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Exposure - now really worried
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Exposure - now really worried

hi ,

recently had 2x unprotected exposure with female who is HSV2+ who takes supression meds 7 weeks ago "im male 24" . Since the exposure i have been really worried , suffering major anxiety and panic attacks as am also strugaling with breakup from old gf and extreme stress from work, i have no sores , but have had general uncomfort in boxer shorts area itchy tingles ect and sore / burning inner thighs. i did at one point decide to shave part of my but cheek as I thought the hairs were causing it but this didnt help , infact i think made its worse and i had 3 small red itchy spots "1mm" appear lasted 2-3 days and what felt like a small cut / tear by my lower anus . I became paranoid and am really fighting these mental problems which are like nothing I have ever experienced and its horid i hope noone has to go through the same. over the last 2 days i have felt physically + mentally more normal and this fear seems to have almost dissapeared. i have had an igg at 2 weeks "baseline" and was neg , alos urine pcr when experiencing symptoms and that was neg. i went at 7 weeks for another igg and they basically talked me out of it. in your opinion are thes symptoms related to the stress and anxiety or hereps. should i follow up with another igg test. the reason i ask is me and my ex are trying to patch things up and i dont want to pass anything to her as i couldnt live with myself for having done that for a mistake on my part when we were on a break. this anxiety i have is realted to having HSV , passing it on and also the fact that so many people have it and dont know ect and that in for some reason it hit me really hard and i didnt know what to do until this girl told me about it i was clueless really and it was a bit of a scare especially as the NHS dont test unless lesions are presnt. i am seeing a physcotherapist which is helping.....but would appreciate an experts advice
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55646_tn?1263664409
Good afternoon,
I am in complete disagreement with the person aeiou1 who responded on this board that your symptoms are consistent with herpes.  I do not feel that they are at all consistent with herpes!  I think you are very aware of all of your body sensations right now due to your fear of getting herpes.  Every little tingle has meaning for you, when in a normal situation, none of this would have meaning.  

I think it is very normal to be concerned about getting herpes when you know that you are having sex with someone who is infected and you know that you are not.  Anyone who says differently just isn't being honest with themselves.  And since you are trying to resume a relationship with someone else, this incident has special meaning for you.  
Its good that you are seeing a counselor to talk this out, great step on your part.  

You've had negative test so far, and I'm thinking that if you not test again it might be good, but if you do feel the need to test once more, don't do it until adequate time has passed for an accurate result.  Sometimes people make the decision that they won't test again because it probably doesn't make sense, but they just can't seem to stop themselves.  So if that is your case, time your testing well, OK?

Your symptoms don't sound herpetic to me at all.  I've specialized in herpes for 30 years, and I want you to try to believe me as best you can.  If an obvious sore shows up, get it checked out of course, but I would be very surprised indeed if that happened.  Do you best to think as clearly as possible here, and remind yourself many times, "herpes doesn't behave like this, my chances of infection are very very low, everything is OK"  Repeat as needed.

Take care!

Terri
21 Comments
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Avatar_f_tn
Everything you describe is consistent with herpes infection.

Blood tests for the long-term IgG antibodies are generally reliable only after 12 to 16 weeks of infection. Please be aware that all blood tests have an error rate and that false negative indications are possible, while false positive indications are almost nonexistent. Within the first few weeks of infection, detection of early antibodies (IgM) may potentially be useful for diagnostic purposes (absence of IgG, but presence of IgM may indicate a new infection). IgM testing is limited in value because it is not type specific.

Type-specific blood tests such as Western Blot, Focus Technologies HerpeSelect,  ELISA or Immunoblot test for both HSV-1 and HSV-2 and can distinguish between the two types of HSV. Active viral shedding is not necessary (unlike PCR or Viral Isolation tests) in order to detect HSV infection. That means they work even if you are not currently having symptoms. There is only one U.S. lab that processes blood samples for the Western Blot (University of Washington) so you may have to wait a week or more for your results (for Canadians, the WB can be processed at lab Virdae Clinic), and if you want WB, you may have to ask for it specifically.

There is plenty of information online about how to prevent transmission of the virus, but be a careful info consumer. Anything that tells you that you can't pass the virus when you don't have active lesions is WRONG. Viral shedding can occur when you have no outward symptoms.

