herpes likely or not?

Hi Dr:

I had unprotected sex 2 times with the same man (actually same night). Not something I typically do, but been a while and made a bad choice.

Anyway, a week later I noticed a slight odor and got really concerned and went to get tested for everything. My Dr. immediately saw I had a slight case of bacteria which vaginal antibiotic cleared up in 3 days. He also did a swab (not sure which one if there are many) for herpes which he said came back positive. After flipping out for a few days, he told me I could come in and get a blood test and he would be able to tell me if this was a recent exposure or not. I also want to mention that many months ago I had tested negative for herpes (and not slept with anyone since). So 3 weeks after the incident, the blood results were as follows: HSV IGG 1 .75 and HSV IGG 2 .17. So I know after reading this site, I need to get tested at 6 weeks and 12 weeks but my question:

1.) since I did have a positive on the swab, does that mean I do indeed have herpes and IGG is low since recent exposre and most likely will be higher at week 6 and 12?

2.) I am now terrified to get Hep C and HIV test. Thinking if someone knew they had herpes and was so inconsiderate, then they could have anything. Of course, he said he was tested for everything and is clean??? So is it likely to catch either from one night of unprotected sex or would you have to be pretty unlucky? Sorry if this is a stupid question...

Thank you for your attention and learned my lesson.

[H. Hunter Handsfield, M.D.]

Your original thread 4 days ago didn't say you had a positive swab test for herpes; it implies only the blood test was done, and that result was negative (because IgM is not reliable).  But if you had a positive test for herpes, that changes my response:  It is likely that after a few weeks, your blood test will become positive for HSV-1 or HSV-2.

1) Yes, you have it right.  Sorry if my response 4 days ago misled you.

2) Hepatitis C is not a risk at all.  Hepatitis C virus is NOT SEXUALLY TRANSMITTED; almost everybody with HCV got it by blood exposure, such as transfusion or shared needles.  HIV is always a theoretical risk when there is any STD, and herpes and HIV sometimes are transmitted together.  But still the chance you caught HIV is very low, both because your partner probably doesn't have it; and if he does, transmission is rare for any single episode of exposure.

You must not assume your partner knows he has herpes.  Most people with genital herpes do not know it; and that includes people who transmit the virus to their partners.  The odds are your partner is correct about being tested for "everything"--except that routine STD testing doesn't usually include herpes.  Your partner definitely needs to be tested for HSV now.  I predict he will have a positive blood test for HSV-2.

Good luck--  HHH, MD

[moet]

Thanks for your response (sort of). So, with all this in mind (and will get confirmation week 6 and week 12:

1.) what preventative therapy do you think is appropriate? My Dr. suggests 1 Valtrex (500 mg) a day.

2.) And just curious without an obvious outbreak, how easy is it to get herpes?

3.) I have 2 friends that have husbands with herpes and they never got it. Am I just really unlucky?

Now I really need a drink ;(

[moet]

and last question:

1.) if the swab came back postive, isn't it more likely that I would have HSV 2? You mention likely it will come back positive HSV 1 OR 2? I'm confused?

[monkeyflower]

Do you mean preventive therapy for yourself, or for your partner? If for yourself, if you're not having frequent and/or bothersome outbreaks, you don't need suppressive therapy at all. If you're concerned about your partner, however, I believe the risk of transmission from female to male, just avoiding sex during outbreaks, is around 4%/year. Male to female, around 8 - 10%/year. Suppressive therapy cuts those risks in about half, maybe more, and consistent condom use cuts it even further. Just avoid intercourse when having an outbreak and during the prodrome phase, if you notice it. Lots of herpes discordant couples stay that way for years, maybe forever :-)

You can have either HSV1 or 2 genitally; HSV1 is transmitted via oral sex.

[t1234]

Do you know if there's any studies to date documenting
transmission rates M-F and F-M in when the infected
partner is totally asymptomatic (never has or had outbreaks)?

I assume it would be at least half F-M 2, M-F 5 as I understand
must shedding occurs during the prodrome period, but I wonder
if it could be more like F-M 1, M-F 2???

I've found lots of studies involving persons with periodic
outbreaks, but none addressing the 80 per cent of the infected
population that are symptom free.

So I'm still looking

[moet]

Thanks Monkey Flower!!

First of all, I've never had an outbreak...I went to Dr. with a bacteria infection a week after unprotected sex and asked to check for everything. So, not looking forward to my first outbreak ;)

I will get a IgG test Monday at week 6 and see if it is HSV 1 or 2 and then again week 12. I guess since the swab came back positive, the Dr is pretty certain (positive) now I have herpes just the question of 1 or 2.

Since we did everything, I'm hoping I only have 1, which seems alot better for me and also to have to explain it to future boyfrined (s) ect. (If I ever get naked again).

This has been a horrible experience of which I know I will never repeat.

