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Misdiagnosed with HSV-2 twenty years ago, now married to man who has HSV-2
When I was 21, in 1987, a nurse at my university clinic diagnosed me with HSV-2 through viral culture (swab) of my genital area. At the time the culture was taken, I saw blisters in the genital area and felt itchiness and a stabbing feeling (pins and needles) in the genital area, etc. I did not have sexual intercourse with the guy that at the time I thought I got herpes from.
Yesterday, my doctor told me that a recent blood test for HSV-1 and HSV-2 revealed that I did NOT have HSV-2 but had HSV-1. How do I know which test is right? I don't think that I have records that date back to 1987. Do universities have medical databases on their students that go back that far?
I have been with my husband for five years. I met him at a HELP, Herpes support group meeting. I was trying to meet someone who had the same disease I did because I did not want to infect anyone. We got married then had two kids, both by c-section because I did not want my kids to start life with HSV-2. Now I realize that my husband and I are a discordant couple. How can my husband and I prevent me from contracting HSV-2 and still enjoy sex (sexual intercourse and oral sex) as much as couples who don't use condoms and dental dams?
My husband believes that he can't give me HSV-2 by giving me unprotected (no dental dam) oral sex as he never experiences outbreaks in the mouth, but I thought I read that a person who has HSV-2, regardless of where his outbreaks occur can transmit HSV-2 through his mouth. Who is correct?
What are the chances of me contracting HSV-2 from my husband if we have (a) unprotected sex and he use does not use suppressive therapy (acyclovir)? (b) unprotected sex and he uses suppressive therapy? (c) protected sex whenever we have sex and he uses suppressive therapy?
Finally, how long does it take for suppressive therapy take to maximally reduce risk of transmission?
Sincerely,
LME
Yesterday, my doctor told me that a recent blood test for HSV-1 and HSV-2 revealed that I did NOT have HSV-2 but had HSV-1. How do I know which test is right? I don't think that I have records that date back to 1987. Do universities have medical databases on their students that go back that far?
I have been with my husband for five years. I met him at a HELP, Herpes support group meeting. I was trying to meet someone who had the same disease I did because I did not want to infect anyone. We got married then had two kids, both by c-section because I did not want my kids to start life with HSV-2. Now I realize that my husband and I are a discordant couple. How can my husband and I prevent me from contracting HSV-2 and still enjoy sex (sexual intercourse and oral sex) as much as couples who don't use condoms and dental dams?
My husband believes that he can't give me HSV-2 by giving me unprotected (no dental dam) oral sex as he never experiences outbreaks in the mouth, but I thought I read that a person who has HSV-2, regardless of where his outbreaks occur can transmit HSV-2 through his mouth. Who is correct?
What are the chances of me contracting HSV-2 from my husband if we have (a) unprotected sex and he use does not use suppressive therapy (acyclovir)? (b) unprotected sex and he uses suppressive therapy? (c) protected sex whenever we have sex and he uses suppressive therapy?
Finally, how long does it take for suppressive therapy take to maximally reduce risk of transmission?
Sincerely,
LME
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. There are lots of questions in there, but here goes.
Probably you indeed had genital herpes at age 21 and HSV-1 was the cause. Positive cultures are reliable, but often the virus isn't typed. Your provider might have assumed HSV-2 because it was genital, without knowing for sure. Your blood test shows it definitely wasn't HSV-2; and since you had not had genital sex with the partner you apparently caught it from, HSV-2 was unlikely on that ground. (Did you receive oral sex from him? That also would be consistent with HSV-1 as the cause. If you had neither genital nor oral sex, that questions the entire diagnosis of genital herpes.) Finally, since you don't say you have had recurrent genital herpes outbreaks over the years, I assume you have not. That also is consistent with HSV-1, which causes many fewer genital recurrent outbreaks than HSV-2.
So now you are the partner of someone with HSV-2. You have not been infected after 5 years, when you obviously were susceptible but did not take any precautions. It's possible you could continue another 40 years of sex with him and still never catch it.
In your circumstance, many persons would just decide not to worry about it. Would it matter all that much if you caught what you always believed you had anyway? If you catch genital HSV-2, you might never know it, since most infections are mild or asymptomatic. If your marriage is strong and you are unlikely to have new partners in the future, then that's not an issue either. And if you do develop genital herpes with symptoms, effective treatment is available both to speed healing and prevent recurrent outbreaks.
That said, it would be perfectly reasonable if you decide to take reasonable steps to prevent catching it. Your a,b,c questions show you know the basic strategies: avoidance of sex when your husband has an outbreak, condoms, and suppressive therapy. Taking them one at a time:
a) In couples exactly like you -- monogamous, HSV-discordant, no condoms, no therapy -- who have sex an average of 2-3 times per week, transmission occurs in about 5% (1 in 20) couples per year. And that risk declines with time: the longer the duration of repeated exposure without transmission, the lower the risk it will ever occur. That's why you and your husband could have regular unprotected forever and you might never catch it.
b) The single research study of suppressive therapy showed a 50% reduction in transmission risk. For a variety of reasons related to study design , that's probably a minimum figure; many experts believe that in the real world, the reduction in transmission is better than that, maybe as high as 80% reduction. So now we're at something like a 1-2% risk of transmission per year.
c) Condoms, used properly for every episode of vaginal sex, are around 90% protective against HSV-2. The combination of suppressive therapy plus consistent condom use probably is very close to 100% protective.
