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STDs (Expert Forum)
Confused and Concerned
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
Confused and Concerned
by Alex1987, Jun 24, 2008 10:18AM
I had been in a monogamous relationship with my girlfriend of two years when I first heard rumors that she was sleeping with another man. She denied everything, but I trusted my instinct and ended the relationship. Soon afterwards, she began dating the man in question.
Needless to say, it was a difficult emotional time for me. A very close female friend of mine spent a lot of time consoling my pain and being very nice to me. Awkwardly, this led to a breif sexual encounter with her, with a condom, which I stopped about a minute into the act given my fear of possibly having caught something from my ex.
I went to my doctor who performed an a barrage of test including an HSV-2 IgG. This had been approximately one month from my last encounter with the ex girlfriend, and fifteen days after my encounter with my friend. My results came back as positive for HSV-2 1.16. I notified both women. The ex never replied, and my friend doesn't feel it is necessary for her to get tested because "there was no way she could have contracted it from me from such a short exposure using a condom."
The two women were my only previous sexual partners, three total including my fiancee who is very understanding of my situation.
When I explained everything to my doctor approximately six months after all this, she repeated my HSV-2 IgG test with a result of 3.39. Her suspicion is that I've had it for a long time. I have always and to this day remained without symptoms.
Even though this happened several years ago, could you possibly figure out based on my story, which of the two women I had slept with gave me the virus? If you think my ex gave it to me, how likely is it that I passed it to my friend? Also, while taking valtrex, what are my chances of passing the virus to my fiancee through oral sex? What precautions should we take if we plan to have children?
Thank you for helping me figure this out.
Needless to say, it was a difficult emotional time for me. A very close female friend of mine spent a lot of time consoling my pain and being very nice to me. Awkwardly, this led to a breif sexual encounter with her, with a condom, which I stopped about a minute into the act given my fear of possibly having caught something from my ex.
I went to my doctor who performed an a barrage of test including an HSV-2 IgG. This had been approximately one month from my last encounter with the ex girlfriend, and fifteen days after my encounter with my friend. My results came back as positive for HSV-2 1.16. I notified both women. The ex never replied, and my friend doesn't feel it is necessary for her to get tested because "there was no way she could have contracted it from me from such a short exposure using a condom."
The two women were my only previous sexual partners, three total including my fiancee who is very understanding of my situation.
When I explained everything to my doctor approximately six months after all this, she repeated my HSV-2 IgG test with a result of 3.39. Her suspicion is that I've had it for a long time. I have always and to this day remained without symptoms.
Even though this happened several years ago, could you possibly figure out based on my story, which of the two women I had slept with gave me the virus? If you think my ex gave it to me, how likely is it that I passed it to my friend? Also, while taking valtrex, what are my chances of passing the virus to my fiancee through oral sex? What precautions should we take if we plan to have children?
Thank you for helping me figure this out.
Doctor's Answer
by H. Hunter Handsfield, M.D., Jun 24, 2008 11:36AM
, Jun 24, 2008 11:36AM
Yours is perhaps the tenth question about low-positive HSV-2 blood test results within the past 7-10 days. The main point is that many (most?) low-positives, especially those with ELISA ratios barely over 1.0, are are false, as might be the case for your initial low-positive result. However, your more recent test, with ELISA ratio 3.39, is much more likely to be truly positive. (There remains a hint of uncertainty, since 3.5 is evolving as the accepted cut-off for a definitely positive outcome. But 3.39 is awfully close and most likely indicates you are infected.) It is possible you have been infected all along, as your doctor suggested, and that your more recent result is more strongly positive on a random basis. It seems more likely that you acquired your HSV-2 infection recently. The window starts about 3 months before the first test.
Assuming a new infection, I would be more suspicious that your former, long-term partner is the source. If I understand the scenario, she was your first and only partner up until the end. In addition, on a statistical basis, the end of a relationship is a common time for STD transmission, when one partner has started to have other partners. But this is by no means certain, and I think it was a mistake for your more recent partner to not be tested. She could have been the source of your infection. Or, as you suggest, you could have infected the second partner -- although the condom use would have largely (but not completely) protected her.
The bottom line is that you're probably never going to know for sure. The only way to sort it out would be for both your former partners to be tested, for them to be willing to share that information with you, and to find only one had HSV-2. But you have no right to insist on that. You informed them both, after which each of them became responsible for her own health, with no further obligation to you. I suggest you just drop it, especially since your new partner/fiance is understanding.
Oral HSV-2 infection is pretty uncommon, and both recurrent oral herpes and asymptomatic viral shedding are rare; kissing and oral sex are not likely to risk transmisison. You can and should assume your infection is genital only. Your partner will be largely protected by your taking Valtrex. However, once you and she are confident your relationship is committed and permanent, you might decide that preventing transmission isn't such a high priority. If she gets infected, it might be asymptomatic; effective treatment is available if she has symptoms; and presumably the fear of transmission to future partners won't be a consideration. (Research shows that the last is the main reason people fear catching genital herpes.) So you may or may not decide to continue the Valtrex. (An advantage of stopping would be to learn whether or not you are in fact prone to have recurrent outbreaks.)
Properly managed, genital herpes is not an impediment to safe pregnancy and healthy kids. The most important aspect of preventing neonatal herpes is to prevent the mother's first genital HSV infection in the last 3 months of pregnancy. In any case, if/when your partner becomes pregnant, at the first prenatal visit, she should explain the HSV situation to her obstetrician, who will know what to do to protect the baby.
Congratulations for having a seemingly objective, rational approach to your new diagnosis. When all is said and done, this isn't likely to be nearly as big a deal in your life as you might have feared.
Best wishes-- HHH, MD
Assuming a new infection, I would be more suspicious that your former, long-term partner is the source. If I understand the scenario, she was your first and only partner up until the end. In addition, on a statistical basis, the end of a relationship is a common time for STD transmission, when one partner has started to have other partners. But this is by no means certain, and I think it was a mistake for your more recent partner to not be tested. She could have been the source of your infection. Or, as you suggest, you could have infected the second partner -- although the condom use would have largely (but not completely) protected her.
The bottom line is that you're probably never going to know for sure. The only way to sort it out would be for both your former partners to be tested, for them to be willing to share that information with you, and to find only one had HSV-2. But you have no right to insist on that. You informed them both, after which each of them became responsible for her own health, with no further obligation to you. I suggest you just drop it, especially since your new partner/fiance is understanding.
Oral HSV-2 infection is pretty uncommon, and both recurrent oral herpes and asymptomatic viral shedding are rare; kissing and oral sex are not likely to risk transmisison. You can and should assume your infection is genital only. Your partner will be largely protected by your taking Valtrex. However, once you and she are confident your relationship is committed and permanent, you might decide that preventing transmission isn't such a high priority. If she gets infected, it might be asymptomatic; effective treatment is available if she has symptoms; and presumably the fear of transmission to future partners won't be a consideration. (Research shows that the last is the main reason people fear catching genital herpes.) So you may or may not decide to continue the Valtrex. (An advantage of stopping would be to learn whether or not you are in fact prone to have recurrent outbreaks.)
Properly managed, genital herpes is not an impediment to safe pregnancy and healthy kids. The most important aspect of preventing neonatal herpes is to prevent the mother's first genital HSV infection in the last 3 months of pregnancy. In any case, if/when your partner becomes pregnant, at the first prenatal visit, she should explain the HSV situation to her obstetrician, who will know what to do to protect the baby.
Congratulations for having a seemingly objective, rational approach to your new diagnosis. When all is said and done, this isn't likely to be nearly as big a deal in your life as you might have feared.
Best wishes-- HHH, MD
