner from getting a genital infection. That makes it an std. If no modification was necessary, then it wouldn't be an std. If it couldn't be passed on through sexual conduct, then it wouldn't be an std...but it can. ar >> So, you're saying I don't have an std. > > I'd say HSV-1 is in a gray area. I found a posting on this very topic > on another forum. http://www.medhelp.org/forums/STD/messages/2811.html > That didn't actually clear up anything. And I really don't like that > doctor's advice: Well I respectfully disagree with you on that. I think this doctor is an expert on the subject, but that's my own humble opinion. > "You probably don't need to worry about transmitting the infection to > anyone, sexually or by any other contact, unless you develop symptomatic > outbreaks, such as cold sores " Keep it in context. That was to a patient who never had a coldsore ever and had no evidence of oral herpes. For all practical purposes, that person can't go around assuming that they are a 24/7 biohazard, rather they need to watch for symptoms and calm down. > That's not true due to asymptomatic shedding. Shedding is proportional to frequency and severity of outbreaks. If the person never had an outbreak ever, consequently, they unlikely shed. > And for this, I discount > pretty much everything he says. He apparently has no problem perpetuating > myths about herpes and therefore, continues to allow people to infect others > out of ignorance. Again, your opinion and I respect it as such :-) > You can't have one virus and call it an std in one location and not an std > in another location. That simply doesn't make sense. How can someone with > genital type 1 catch an std from someone who doesn't have an std? It makes perfect sense. Many diseases can be transmitted many different ways. Look at how many ways the common cold seems to keep us annoyed. Look at yeast infections. They can be transmitted to a partner, but more often than not, they occur totally independent of sex. So we don't say that yeast infections is an STD because they usually aren't. Likewise, HSV-1 can be sexually transmitted. But clearly, it's chief mode of transmission is non-sexual, transmitted to and from the oral area. > Unfortunately, no matter the mode of transference, herpes is a sexually > transmitted disease. Perhaps the definition of std needs to be refined to > take in to account changing sexual practices. No, we can't call oral HSV-1 and STD because sex isn't in the picture. Forget about sex. Kids get HSV-1 more than anyone else. They aren't having sex to get their coldsores. Likewise, we don't say that their coldsores are an STD. > If someone has oral herpes, > they need to modify sexual behavior to keep their partner from getting a > genital infection. That makes it an std. If no modification was necessary, > then it wouldn't be an std. If it couldn't be passed on through sexual > conduct, then it wouldn't be an std...but it can. No. I'll stick with my current example of a yeast infection. This can be spread to a partner during sex. But the vast majority of the time, yeast infections occur totally independent of sex. Yeast infections are not an STD. Neither is oral HSV-1. But yeast infections are produced independently in the body and have nothing to do with sex. Yeast infections aren't really a good example. So, more times than not, a person develops a yeast infection without ever being in contact with another person. However, herpes must be spread by skin to skin contact. No one develops a spontaneous herpes infection--it always comes from someone being in close contact with them. > Shedding is proportional to frequency and severity of outbreaks. If the > person never had an outbreak ever, consequently, they unlikely shed. However, there are lots and lots of people who received herpes from partners who never had an outbreak. Shedding is a reality whether or not the person has actual outbreaks. > No, we can't call oral HSV-1 and STD because sex isn't in the picture. But it is in the picture. It just isn't 100% the picture. > Forget about sex. Kids get HSV-1 more than anyone else. They aren't > having sex to get their coldsores. Likewise, we don't say that their > coldsores are an STD. But they can pass those cold sores on to their partner's genitals, giving them an std. Gonorrhea is an std. It can also be spread to a person's throat through oral sex with someone who has it. When it is in that person's throat, it is still an std. It's passed this way the same way oral herpes is spread to genitals. ar > But yeast infections are produced independently in the body and have nothing > to do with sex. Yeast infections aren't really a good example. So, more > times than not, a person develops a yeast infection without ever being in > contact with another person. However, herpes must be spread by skin to skin > contact. No one develops a spontaneous herpes infection--it always comes > from someone being in close contact with them. Yes, yeast infections have nothing to do with sex, even though they aren't "produced independently" because it is of course an infection. Oral HSV-1 has nothing to do with sex for the majority of folks with it. More times than not, people who are exposed to HSV-1 are very young children. They obviously never had sex to get this. Yes, herpes does develop from being in close contact with someone. So does the flu. So does a cold. > > No, we can't call oral HSV-1 and STD because sex isn't in the picture. > > But it is in the picture. It just isn't 100% the picture. Exactly my point! HSV-1 sits in a gray area. Clearly, much more often than not, it's transmitted non-sexually. > But they can pass those cold sores on to their partner's genitals, giving > them an std. They can. But much more frequently before they even get to have sex they can kiss someone and give them oral herpes. I don't know how to explain this issue any clearer, Grant. HSV-1 can infect the skin, the finger, the eye, the oral area, the genitals. Based on what happens most often, HSV-1 is spread non-sexually. Ask a physician, maybe they can explain it