Herpes Concern

[Loversnookie]

We were both tested before becoming sexually active.  We both had HerpesSelect tests done at the end of April through Quest diagnostics.  His came back with positive antibodies for HSV 1, negative for type 2 and mine came back negative for both types.  My concern relates to a small cut I have observed on my hymen near the vaginal opening.  It is a thin slit that appears to have fresh blood on it.  I have to use a magnifying makeup mirror to see it well.  Although I see nothing that looks like a blister/bump I am very concerned.  I use the Nuva Ring for birth control and frequently have to "push it up" further so I initially thought that what I was observing was a scratch from my finger nail.  However, my nerves/paranoia are getting the best of me. I have made an appointment with my family doctor but am unable to be seen until Friday.  My concern is...

1. Does this sound like Genital HSV-1 (there are no other lesions, cuts, bumps or redness present)?  
Also, I am finding myself thinking of many unlikely scenarios such as the possibility that my partner is one of the few who might have HSV-2 with no antibodies (like up to 5% of those infected)  I realize these scenarios are likely implausible but nonetheless they have entered my mind and are getting the best of me.  

[H. Hunter Handsfield, M.D.]

It is exceedingly unlikely your genital lesion is due to herpes.  There is some very small chance you could have acquired HSV-1 from your partner, if cunnlingus is one of your sexual practices.  But most likely his HSV-1 infection dates to childhood; if he isn't having recurrent oral or genital herpes symptoms, most likely he isn't infectious.

And what would it matter if you caught HSV-1?  If oral from kissing (which is more likely than genital) you would just join the other half the population that already has oral herpes.  And if genital, if someone has to get genital herpes, HSV-1 is the preferred type.  Most people with genital HSV-1 have no recurrent outbreaks or only 1 or 2 recurrences over a year or two, then nothing; and they don't tend to have much asymptomatic viral shedding.  That means there would be little risk of genital transmission to a future partner, if your new relationship doesn't last and you end up dating again.  So while avoiding genital HSV-1 makes sense because of the rare cases that turn out badly, truly there really isn't very much to be concerned about in your situation.

Is it conceivable that the various scenarios you describe could be present, despite their implausibility?  Yes.  It is also plausible you could be hit by a meteor, but you don't take precautions against it.  That should be your attitude here.  The likelihood is more or less the same.

Follow through with plans to see your doctor.  If you explain that you have a lesion and are concerned about herpes, the office staff might work you in right away; they probably will know that accurate diagnosis depends on examining lesions before they start to heal on their own.  Whenever you see the doc, if s/he agrees that herpes is a possibility (i.e., disagrees with me), then follow his or her advice about diagnostic tests.  If you decide to pursue this, you could have another blood test in about 3 months, to see if your HSV-1 antibody test has become positive.

In the meantime, please try not to worry about this.  The possibility of herpes is very low, and it probably wouldn't be a serious deal anyway.

Best wishes--  HHH, MD

[Loversnookie]

Just a couple of follow-up questions...
I did see the Dr. on Friday (was not able to be seen any sooner) and she agreed that herpes was very unlikely, stated that it looked nothing like a herpes lesion but took a culture anyway just to err on the side of  caution and likely to ease my mind.  I have not received the results from that yet.  I assume they will be negative either due to the spot healing and having been to late to obtain a reliable culture or due to it not being herpes at all.

My question relates to the possibility of dating again in the future.  If I get tested after this relationship and am suddenly positive for HSV-1 I will have no way of knowing the location of the infection unless I have symptoms (could be oral, or genital or rarely but possibly both).  In that instance what kind of ethical responsibility would I have to notify a new partner...wanting to be responsible but not neccesarily to overly alarm that person about risks that are not likely such as (genital to genital transmission) but still possible.  

Secondly, since I know I was seronegative for both types as of the end of April, is it a safe assumption that if I became infected in either location I would likely notice (as my body has no immunity whatsoever to either type) and would likely have some of the "whole body" symptoms such as fever, etc.  I am concerned that a genital outbreak and that sores or lesions would be so slight or easily missed that I wouldn't notice it and I am wondering if you could comment on the likelihood of that situation.

Thank you very much for your expertise and your timely response.  I know much of my anxiety comes from being with a partner who is much more experienced than I, I also know I made the right choice by getting tested and informing myself...but unfortunately the knowledge I gained has left me with more "what ifs" and more questions about how this could impact future relationships.

[H. Hunter Handsfield, M.D.]

OK.  Let's assume you have genital HSV-1, despite all evidence and despite the improbabilty of it.

1) People with initial genital HSV-1 tend to have few recurrences - 40% have none at all and most of the rest apparently have just 1 or 2 more outbreaks over the next couple of years, then none.  And asymptomatic viral shedding is uncommon as well.  Because of these things, I have never seen or heard of a case of genital to genital HSV-1 transmission.  Also, on average half of all men you might have sex with already have been infected with HSV-1 and are immune to new infection.  So if you have it, there is little risk of transmission to future partners.  This is the main reason that you shouldn't be worried about the unlikely possibility you in fact are infected.  But of course there are no ethical black and white answers.  Given these circumstances, some people could reasonably conclude there is no obligation to speak with partners about the infection before having sex -- at least, less need than for genital HSV-2.  Others would argue that even if the risk is extremely low, partners should be informed. You would have to make your own decision.

2) Mild initial infections certainly can happen.  But since your partner probably had distant chronic infection and no known oral herpes outbreak, it is statistically unlikely he could have infected you.  As suggested above, you have to assume that several unlikely possibilities all went the wrong way, which is very unlikely.

But if you remain concerned, just have another HSV-1 antibody test 3 months after your last experience with cunnilingus with your former partner, presumably sometime in the next few weeks (counting from April).  If it's still negative, you're home free.

That will have to end this thread.  Take care.

[Loversnookie]

I understand that it is very unlikely however my first question wasn't worded very well and if I could ask for some clarification. I recieved the culture results today adn they came back negative.  However my question remains...if I do get a blood test three months from the last possible exposure and it is positive (providing there has not been a noticeable outbreak in either location) do I assume a genital infection or is an oral infection still more likely AND, without an outbreak and knowing the location of the infection, does that do anything to change partner notification or ethical obligations?

[H. Hunter Handsfield, M.D.]

Yes, if your HSV-1 test becomes positive at 3 months, you probably can assume a genital infection.  But I already responded to the partner/ethical issue in that case; please re-read my response yesterday.

That's all for this thread.  Take care.