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HSV2 positive - need some clarification
1) I recently have been given a clean bill of health after a full std test, unfortunately in the UK we don't test for hsv by default, why is this?
I got HSV2 from unproteced sex with a girl that also had all the standard tests done and didn't know she had it. We are still potentially seeing each other, her blood test came back positive for hsv2.
2) Is there any danger in us having unprotected sex?
3) if we have oral sex and as far as we are aware have no oral infections or hsv1, can we still transfer hsv2 to each others mouth? What is the likelyhood? Can I still get hsv1 down there or up near my mouth or am I sort of "protected" against new infections? If not, are the chacnes of receiving a new infection actually just academic or have real world relevance?
4) I read that without an outbreak the chances of passing on the virus are quite low, under 10% for men, much less for passing hsv2 on to somebody's mouth. Is this true?
5) Considering that antiviral therapy is harmless and reduces the possibility of passing on the virus by another 50% or so ... aren't the numbers suggesting (2-4% chance per year?) that it would be more likely to get pregnant when having sex with a condom, then to pass on hsv to a partner? I am trying to establish whether the need to tell somebody when using a condom and using antivirals is really just due to stigma, not to practical requirements?
6) My first outbreak was very mild with one dot at the tip of my penis. Will it only shed from there or widely from the genital area? A condom would completely cover the area, so maybe shedding is less of an issue?
7) Considering the mild nature of my first outbreak ... can I draw some sort of conclusion of further outbreaks from it an also their potential intensity? What I of course want to hear is that chances are very good that I won't see it ever again and that if it shows up it will be even more insignificant than before.
I got HSV2 from unproteced sex with a girl that also had all the standard tests done and didn't know she had it. We are still potentially seeing each other, her blood test came back positive for hsv2.
2) Is there any danger in us having unprotected sex?
3) if we have oral sex and as far as we are aware have no oral infections or hsv1, can we still transfer hsv2 to each others mouth? What is the likelyhood? Can I still get hsv1 down there or up near my mouth or am I sort of "protected" against new infections? If not, are the chacnes of receiving a new infection actually just academic or have real world relevance?
4) I read that without an outbreak the chances of passing on the virus are quite low, under 10% for men, much less for passing hsv2 on to somebody's mouth. Is this true?
5) Considering that antiviral therapy is harmless and reduces the possibility of passing on the virus by another 50% or so ... aren't the numbers suggesting (2-4% chance per year?) that it would be more likely to get pregnant when having sex with a condom, then to pass on hsv to a partner? I am trying to establish whether the need to tell somebody when using a condom and using antivirals is really just due to stigma, not to practical requirements?
6) My first outbreak was very mild with one dot at the tip of my penis. Will it only shed from there or widely from the genital area? A condom would completely cover the area, so maybe shedding is less of an issue?
7) Considering the mild nature of my first outbreak ... can I draw some sort of conclusion of further outbreaks from it an also their potential intensity? What I of course want to hear is that chances are very good that I won't see it ever again and that if it shows up it will be even more insignificant than before.
MEDICAL PROFESSIONAL
Welcome to the Forum. Your experience is typical for many persons who acquired HSV and your questions are likewise appropriate and on target. I'll go straight to your questions:
1. Your experience is typical. Most persons who acquire HSV do so from partners who do not know that they are infected. Herpes testing is not routinely performed, even when persons ask to be tested for "everything", for a number of reason. Most importantly is that while today's blood tests for HSV antibodies are much better than they were 20 years ago they still relatively frequently give false positive results in persons who are not likely to be infected and thus provide potentially troublesome incorrect information.
2. There is no reason to worry about further HSV transmission between you and the partner whom you became infected from. Both of your immune responses will prevent re-infection at other sites. You cannot give "more HSV" to someone who is already infected with that type of virus.
3. If you have not had HSV-1 you can still become infected with that virus at a site of sexual contact. Statistically this is most likely to occur through oral genital contact. As mentioned above, you cannot acquire oral HSV-2 from oral sex with an infected partner if you already have HSV-2 yourself, even if it is at a different location.
4. With or without lesions, the risk of getting herpes from a direct exposure to an infected person is less than 1% and many would say less than 1 in 1000. We presume that direct lesion contact is somewhat more infectious but as noted above, because so many people with HSV do not know they are infected, most HSV is transmitted by persons who are asymptomatic and without lesions.