As for oral transmission, your husband is right and you are wrong. Oral infection is uncommon in people with genital HSV-2. There is little if any risk of transmission to you by cunnilingus. No dental dam is necessary. (You could catch HSV-2 orally by performing oral sex on your husband. But the risk is low. HSV-2 doesn't survive well in the oral area, which is one reason why oral HSV-2 is uncommon.)
So those are your choices. Turning to a personal perspective, if I were in your situation, knowing what I know (and assuming a strong marriage with no likelihood of new sex partners), the only precaution I would take is to avoid sex when my husband had a symptomatic outbreak. Otherwise, I would just take my chances, knowing that effective treatment is available if I got genital herpes with symptoms. Obviously that strategy has "worked" for you and your husband for 5 years.
But I'm not you and the choice is not mine. The next higher level of protection is for your husband to take suppressive therapy, preferably with valacyclovir (Valtrex). The drug has no significant side effects, so the only downside is the cost, probably around $200-300 per year. Finally, if consistent condom use is acceptable to both you and your husband, you might consider it. That's a pretty tough road for many couples, but it's an option -- but I stress only if it is acceptable to both of you.
As for your last question, suppressive therapy achieves its maximum effect almost immediately, certainly within a few days of the first dose.
So there are the options. I hope the information is helpful. Best wishes--
HHH, MD
Probably you indeed had genital herpes at age 21 and HSV-1 was the cause. Positive cultures are reliable, but often the virus isn't typed. Your provider might have assumed HSV-2 because it was genital, without knowing for sure. Your blood test shows it definitely wasn't HSV-2; and since you had not had genital sex with the partner you apparently caught it from, HSV-2 was unlikely on that ground. (Did you receive oral sex from him? That also would be consistent with HSV-1 as the cause. If you had neither genital nor oral sex, that questions the entire diagnosis of genital herpes.) Finally, since you don't say you have had recurrent genital herpes outbreaks over the years, I assume you have not. That also is consistent with HSV-1, which causes many fewer genital recurrent outbreaks than HSV-2.
So now you are the partner of someone with HSV-2. You have not been infected after 5 years, when you obviously were susceptible but did not take any precautions. It's possible you could continue another 40 years of sex with him and still never catch it.
In your circumstance, many persons would just decide not to worry about it. Would it matter all that much if you caught what you always believed you had anyway? If you catch genital HSV-2, you might never know it, since most infections are mild or asymptomatic. If your marriage is strong and you are unlikely to have new partners in the future, then that's not an issue either. And if you do develop genital herpes with symptoms, effective treatment is available both to speed healing and prevent recurrent outbreaks.
That said, it would be perfectly reasonable if you decide to take reasonable steps to prevent catching it. Your a,b,c questions show you know the basic strategies: avoidance of sex when your husband has an outbreak, condoms, and suppressive therapy. Taking them one at a time:
a) In couples exactly like you -- monogamous, HSV-discordant, no condoms, no therapy -- who have sex an average of 2-3 times per week, transmission occurs in about 5% (1 in 20) couples per year. And that risk declines with time: the longer the duration of repeated exposure without transmission, the lower the risk it will ever occur. That's why you and your husband could have regular unprotected forever and you might never catch it.
b) The single research study of suppressive therapy showed a 50% reduction in transmission risk. For a variety of reasons related to study design , that's probably a minimum figure; many experts believe that in the real world, the reduction in transmission is better than that, maybe as high as 80% reduction. So now we're at something like a 1-2% risk of transmission per year.
c) Condoms, used properly for every episode of vaginal sex, are around 90% protective against HSV-2. The combination of suppressive therapy plus consistent condom use probably is very close to 100% protective.
As for oral transmission, your husband is right and you are wrong. Oral infection is uncommon in people with genital HSV-2. There is little if any risk of transmission to you by cunnilingus. No dental dam is necessary. (You could catch HSV-2 orally by performing oral sex on your husband. But the risk is low. HSV-2 doesn't survive well in the oral area, which is one reason why oral HSV-2 is uncommon.)
So those are your choices. Turning to a personal perspective, if I were in your situation, knowing what I know (and assuming a strong marriage with no likelihood of new sex partners), the only precaution I would take is to avoid sex when my husband had a symptomatic outbreak. Otherwise, I would just take my chances, knowing that effective treatment is available if I got genital herpes with symptoms. Obviously that strategy has "worked" for you and your husband for 5 years.
But I'm not you and the choice is not mine. The next higher level of protection is for your husband to take suppressive therapy, preferably with valacyclovir (Valtrex). The drug has no significant side effects, so the only downside is the cost, probably around $200-300 per year. Finally, if consistent condom use is acceptable to both you and your husband, you might consider it. That's a pretty tough road for many couples, but it's an option -- but I stress only if it is acceptable to both of you.
As for your last question, suppressive therapy achieves its maximum effect almost immediately, certainly within a few days of the first dose.
So there are the options. I hope the information is helpful. Best wishes--
HHH, MD
Thank you for a prompt and very detailed response.
LME
LME
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.
