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Exposed to Herpes... What should I do?
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The STD Forum 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.

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Exposed to Herpes... What should I do?

Hi Drs. Handsfield and Hook,

I'm scheduled to see my primary doctor today but I need some advice from an expert.

I (a man) recently (about 1 month ago) had relations (unprotected oral and protected vaginal sex) with a new partner (woman). We had oral sex about 2 weeks before we had vaginal sex. About 4 days after our sexual encounter she complained of vaginal discomfort and itching. She said that "this happens every time I have a new partner" and she chalked it up to a yeast infection but, out of concern, I told her it was probably best to see her doctor for an exam. In the past she's had friends call in Rx's for antifungals and has not gone to see her physician every time this has happened.

After being examined her doctor wasn't sure it was a yeast infection and was concerned she had genital herpes. Low and behold, she had a positive PCR/culture for HSV-1 and positive HSV-1 IgG (was about 4 on a 0-5 scale). Upon further questioning she told me that she was tested in the past and had previously been positive for HSV-1. She denies ever having recurrent cold sores.

To this day, I have never had any cold sores (to my knowledge) and I have never had genital sores, pain with urination or anything to suggest infection with HSV. I have never had antibodies tested.

My questions are:
1. What are my risks of exposure? (Low?, high?)
2. Could my partner have had genital herpes HSV1 (based on past symptoms and lab work) and not know/tell me?
3. Is it worth it to be tested for antibodies if I never had and have not had symptoms thus far?
4. If so, how would I interpret the results?
5. Could I be an asymptomatic carrier and given her genital HSV-1 if she's already tested positive for HSV-1 Antibodies way before me?

Any advice is greatly appreciated!
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Welcome to our Forum.  I will address your questions in a moment but before I do, let me ask a bit more about your partners' laboratory tests.  Are you sure she had a swab test from her genitals which was positive for HSV-1?  Do you know if she had a PCR test or a culture? They are different tests.   This is a bit surprising as most people with genital herpes due to HSV-1 do not have recurrences and/or positive tests.  

At any rate, the combination of her history of prior similar episodes, a positive culture or PCR with a positive blood test suggests that her HSV outbreak was a recurrence, not an initial episode.  It is not at all uncommon for people to mistake their genital herpes for something other else, including yeast infections and, since recurrences of HSV are self limited, they would go away following application of a yeast medication (or anything else) With that as background, let's deal with your questions:

1.  Most exposures to partners with herpes do not lead to transmission of infection.  Infection occurs more often following exposure to lesions (sores) than when they are not present but either way, as I said, only a small proportion of exposures lead to transmission of infection.  If you have not experienced an outbreak in the 2 weeks since your exposure, it is unlikely that you got HSV from this exposure.

2.  Over 60% of Americans have HSV-1 and of those, 80-90% do not know that they do. It is certainly possible that she did not know about her infection.  You have a better than 50/50 chance of having it too (and not from her).

3.  As I said above, there is a good chance you have HSV-1 already.   If you do, you will not be able to get it again and thus the knowledge can and perhaps should influence your use of condoms and other protective measures.  If you get tested, be sure that you get a type specific, gG based IgG (not IgM) test.

4.  Depends on the results.  A positive blood test cannot tell you how long you have been infected , where on your body your infection is, or who gave it to you.  

5.  Again, while there are exceptions, the time line you describe is more consistent with her having been infected prior to your interactions.

Hope these comments help. More excellent information of HSV can be found at the American Social Heath Association web site.  In the spirit of full disclosure however, I should also point out that both Dr. Handsfield and I are on the ASHA Board of directors. EWH

Thanks for the quick response. She had PCR done. I will have IgG tests done for both HSV-1 and 2.

As far as informing future partners about their risk, what should I tell them about having relations with me? If my HSV-1 IgG is positive in the absence of symptoms, does that mean I have herpes and have a duty to inform future partners, or does it mean that I've only been exposed to the virus?
Let's see what your test results show and go from there.  If you have HSV-1, you should disclose that you have HSV-1 and may have cold sores. If you have HSV-2, you should probably disclose that you may have ential herpes.  but let's not put the cart before the horse.  EWH
Hi Dr. Hook,
My results are in and I tested positive for HSV 1 antibody (>5.0) and negative for HSV 2 antibody (0.42) on a 5 point scale.

Again, I have never had an outbreak to my knowledge. That's not to say I didn't have a cold sore when I was three years old...

I want to be upfront with potential partners without scaring them away with information that may not matter if >50% of the population is seropositive. What should I tell potential partners? Does my being positive for HSV antibody without clinical symptoms or signs mean anything in the grand scheme of things?
Your test tells you that you have HSV-1, like the majority of American adults. The results tell you nothing about how long you have had it, who you got it form or where the infection is.   Statistically it is most likely to be an oral infection.  In the interest of full disclosure you should tel partners that you had a test which told you that you have HSV-1, the virus that primarily causes cold sores but the you have never had one.  

For additonal infomration on HSV-1, there is excellent, highly informative information available at the web site run by the American Social Health Association.  (Disclosure. Dr. Handsfield and I are both members of the American Social Health Association Board of Directors.)  EWH
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University of Washington
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