The symptoms you describe are all consistent with HSV infection, including the burning on your thighs. Neuropathic pain is a common, but mostly unrecognized, symptom of herpes infection.  Most doctors are not even aware of the neuropathic aspect of herpes infections.

Stress tends to bring on outbreaks, so try to make peace with it. HSV is an epidemic, though most people who are carriers do not have outbreaks, or manifest with subclinical episodes, meaning that they don't get lesions or signs that are visually observable.  You'll need to keep your immune system robust, get enough sleep and plenty of water.  If the neuropathic pain becomes severe, you could try neurontin (gabapentin), which is helpful for some people, while opiods and anti-inflammatory medications usually are not much help. Again, most doctors are not aware of this.

You are a good egg to be so concerned, but do not make yourself sick with worry.  I hope that helps some.

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Avatar_m_tn
the burning of the thighs only happened once , just to add these symptoms seem not to be all together , but have been over the last 2-3 months since i met this girl and she told me about her status. the main thing i have is just itching.
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Avatar_m_tn
itching accompanied with extreme anxiety and paranoia :( lol
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Avatar_m_tn
None of what you listed is a symptom of a primary herpes infection.

Lesions/sores from herpes do not go away in 2-3 days, especially if it's a primary outbreak, it usually takes 2-3 weeks for herpes sores to heal.

In addition, your first outbreak will always be where you were exposed, which in your case would most likely be the head/shaft of your penis.

Finally, the odds of catching herpes from your exposure is very small, especially since she was also on meds.

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Avatar_f_tn


As Terry says, you go ahead and do as you see fit. Her answer is compassionate and sensible.  Certainly, the amount of stress you have associated with it could be enhancing your awareness and experience of anything you have going on down there.  But if you have it within your means to have a proper typing blood test done that will answer the question definitively, I cannot for the life of me see how it is in your best interest to stick your head in the sand and just not worry about it, particularly since you are trying to reunite with someone to whom you could possibly pass the disease.

And I disagree with her about how herpes "behaves." Research shows that herpes doesn't manifest according to the standard profile in more than HALF of cases, and that 70% or more of cases go unrecognized by patient or clinician. But thanks to medical professionals who don't stay current on the literature, people with lesions outside the genital area are often told it's not herpes and don't worry about it.  People with neuropathic manifestations are told it's not herpes and don't worry about it.  People with other subclinical manifestations are told it's not herpes and don't worry about it.  With all due respect to Terry's 30 years specializing, that's a good long time to become attached to a particular dogma.  I'm not saying she is attached to the conventional limited view, because i generally have great respect for her answers, but what we DON'T know about herpes still exceeds what we DO know, and the limited-testing public health policy about the disease is informed by a cost analysis that has without question contributed to the spread of the disease.

I took into account in my answers that the little spots you did notice might have been there before you noticed them, and might not have been herpes at all. What caught my eye about your story was the neuropathic sensations, which are conventionally expected to limit themselves to prodrome and alleviate thereafter.  This is so often not the experience of those infected. Many people experience neuropathy and neuralgia coincident with their outbreaks.  

Personally, that's usually all I have to contend with, because I am on suppressive therapy, and when I NEVERTHELESS feel the familiar sensations of a prodrome, I double or triple my doses of antivirals, according to my doctor's instructions.  Thus, I virtually never have to deal with lesions, but am still nevertheless subclinically symptomatic. Fortunately for me, as a health writer and pretty responsible patient, I had good credibility with my doctor. Also, I had chosen a doctor who is rigorous about being current on the research and literature, so she was aware of the neuropathic presentation and other "anomalies" of HSV infections.  And when I described what I was experiencing two years ago, she said uh-oh.  She had me blood-tested, even though I had no lesions.  And ta-da!  A fresh new herpes infection.  We followed the first test with a second that was type specific.

Further, it took eight years before my husband (who was HSV2 positive and on suppressives, whereas I was negative--yes, we tested before we got married) passed the virus to me. We were both aware, informed, careful, and deeply devoted to each others' wellbeing, but asymptomatic shedding happens.  Indeed, it is estimated to be when most passage of the virus occurs.  Makes sense, doesn't it?  

You're clearly a man with a conscience.  Let that be your guide.  You can wait a sufficient time from your suspected exposure that you'd have enough antibodies built up, and get a type-specific blood test, and put your mind at ease one way or the other.  Or, do what is recommended by the conventional "standard of care," and don't worry about it.  So many people have it already, what's the harm of passing it to one more?

