Concern about exposure

[beantowner]

A girl I've been dating recently told me she has genital herpes. She contracted it 5 years ago and only had one outbreak. We were not sexually active until this past weekend. She did not have a visible outbreak. We had sex using a condom. Since that night, I can't get it off my mind. I'm quite worried and becoming very emotionally upset. I thought I could handle the risk, but I was wrong. I expressed this to her and we have decided to avoid sex for now. It's only been a few days and no signs of any visible problem thus far. I believe I have some extra itchiness or redness near the tip of my penis, but it may all be in my head after doing so much reading on symptoms. Also, I used a spermicide condom and I hear they can cause irritation, but wouldn't that go away after 4 days if any irritation was present? I want to know the chances of contracting the disease from my one-time exposure and also what steps I can take to see if I have contracted it. I want to get tested asap. When can I get tested? Do I really just have to wait months to get a blood test if there is no outbreak? Any other options?

thanks for the help

[H. Hunter Handsfield, M.D.]

Wow, you're really overreacting.  The chance you acquired genital herpes, given the circumstances as you describe them, are much less than the chance you're going to die tomorrow in an accident or from some unexpected illness.  I mean that literally; there just is no realistic risk of herpes.  Your symptoms are too subtle to suggest anything wrong; 'I believe' there might be 'extra itchiness or redness, but it may all be in my head' means almost certainly nothing is wrong.  Anyway, that symptom doesn't suggest herpes.  I don't recommend HSV testing in this circumstance, but if you insist, you need to wait 3-4 months for accurate testing.  (Even then, if positive it won't mean you were infected by this particular partner.)

HHH, MD

[confused3575]

Really, what are you so afraid of? Most people with herpes do not even know it.  Clearly, your girlfriend is fine.  Why are you so freaked out? The risk is like 1% if she takes suppressive therapy.  25% of the population has genital herpes and upwards of 60% have oral herpes - which, by the way sheds the most (18% I think is the number) so there is a greater chance of you getting herpes from oral sex than genital sex, I believe. You need to take it easy if you plan on dating ever again.  Unless of course you are going to demand that every partner be tested, you both abstain from sex for 3 months and then re-test again to be sure you both could not possible have herpes. honestly, you really are overreacting.  I think you need to think about what it is you are afraid of.  The risk is only 4% over the course of a year that you would even get this if you did nothing but avoid sex during an outbreak. Relax.   If you plan on dating in the real world, you need to realize that it is more than likely you will come accross many people with herpes in one form or another.  It is not worth all the stress and anxiety.  It is not that easy to get.  you have probably even come accross it already unknowingly.  Unless you were a virgin who never had oral sex or kissed anyone.

[pleasehelp777]

Dr. H, is it true what confused3575 just said about oral herpes shedding more (asymptomatically) than genital?  

[gracefromHHP]

oral hsv1 sheds about 18% of days.  compared to genital hsv1 which sheds about 3% of days.  Oral hsv2 1% of days.  Genital hsv2 about 15% of days.  These are all averages - it differs from person to person.

grace

[concerned66]

can you be more specific of what you mean by with "x% of the days" of what days? days of the year? thanks! :)

[t1234]

I would disagree that any definite conclusions could be drawn about shedding rates.

There are studies that show these high shedding numbers. But in one for example the subjects were limited to patients with a diagnosis of a first episode of genital HSV-2 infection <6 months before enrollment or if they had longstanding genital herpes infection and a recurrence rate of >6 episodes during the preceding year.  High shedding rates would be expected in these subjects.

However, as was pointed out in an editorial BMJ 1997;314,85 (11 January)
Advising Patients with genital herpes “....it should be stressed that in about half of the women in Wald et al's study no subclinical shedding was detected at all and that, in those who did shed virus, shedding was detected on only a few days overall. Infected patients with infrequent clinical recurrences can be reassured that subclinical shedding is uncommon. “

Also, rightly or wrongly people are subjected to drug advertisements and self-help medical advise on various websites and popular magazines.  You must be aware that many studies are small scale and may be funded by grants from commercial drug interests and the medical professionals performing them may receive consulting fees, grants, lecture fees, etc. from these interests. These disclosures are sometime made (CME) at the professional level and are required by the FDA but are rarely made to the lay public in the popular self-help press.  So I would take lot of stuff out there with a "grain of salt."

It really impossible to know on an individual basis what if any the shedding rate is or if a particular individual will shed a viral load sufficient for transmission.

My point is that you can not really know what your individual risk is; and if it were me, I would take reasonable precautions (condoms), but I wouldn’t loose any sleep over it.

[t1234]

Sorry, I mean my previous comment to beantowner

Another comment, I would agree with Dr HHH.  I would not recommend
HSV-2 testing.