July 23, 2014
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Infection

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Herpes: can I be infected twice?

If you have herpes, are you immune to a second infection from someone else?

A study done in 1980 in Atlanta, Georgia, showed that genital herpes can recur with more than one strain of the virus. People with one strain of herpes can get another. Since immunity is important, it is generally thought that getting herpes a second time is much harder than getting it the first time. Transmission of type 2 genital herpes to a person who has antibodies against type 2 herpes is rare. Studies have shown that a person with genital herpes can catch a new case of genital herpes, but other studies have shown that this happens only rarely. In most cases, if a person with genital herpes catches genital herpes while with a partner, they are catching it from themselves - having a recurrence. Type-specific antibody against your own strain of virus makes it very difficult to catch a second infection of the same strain from a different person.

Telling one strain of herpes from another

It takes painstaking effort to tell one herpes strain from another, but it can be done by obtaining a "DNA fingerprint." The test is not one a family doctor or even a specialist can perform. Rarely, 2 strains on separate recurrences in the same person and dual infections of 2 strains at the same time have been observed. However, second infections with new strains are considered to be extremely rare.

Studies that have sought different strains from a single person with genital herpes have had a very difficult time finding them in most people. Yet statistics suggest that people with genital herpes commonly come in contact with herpes from more than one partner. There must be a very strong immunity to second infection, although it is not yet defined scientifically.

How will you know if you have a second infection?

Although incomplete, immunity to type 1 herpes affords some protection against infection with type 2 herpes. This protection makes type 2 somewhat more difficult to get. Antibody to type 1 herpes, however, does not fully protect against type 2. Many people who get type 2 herpes do so despite having type 1 herpes. People with type 1 who do get type 2 will, by definition, not experience a true primary infection.

The first episode will likely be less severe than for people who have no preexisting immunity to type 1 or type 2. It may be that people with type 1 immunity are more likely to get type 2 genital herpes without any noticeable symptoms. Since their bodies are already fully equipped to fight off the infection effectively, people with type 1 herpes are probably more likely not to notice infection with type 2. But type 1 herpes is just as likely as type 2 herpes to be caught without any noticeable symptoms. So, while having recurrent cold sores strongly suggests that a person has type 1 herpes, not having cold sores does not guarantee that a person does not have latent type 1 herpes. Only type-specific antibody tests like the Western blot can tell for sure what type of herpes a person has.

 
Stephen Sacks, MD, FRCPC, with revisions by the MediResource clinical team

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