This isn't just an epidemic, it's an ethical crisis.

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Avatar_f_tn
Have any recent research/findings connected HSV I & II to PHN??  I agree that most experts (at least on this forum) only tie it to Zoster & dismiss its relation to HSV Simplex.
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Avatar_f_tn
Hi.

Just breathe! You will be fine especially since she takes supressive meds.. its a very very small chance you will have anything.

Seriously you will make yourself more sick worrying about having it than actually having it!
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55646_tn?1263664409
"And I disagree with her about how herpes "behaves." Research shows that herpes doesn't manifest according to the standard profile in more than HALF of cases, and that 70% or more of cases go unrecognized by patient or clinician."

Actually, the statistic is that 80-90% of people who have HSV 2 infection don't know it.  So you are certainly correct that most people with herpes don't know it.  There are lots of reasons for that, mainly that people who have HSV 1 and acquire HSV 2 have few symptoms to recognize.  But in this case, that is unlikely to happen because this person is hyperaware of any symptoms that might be herpetic.  He is aware that the person he had sex with had herpes, and is very carefully, perhaps obsessively, observing his genital area for anything out of the ordinary.  The person in this situation is in a class that is different, by themselves.  

But thanks to medical professionals who don't stay current on the literature, people with lesions outside the genital area are often told it's not herpes and don't worry about it.  People with neuropathic manifestations are told it's not herpes and don't worry about it.  People with other subclinical manifestations are told it's not herpes and don't worry about it.  With all due respect to Terry's 30 years specializing, that's a good long time to become attached to a particular dogma.  I'm not saying she is attached to the conventional limited view, because i generally have great respect for her answers, but what we DON'T know about herpes still exceeds what we DO know, and the limited-testing public health policy about the disease is informed by a cost analysis that has without question contributed to the spread of the disease.

Actually, I think our clinic is one of the few clinics around to include an HSV test in every STD screen because we know that lots of herpes is missed.  As for being attached to a particular dogma, I don't agree.  For years, I believed, as others did, that you could only transmit when showing symptoms.  Big dogma to change, but change, we did.  Then we believed that aysmptomatic shedding was rare, another big dogma to change.  But we did.

"I took into account in my answers that the little spots you did notice might have been there before you noticed them, and might not have been herpes at all. What caught my eye about your story was the neuropathic sensations, which are conventionally expected to limit themselves to prodrome and alleviate thereafter.  This is so often not the experience of those infected. Many people experience neuropathy and neuralgia coincident with their outbreaks. "

I totally agree that people with herpes get neuropathic sensations in the genital area.  And I believe that in the face of most clinicians not believing it.  I believe it because many patients tell me they get it, and in studies, we see it documented.  However, what I don't think happens very often at all is that a person who has no antibody to HSV gets ONLY neuropathic pain as their only symptoms of infection.

My point is, you have to look at the total picture of each patient, individually.  This person had two contacts with someone HSV 2 positive.  He tested negative.  Subsequent to that, he had vague symptoms and a great deal of anxiety about acquiring HSV.  Anxiety over acquiring HSV can be debilitating - read the posts that come up here.  Most are not from people who have herpes and wondering about managing it or transmitting it, most are from people who have very limited contacts but have lots of fear, who live in terrible angst over getting herpes, but have little or no risk.  
You raise good points, for sure, but when I look at this person's post, the physical history, the emotional responses, and the actual risk, I stand by my assessment that he does NOT have typical herpes, whatever that is.  Clearly, neither of us can be certain that he does or does not have herpes, and testing again will probably clear up that answer.  

One more thing - false positives on the antibody tests certainly happen!  About half of the people who test positive on the ELISA test between 1.1 and 3.5 are false positives.  That's one more reason I encourage or discourage people to be tested.  Once a person has a false positive test, even when not confirmed by western blot, it is very hard to get them to believe that they aren't really infected.