better than I could. I'm just playing Devil's advocate, Eric. I agree, it is in a gray area. However, your arguments are convincing me 100%. > Yes, yeast infections have nothing to do with sex, even though they > aren't "produced independently" because it is of course an infection. Yes, an infection that the body creates on its own. It doesn't take another person in the picture to make it happen. > Oral HSV-1 has nothing to do with sex for the majority of folks with > it. More times than not, people who are exposed to HSV-1 are very young > children. They obviously never had sex to get this. Yes, herpes does > develop from being in close contact with someone. So does the flu. So > does a cold. The flu and cold viruses can be picked up from touching objects that were handled by others. Herpes cannot. So, the flu and cold are also not good examples to make your point with. > I don't know how to explain this issue any clearer, Grant. HSV-1 can > infect the skin, the finger, the eye, the oral area, the genitals. So can HSV-2, which is an std. > Based on what happens most often, HSV-1 is spread non-sexually. Ask a > physician, maybe they can explain it better than I could. I really don't think a physician will have anything useful to say on this matter. My point is that I don't believe you can't have a virus, type 1, which is an std in one location and not an std in another. It either is or it isn't. So, back to my original question, do people with genital herpes type 1 have an std or not? I believe they do. In which case, oral herpes is also an std. ar > I'm just playing Devil's advocate, Eric. I agree, it is in a gray area. I'm happy to have you playing devil's advocate! Glad to see you agree. > However, your arguments are convincing me 100%. You mean are not convincing you 100%? Read on. > Yes, an infection that the body creates on its own. It doesn't take another > person in the picture to make it happen. My point is that yeast infections can be sexually transmitted and yet we don't refer to it as a sexually transmitted disease simply because it isn't usually transmitted that way. > The flu and cold viruses can be picked up from touching objects that were > handled by others. Herpes cannot. So, the flu and cold are also not good > examples to make your point with. Actually herpes can spread from objects--if someone were to share my utensils when I have a coldsore, they risk contracting oral herpes. > So can HSV-2, which is an std. HSV-2 can but usually doesn't spread to those places. Since HSV-2 prefers the genital area, it is primarily spread genitally during sex. Since HSV-1 prefers the oral area, it is primarily spread orally during kissing and other non-sexual ways. It's simply a matter of which way the viruses NORMALLY spread. > I really don't think a physician will have anything useful to say on this > matter. You don't know unless you try, Grant. > My point is that I don't believe you can't have a virus, type 1, > which is an std in one location and not an std in another. It either is or > it isn't. No, I wish it were that simple but it's not. Since HSV can infect so many areas, we look at the PRIMARY mode of infection. If something is primarily spread through sex, then it's an STD. HSV-2 falls into that cetegory. HSV-1 is rarely if ever spread via intercourse but oral sex can allow for HSV-1 to infect the genital area. However, the vast majority of HSV-1 infections are oral and they non-sexual. It's blurred even further by how society defines an STD. If you do call HSV-1 an STD, then you say that up to 90% of the population has an STD! More importantly, overemphasizing an infection as ubiquitous as HSV-1 by calling it an "STD" erodes protection against more important things like HIV, HBV, etc. If you tell a person to wear a condom for oral sex, it doesn't pass the laugh test, and you run the risk of having them view safe sex as "unrealistic". > My point is that yeast infections can be sexually transmitted and yet > we don't refer to it as a sexually transmitted disease simply because > it isn't usually transmitted that way. I just want to make sure you understand that yeast infections are pretty much NOT spread through sex. I would prefer you came up with another example because, again, yeast infections are rarely spread through sex. Where as genital HSV-1 is pretty much always spread through sexual contact. > Actually herpes can spread from objects--if someone were to share my > utensils when I have a coldsore, they risk contracting oral herpes. It's very, very rare for herpes to be picked up that way. But it is the one of the most common ways for the cold and flu. So again, a bad example. > HSV-2 can but usually doesn't spread to those places. Actually, HSV-2 is often autoinoculated. I read somewhere recently that it is more often spread to other body parts than type 1. > Since HSV-2 > prefers the genital area, it is primarily spread genitally during sex. > Since HSV-1 prefers the oral area, it is primarily spread orally during > kissing and other non-sexual ways. It's simply a matter of which way > the viruses NORMALLY spread. But genital type 1 is always spread through sexual contact, therefore making it an STD. >> My point is that I don't believe you can't have a virus, type 1, >> which is an std in one location and not an std in another. It either is [quoted text clipped - 4 lines] > many areas, we look at the PRIMARY mode of infection. If something is > primarily spread through sex, then it's an STD. Like genital type 1. >HSV-2 falls into that > cetegory. HSV-1 is rarely if ever spread via intercourse but oral sex > can allow for HSV-1 to infect the genital area. Oral sex is sex. Thus making it an std. ;) >However, the vast > majority of HSV-1 infections are oral and they non-sexual. No, the vast majority of oral hsv infections are non-sexual. But ALL genital type 1 infections are spread through sexual contact. It would be rare for it not to be. > It's blurred even further by how society defines an STD. Which is why I said it might be time to refine the definition. > If you do call > HSV-1 an STD, then you say that up to 90% of the population has an STD! Bully for them. :) It's about time. Perhaps it would reduce the stigma problems. > More importantly, overemphasizing an infection as ubiquitous as HSV-1 > by calling it an "STD" erodes protection against more important things > like HIV, HBV, etc. I don't think so. >If you tell a person to wear a condom for oral sex, > it doesn't pass the laugh test, and you run the risk of having them > view safe sex as "unrealistic". They view it that way anyway, and that's part of the problem we all have with the spread of stds. But I don't understand your point. Since pretty much all type 1 genital infections are spread through sex, then it is an std. And, since some of the oral infections are also spread through sex, then that still leads me to believe it is an std. ar > I just want to make sure you understand that yeast infections are pretty > much NOT spread through sex. I would prefer you came up with another > example because, again, yeast infections are rarely spread through sex. > Where as genital HSV-1 is pretty much always spread through sexual contact. Grant, they absolutely can be. Enough said about this. > It's very, very rare for herpes to be picked up that way. But it is the one > of the most common ways for the cold and flu. So again, a bad example. How do you know that it's very rare? > Actually, HSV-2 is often autoinoculated. I read somewhere recently that it > is more often spread to other body parts than type 1. Well if you find where you read that send it my way because I doubt it. > But genital type 1 is always spread through sexual contact, therefore making > it an STD. But genital HSV-1 is much much rarer than oral HSV-1 which is rarely if ever spread through sexual contact. > > No, I wish it were that simple but it's not. Since HSV can infect so > > many areas, we look at the PRIMARY mode of infection. If something is > > primarily spread through sex, then it's an STD. > > Like genital type 1. Did you not read what I wrote? LOL. I just said that HSV-1 is primarily spread though non-sexual means. > Oral sex is sex. Thus making it an std. ;) Debate that with Bill Clinton and many, many Americans who disagree. I'm not going there. > No, the vast majority of oral hsv infections are non-sexual. But ALL > genital type 1 infections are spread through sexual contact. It would be > rare for it not to be. Look, this is as clear as day. Can we agree that the vast majority of HSV-1 is oral? Yes. Can we agree that the vast majority of oral HSV-1 is transmitted by kissing? Yes. Then the vast majority of HSV-1 is transmitted by non-sexual means. End of story. > > It's blurred even further by how society defines an STD. > > Which is why I said it might be time to refine the definition. Go for it. > > If you do call > > HSV-1 an STD, then you say that up to 90% of the population has an STD! > > Bully for them. :) It's about time. Perhaps it would reduce the stigma > problems. Do I sense some activism here? LOL. Bully for 90% of the population? Go for it. > > More importantly, overemphasizing an infection as ubiquitous as HSV-1 > > by calling it an "STD" erodes protection against more important things > > like HIV, HBV, etc. > > I don't think so. Public health experts know so. If you tell people that they have to wear a condom to protect the receptive partner from the lips of the performing partner during oral sex, they'll laugh at you. > >If you tell a person to wear a condom for oral sex, > > it doesn't pass the laugh test, and you run the risk of having them > > view safe sex as "unrealistic". > > They view it that way anyway, and that's part of the problem we all have > with the spread of stds. But I don't understand your point. Grant, if you tell someone that in order for them to protect against STD's they must protect their partners from their lips, they won't do it. Yes, that is the problem, and imagine how bad it would be if the lips they use to kiss each other we now tell them they have to protect with a condom in order to have safe sex. Got my point? So then my husband who has HSV-1 antibodies does not have an STD. Hmmm... then what your saying is that Herpes Simplex Virus type-1 is not an STD. Well, if that's the case Eric then you have nothing to worry about. You don't have to tell your partners that you have HSV-1. I'll be sure to let my husband know when I talk to him tonight that his HSV-1 is not an STD at all. (Not that he was worried about that) Ar ~ this means that you don't have an STD either. Hmmm... >> So, you're saying I don't have an std. > > I'd say HSV-1 is in a gray area. I found a posting on this very topic > on another forum. http://www.medhelp.org/forums/STD/messages/2811.html > Ar ~ this means that you don't have an STD either. > > Hmmm... I should leave the group, then. I would hate to misrepresent myself. :) ar I should join you. Can I come too? Angela :) lol >> Ar ~ this means that you don't have an STD either. >> [quoted text clipped - 3 lines] > > ar >I should join you. > > Can I come too? > > Angela :) lol Anytime. :) ar Come on Ar, let's blow this thread... we've already wasted enough time on it... don't ya think!? lol It's like talking to a wall. :) >>I should join you. >> [quoted text clipped - 5 lines] > > ar > Come on Ar, let's blow this thread... we've already wasted enough time on > it... don't ya think!? lol > It's like talking to a wall. :) True, I'm done anyway. I'm still trying to figure out how he thinks yeast infections are considered sexually transmitted. Perhaps he doesn't quite understand female anatomy and what usually causes yeast infections. ar >> Come on Ar, let's blow this thread... we've already wasted enough time on >> it... don't ya think!? lol [quoted text clipped - 3 lines] > infections are considered sexually transmitted. Perhaps he doesn't quite > understand female anatomy and what usually causes yeast infections. Yup, that comment about yeast infections being sexually transmitted had me roaring with laughter. Angela :-) |
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