I'm still scared of HIV, although I have no reason to think he is high risk, other than he is really really gorgeous and probably out with a million people. That really flips me out!

[monkeyflower]

You might not ever have an outbreak. I have both HSV1 and 2, probably for years and years (at this point, at least 3 years but I'm sure much longer), and have never had a recognizable outbreak. I suspect a painful "yeast infection" I had once may have been an outbreak, but that's it. I sure wouldn't go on suppressive therapy, just in case you DO have an outbreak. If you have one, then you can take Valtrex for a few days. Otherwise, don't worry.

And don't worry about getting naked again, lol. I think it takes a little time for it to sink in, but once you reframe it you'll be fine. If it helps, I have a happy and fulfilling sex life, and expect to continue this way for the rest of my life - herpes or not. Heck, 25% of people have genital herpes, and it's not slowing most of them down, either. I always look at it this way - if someone rejects you just because of herpes, then that's certainly someone you wouldn't have wanted to be with anyway. Really, having a STD doesn't mean anything about who you are and shouldn't affect your life in the slightest :-)

As for HIV, don't worry. The risks from a one-time exposure are awfully slim - I wouldn't give it another thought. Get tested, but just because it's good to know your status. It's not worth worrying about, though.

To the other poster: from what I've read, the transmission rates don't matter whether you're symptomatic or not - you shed about the same percentage of time as someone who does have visible outbreaks.

[Curiousabout]

I am confused about what I might have:  For the past 2 - 3 months I have had some red dots appear beneath my pubic hair.  It is limited to just the pelvis/groin area, not on the penis or scrotum.  The symptoms appear to be Molluscum Contagiosum, but I have had exposed sex with a person who had hsv-2, so that is why I'm worried. The pictures I see on the web of MC look EXACTLY like what I have, also the length of outbreak is much more similar to MC (about 10 weeks so far).  And there has been no pain whatsoever.

My question is simple, what are the odds this is HSV-2 and not MC?  And second, what is the best treatment of MC?

PS -  If you feel this may be HSV-2, is there a definitive test?  Also, what are the chances there will ever be a vaccine or cure for the HS Virus?

Thanks in advance for your help, it means a lot,

[H. Hunter Handsfield, M.D.]

I deleted your new thread, started November 9.  It is inappropriate to keep posting new questions that are more properly part of preceding threads.  Only a limited number of persons can post questions each day, so each inapprorpiate question prevents someone from asking a legitimate one.

Your new questions were:

1.) Since my swab came back positive, does it differentiate between 1 and 2? If so, how can a Dr. just announce you tested positive for herpes without being specific? I consider it a big difference between one and two and I'm no authority (well getting there).

REPLY:  Labs should distinguish HSV-1 from HSV-2 on a positive culture, and it is easy to do.  But some labs don't do it unless the provider requests it.

2.) Since it was a vaginal swab, does that mean somewhere up inside me I must have had a sore since it was positive (it was about 8 days after exposure)?

REPLY:  Nothing can be said about the location of the lesion(s) from which the virus was being shed. The cervix is a good bet, but you could have had external genital lesions that you didn't notice and your provider didn't see.

3.) And if HerpesSelect came back .75 for one and .19 for two, sure it was that recent exposure and we all expect it to be higher Monday at 6 weeks or certainly at 12 weeks. So my question is if (I know dangerous to ask "if" questions) my one continues to go up and not two, then I would have HSV 1 vaginally. Is that correct?

REPLY:  No, not correct.  Any result below 1.0 is negative, period. There is no difference in the meaning of 0.75 and 0.19.

4.) and lastly, if you were me would you be taking Valtrex once a day if you never wanted a sore on either lips

REPLY:  I cannot prescribe or give advice on threatment from an online description; too close to practicing medicine from a distance.  Most people with genital herpes do not need chronic suppressive therapy, but there are too many factors in each case for me to speculate in yours.

HHH, MD

[moet]

Dr: I only started new threads so I could donate the $10 that I thought was appropriate if I had continued to ask questions.

And, I didn't think the last few questions were inappropriate.  This is all foreign to me and although I'm educating myself, you do bring clarity to some of the ambiguity.

But no hard feelings...Thank you!!

[H. Hunter Handsfield, M.D.]

I could have been more diplomatic in my response; sorry.  Your questions weren't so much inappropriate as unnecessary in a new thread--I would have answered them in this one.  (Your writing style doesn't imply an abuser of the system--and believe me, some people's does!)  But it's still true that it tends to block others who have questions they are trying to post, once the daily limit of new questions is reached.

If you contact the MedHelp webmaster/adminstrator and tell them the story, they probably will happily refund your last donation.

Best wishes--  HHH, MD

[moet]

Dr: Thanks for your response...I have gotten more than $30 worth of valuable information from you and others...Thank you!!

[bren785]

A related discussion, herpes or not? was started.