brief contact herpes risk

[panicagain]

Dear Dr., I had an encounter with a woman I've known for a long period of time but haven't seen in years. This encounter included her kissing me and performing oral sex on me. I briefly touched my penis to her vagina without any penetration. This occured 5 days ago. I have been tested using herpes select type specific tests very recently after six months without any sexual activity. This revealed HSV1 IgG  positive and HSV2 IgG negative. I knew I had type1 since I have gotten coldsores since childhood but very rarely. I also have taken the IgM which has always shown negative. My questions are as follows.
1) If I had an IgM test at 6 days which reveals negative am I most certainly free of a recent infection? Knowing that a positive could be a reactivation of type1. 2) Can my type1 be passed from my mouth to my genitals after kissing and then receiving oral sex with or without a cold sore? 3) Does type1 oral indeed make it more difficult to contract type2 at all or type1 in a different location? 4) If there is no redness, itching, or sores after 5 days should I drop the possibilty of genital herpes? 5) Can a brief contact with vaginal fluid and skin be enough to contract herpes? or does it require actual penetration or friction? 6) Is it really possible to have genital herpes and never have symptoms or are those cases of a person not checking themselves or ignoring symptoms?    Thanks for your help. Kinda freaked out!    

[H. Hunter Handsfield, M.D.]

If you have developed no symptoms of herpes since the sexual exposure, and if none show up in the next couple of weeks, you can be confident you weren't infected.  The odds of catching HSV from a single exposure of the sort you describe is zero, for practical purposes.  You are immune to HSV-1, so the oral sex wasn't a concern at all; and the brief genital contact you describe carried no measurable risk.  You could add to the confidence of no risk if you talk to your partner:  if she says she doesn't have herpes, I sgugest you just drop this whole business.  It isn't worth the time, energy, and money for testing.

1) Do not request an IgM test.  IgM testing is always unreliable (read other threads by using the search link to look for 'IgM' and 'herpes diagnosis'.  We have never once ordered an IgM HSV test on a patient in my STD clinic and never will; but we deal every day with people who have false IgM results from other providers.

2) People with HSV are immune, or at least highly resistant, to new infection with the same HSV type, anywhere on the body.

3) HSV-2 isn't a risk based on the exposure you describe.  HSV-1 might reduce the risk of HSV-2 if exposed (research has given conflicting results); but if so, it is only a slight reduction in risk.

4) Yes, see above.  5) See above.  6) Yes, asymptomatic herpes is possible.  But it's probably uncomm in people as hyper-concerned as you clearly are.  Most 'asymptomatic' cases probably have typical herpes lesions, i.e. blister-like lesions that turn to sores, but the symptoms are mild.  Believe it or not, most people at risk don't worry about it much, so they aren't paying attention and don't notice the lesions.  A hyper-alert person is unlikely to miss the symptoms, however.

You are seriously overreacting.  Do you think everybody with a single exposure to new sexual partner needs to automatically go out and get tested for herpes or other STDs? The health care system couldn't handle the load.  I say mellow out and drop the whole thing. But if your anxieties prevent that, wait 3 months and have a blood test for HSV-2.

Good luck--  HHH, MD