5. Your figures are correct and I agree that even with a condom the risk of getting a partner pregnant is higher than the risk of transmitting HSV. That said, when possible and appropriate, disclosure is always the best practice.
6. I agree with your assumption. While there is a possibility that there may be shedding in other areas served by the same nerves that are the source of your recurrences (HSV is an infection of nerves, not the skin), your risk for transmission with condom protected sex is quite low.
7. Recurrences tend to be milder than initial episodes and given the mild nature of your initial episode, your recurrence are likely to be mild as well. There is a small (10-15%) chance you will not have any further recurrences.
I hope these answers are helpful. Your questions were rather extensive. Further information is available on the ASHA (American Sexual Health Association) website. My on follow-ups will, of necessity be limited. EWH
1. Your experience is typical. Most persons who acquire HSV do so from partners who do not know that they are infected. Herpes testing is not routinely performed, even when persons ask to be tested for "everything", for a number of reason. Most importantly is that while today's blood tests for HSV antibodies are much better than they were 20 years ago they still relatively frequently give false positive results in persons who are not likely to be infected and thus provide potentially troublesome incorrect information.
2. There is no reason to worry about further HSV transmission between you and the partner whom you became infected from. Both of your immune responses will prevent re-infection at other sites. You cannot give "more HSV" to someone who is already infected with that type of virus.
3. If you have not had HSV-1 you can still become infected with that virus at a site of sexual contact. Statistically this is most likely to occur through oral genital contact. As mentioned above, you cannot acquire oral HSV-2 from oral sex with an infected partner if you already have HSV-2 yourself, even if it is at a different location.
4. With or without lesions, the risk of getting herpes from a direct exposure to an infected person is less than 1% and many would say less than 1 in 1000. We presume that direct lesion contact is somewhat more infectious but as noted above, because so many people with HSV do not know they are infected, most HSV is transmitted by persons who are asymptomatic and without lesions.
5. Your figures are correct and I agree that even with a condom the risk of getting a partner pregnant is higher than the risk of transmitting HSV. That said, when possible and appropriate, disclosure is always the best practice.
6. I agree with your assumption. While there is a possibility that there may be shedding in other areas served by the same nerves that are the source of your recurrences (HSV is an infection of nerves, not the skin), your risk for transmission with condom protected sex is quite low.
7. Recurrences tend to be milder than initial episodes and given the mild nature of your initial episode, your recurrence are likely to be mild as well. There is a small (10-15%) chance you will not have any further recurrences.
I hope these answers are helpful. Your questions were rather extensive. Further information is available on the ASHA (American Sexual Health Association) website. My on follow-ups will, of necessity be limited. EWH
MEDICAL PROFESSIONAL
This estimate is based on extrapolation from studies of HSV transmission, over 30 years of clinical observation and counseling of infected persons including those who have become infected in longstanding monogamous relationships, and many discussions with others who, like me, have studied the disease for decades. There are no formal studies. EWH
Dear Dr. Hook,
apologies for the follow-up - regarding your above answer (see attached below) - can you provide some reading that explains/talks about the 1% or even 1 in 1000 infection risk that you provided? I find it hard to find a reputable source that states this information. Many thanks.
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"4. With or without lesions, the risk of getting herpes from a direct exposure to an infected person is less than 1% and many would say less than 1 in 1000. We presume that direct lesion contact is somewhat more infectious but as noted above, because so many people with HSV do not know they are infected, most HSV is transmitted by persons who are asymptomatic and without lesions. "
apologies for the follow-up - regarding your above answer (see attached below) - can you provide some reading that explains/talks about the 1% or even 1 in 1000 infection risk that you provided? I find it hard to find a reputable source that states this information. Many thanks.
----
"4. With or without lesions, the risk of getting herpes from a direct exposure to an infected person is less than 1% and many would say less than 1 in 1000. We presume that direct lesion contact is somewhat more infectious but as noted above, because so many people with HSV do not know they are infected, most HSV is transmitted by persons who are asymptomatic and without lesions. "
MEDICAL PROFESSIONAL
Correct, there ar HSV-2 oral infections but they are quite rare and as a result, poorly studied. Similarly, I suppose if is possible that a person infected genitally could later get a second infection in the mouth. There is also a possiblity that you'll be struck by a meteor from space, just not a realistic probability.
Take care. End of thread. EWH
Take care. End of thread. EWH
Thank you again.