I appreciate your input, really I do, but I will disagree when I think it is appropriate.
Respectfully,

Terri
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Avatar_f_tn
I take it, then, that you believe that individuals (with proven HSV infection, of course) can suffer from PHN?  I've been scouring the internet & cannot find ANYTHING that supports the connection between Simplex & PHN!  Can you offer me any literature to read??  (I apologize for keeping this conversation going; this will be my last post  -- Sorry defiant!!)
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55646_tn?1263664409
I definitely think that people with genital herpes experience neuralgia in the leg, thigh and buttocks.  I'm not clear about references in the literature, but I can tell you that my patients describe this experience, both orally and genitally, all the time.  It is very common for people with cold sores to experience pain into their face, eye, ear and nose prior to outbreaks, as well as people with genital herpes who experience pain into the leg, thigh, buttocks and hip.  I wasn't aware that there was enough any controversy about this until recently - I thought it was a given.
Terri
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Avatar_f_tn
Sorry - last one, I promise!

So, what can people who suffer from extreme, constant neurological pain (not limited to breakouts) do whose PHN does not respond to suppressive therapy?

(I would post a new thread but my 2 posts in a 6 month period were exceeded).  
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55646_tn?1263664409
If suppressive therapy makes no difference, then I would look to something else for a cause.  Most of my patients who experience herpetic neuropathy respond very well to suppression.  The neuropathy could be due to something else.  Something like Lyrica may be of help, in that event.

Terri
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Avatar_m_tn
Well I did get another igg and am awaiting the results but havnt been able to get hold of the clinic for the last two days , I still have this heaviness feeling in my perineum but it's an anoying feeling not painful no blood or visable sores. Is anal herpes a common site for my type of exposure? I hope the test is negative but even then am not sure it will put my mind at rest it will be 7-8 weeks for this test. I'm kind of gearing myself up for a positive test then somehow I have to explain to my old girlfriend I don't think I would be able to attempt to repair the relationship as I would not want to put her at risk in any form and the guilt would kill me. I did get some general odd feelings in my butcheeks yesterday only after walking about though
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Avatar_m_tn
anal sores would be very rare for an initial outbreak... Given that she was on suppressive meds, you had limited contact, and you had no visible outbreaks within the normal time, I seriously doubt you'll have a positive test.
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Avatar_m_tn
Well the clinic called and said some confusing things.... Aparantly igg was positive but they are not sure which type and I have to call back next week , does this sound like a spurious result? Also should I get the levels?
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55646_tn?1263664409
Its difficult to say what might be going on here.  But if I were you, I would not wait until next week because I think you will worry yourself into illness if you have to wait four more days.  I would advise that you call back and ask to speak with the nurse and have her tell you exactly what the test results are.  Be certain it was IgG testing only, and if positive, for which type.  Remember that combined 1 and 2 tests are not as accurate as separate ones.  If the IgG is positive, yes, ask for the index value (it is a number).  Write and let me know, OK?
Terri
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Avatar_m_tn
Clinic is closed now until Monday so I have to wait anyway , I did explain to my old girlfriend tonight that I have a coldsore on my anus , and that it is transferable through contact and she seemed to think I was majorly over reacting I explained all the facts but didn't use the word herpes , I'm quite concerned about her apparent lack of concern she just said so what it's a cold sore and yeah I could catch it but why worry so much. Am I majorly worrying to much over this or is she more accepting of what this actually means and I'm just paranoid? I feel like maybe I'm not telling her the whole truth? Or is it just me?
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55646_tn?1263664409
I can't answer your questions until I get more information about your exact test results.
Terri
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Avatar_m_tn
Had test results , these were positive for hsv1 only , I'm assuming that I have it genetaily due to the recent symptoms I've been experiencing these are almost non existent apart from I can still feel minor irritation around my anus which has been present for around a month now with regards to transmission genitally to genitally is this some thing I should be concerned about as I understand genital hsv1 is far less recurrent or active as it is out of it's site of preference?
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55646_tn?1263664409
Why do you assume that you have HSV 1 genitally?  I thought the woman you were concerned about had HSV 2 infection?  If you've had irritation symptoms for a month now, it could be anything!  Herpes generally doesn't stay around for a month at a time.  I have no idea why you are jumping to the conclusion that you now have genital HSV 1.  Most people who have oral HSV 1 don't report oral symptoms  I personally think the chances are far higher that you have oral HSV 1 than genital HSV 1.  

I think you've talked yourself into having herpes, frankly.  The typing doesn't match, the symptoms don't match, but you still believe you have this genital infection.  I feel like I've done what I can to help you with this, but at this point, you can go with what you think.  

This thread is now closed.

Terri
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Westover Heights Clinic
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