No symptoms after 4 weeks, should I worry?

[biffred]

I had protected sex with a woman twice (somebody I have known for a long time, but apparently not very well), about four days apart. The second and last time was January 1st. She did not tell me the first time that she has HSV2, but she did the second time. I wore a condom both times, but on the second night the condom came off for about a minute before I noticed.

She said she is taking Valtrex on a regular basis and had no current symptoms. She also said she has had a few long-term boyfriends (she has had HSV2 for about 18 years) who had unprotected sex with her on a regular basis, and they were not infected.

I have not had any type of outbreak which resembles what I know of herpes... just a small thing about a week later that looked a little like a single little pimple or ingrown hair which I popped and whitish fluid came out, just like an ingrown hair anywhere else. It went away after a couple days and did not hurt or itch, etc.

Should I be worried? I have heard that 2 months are required for a reliable test for antibodies, but I guess my question is... since I have had no symptoms, can I reasonably conclude that I was not infected?

[H. Hunter Handsfield, M.D.]

So what if the condom protection factor is only 80%? Or 50%?  Re-read my reply above.  Even if you take the condom completely out of the picture, the risk remains near zero.

You came here for reassurance, presumably.  I gave it.  Accept it and move on.  Truly, the risk is not significant.

[H. Hunter Handsfield, M.D.]

The risk you caught HSV-2 is exceedingly low, if not quite zero.  Among herpes-discordant couples (one partner with HSV-2, the other without) who are in regular relationships, having unprotected sex an average of 2-3 times per week, the annual risk of HSV-2 transmission is 5%, i.e. 1 in 20 susceptible partners is infected.  So the average risk calculates to somewhere around 3 per 1,000 episodes of sex.  In your situation, you add the condom (>90% protection) and your partner taking valtrex (at least 60% protection), and it takes you into the astronomically low range.

To put this into perspective (and not to frighten you for a different reason):  If you live in the US, statistically there is 1 chance in 1,756 that you will be dead a year from today because of some accident (auto wreck, a fall, drowning, etc, etc).  The chance you caught herpes is a lot lower than that.

The most commonly used HSV antibody test is usually positive by 2 months, but it takes up to 3-4 months in at least 10-20% of cases.  I really don't recommend testing at all in this circumstance, as long as you remain symptom free.  (The zit you describe sounds just like that, a zit. Herpes is uncommon in hair bearing areas anyway.) If you get tested and are positive, probably it would be from sometime other than the exposure events you desribe here.

I hope this helps.  The bottom line is that you have no serious worries here.

Regards--  HHH, MD

[biffred]

Yes, as I was driving home I thought about my second question and I was going to write another telling you to forget it, you did indeed address that concern already. Like I said, paranoid by nature. Thanks very much for your guidance.

[biffred]

Even though the condom came off for about a minute? I would think my >90% protection factor would drop greatly, but I'm paranoid by nature too. We were engaged in intercourse at the time, not too vigorously but not too lightly either. Just kinda regular, I guess.

Thank you, doctor.