So there are HSV2 oral infections but they are so rare that when you already have "hsv2 antibodies" from a genital infection it is basically impossible to get them in your mouth, too? Does that mean it is possible, and that is what a government website for health would state, regardless of the "far, far less common" reality of it actually occurring?
You are right in your observation that I am not necessarily asking out of concern, I am just trying to get a better idea of how to process the large amount of "conservative" information that I am taking in at this point.
This will be my last reply, thank you again.
So there are HSV2 oral infections but they are so rare that when you already have "hsv2 antibodies" from a genital infection it is basically impossible to get them in your mouth, too? Does that mean it is possible, and that is what a government website for health would state, regardless of the "far, far less common" reality of it actually occurring?
You are right in your observation that I am not necessarily asking out of concern, I am just trying to get a better idea of how to process the large amount of "conservative" information that I am taking in at this point.
This will be my last reply, thank you again.
MEDICAL PROFESSIONAL
It appears that you are asking more for comments than asking questions at this point. There are facts and there is context- both are important. For some something that occurs once in a thousand occasions is not something to worry about, for others something that might happen to them once in a million times is cause for great concern. All of this is further influenced by the impact of context- in our forum that context is all too often sex outside of the context of a "committed" relationship (no judgment here- just my observation).
Further brief comments. "Official" sites must provide general information, often in a politically influenced environment. Further, their job is to inform persons how to minimize risk. Mix this perspective with an all too large a dose of societal overreaction and stigma and messages are understandably conservative. On this forum we have the luxury of providing more individualized interactions. We don’t disagree with the facts provided by most official sites, in fact we both have regularly contributed to theire creation.
There are HSV-2 oral infections but these are far, far less common than genital infections and, for reasons that are poorly understood, HSV-2 oral infections appear to be spread less easily and clinically recur less often than when they occur at genital sites. The mirror image situation occurs with HSV-2, recurring less when it is present at genital sites. The biological reason for this is not well understood.
As to your last comment. Probabilities are just that. with something that occurs once in 1000 times, someone will become infected the first time they have sex, someone the second, etc.
I hope these comments provide further perspective. EWH
Further brief comments. "Official" sites must provide general information, often in a politically influenced environment. Further, their job is to inform persons how to minimize risk. Mix this perspective with an all too large a dose of societal overreaction and stigma and messages are understandably conservative. On this forum we have the luxury of providing more individualized interactions. We don’t disagree with the facts provided by most official sites, in fact we both have regularly contributed to theire creation.
There are HSV-2 oral infections but these are far, far less common than genital infections and, for reasons that are poorly understood, HSV-2 oral infections appear to be spread less easily and clinically recur less often than when they occur at genital sites. The mirror image situation occurs with HSV-2, recurring less when it is present at genital sites. The biological reason for this is not well understood.
As to your last comment. Probabilities are just that. with something that occurs once in 1000 times, someone will become infected the first time they have sex, someone the second, etc.
I hope these comments provide further perspective. EWH
Thank you Dr. Hook for your extensive answers. I am under the strong impression that your answers compare very favorably to a lot of "official" information that is found on national health websites. Is this because facts by themselves have not that much meaning unless context is provided by somebody like yourself? Or is this some misguided way of making sure the virus is spread as little as possible instead of actually just stating that it really is unlikely if some reasonable behaviour is applied?
I read in many places that HSV2 infections can happen orally, and genitally at the same time. I also read that the chances of passing on the virus passively are much, much higher - I assume shedding rates and actually transfer are used without much distinction?
Lastly - the fact I got hsv2 from a partner after only a few times of vaginal sex and without any visible symptoms on her - does it mean that was a very unlikely scenario? Are we basically all (in these forums) experiencing some sort of anthropic principle/confirmation bias as only those rare cases where a transfer occurs are the ones frequenting these forums? I suppose millions of people have sex every day with people that have hsv or have hsv themselves and nothing happens at all?
I read in many places that HSV2 infections can happen orally, and genitally at the same time. I also read that the chances of passing on the virus passively are much, much higher - I assume shedding rates and actually transfer are used without much distinction?
Lastly - the fact I got hsv2 from a partner after only a few times of vaginal sex and without any visible symptoms on her - does it mean that was a very unlikely scenario? Are we basically all (in these forums) experiencing some sort of anthropic principle/confirmation bias as only those rare cases where a transfer occurs are the ones frequenting these forums? I suppose millions of people have sex every day with people that have hsv or have hsv themselves and nothing happens at all?
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
