hsv2/std question

[confused_boy]

I had protected sex 6 weeks ago however the condom vanished at the end and I am worried I may have been exposed. I don't know her status and I don't believe she was having an outbreak. After 2.5 weeks I tested for HIV, HSV, Syphilis, and Hepatitis B and C. All of the test were negative, the IGG was positive for HSV1 which I'm sure I had since childhood. I know you don't believe in IGM but it was negative as well. Last week I went to see a doctor to discuss the results, she felt the only re-testing I need is for HIV. The doctor felt that the IGM is a good baseline for recent exposure and reliable in most cases(no false positive)but I disagreed based on your posts. I have no symptoms, blisters, sores, only minor itching for the last 3 weeks on the upper thigh and in the groin which she felt was folliculitis and gave me a prescription. My questions are:
1) Should I ask for a re-test in 12 and 16 weeks for HSV and HIV?
2) Are there any other re-tests I should do since I tested too early the first time?
3) I have a mixed conclusion, most people say 2-20 days after exposure for blisters/sores to appear, but I also hear most are asymptomatic, can I be asymptomatic, how common is it and for how long?
4) I will be out of the country for the next 3 weeks should I be concerned?
Thank you doctor for your time and energy.

[H. Hunter Handsfield, M.D.]

You have overreacted.  STD testing after a single episode of sex rarely makes sense.  And certainly testing for HSV in this context is unnecessary; the risk of transmission for any single exposure is simply too low to make it worth the time, energy, and money.  (If everyone with a single casual, unprotected coupling got HSV/STD/HIV testing, the health care economy might not be able to handle it!  It is much smarter for sexually active people to get checked periodically, such as once every 6 months to 2 years, depending on frequency of new partnerships etc--but to not worry about individual exposures unless a partner is known to be infected.

1) Therefore, I do not reommend further testing.  But if your anxieties are not resolved by the comments above, have another test in 3-4 months for HSV; and HIV testing can be done reliably any time after 6 weeks.

2) Don't have any other tests.

3) Most 'asymptomatic' cases actually have symptoms, just mild and not noticed.  Most exposed people either don't know it or don't react with the level of concern you have, so they aren't on the lookout for subtle symptoms.  With your heightened awareness, absence of symptoms is a strong indicator you didn't catch herpes.

4) Being out of the country doesn't have any effect on all this.

Good luck--  HHH, MD

[confused_boy]

Thanks doctor for your reply. I wouldn't be this concerned normally but the girl happened to be a topless dancer (high risk) who I'm sure has exposed herself to others besides myself. She claimed to be disease free and regularly tested but I can't prove that obviously. So if I may ask a couple of follow up:
1) what about my doctors IGM beliefs, when I criticized the IGM test to my doctor she asserted her knowledge of hsv and blood tests to me. She said a false positive is common and an HSV1 old infection may affect a positive result but antibodies (antigens?) in IGM are almost always detected for 'acute' infection and a negative result is 'much more reliable' than a positive one.  
2) If I have no symptomatic or even slightly mild genital symptoms whatsoever after 6-7 weeks can I assume I am fine? I heard an HSV1 infection may make an hsv2 infection so asymptomatic you wouldn't be able to tell for months.
Just for peace of mind, I am going to test after week 12 with a HerpesSelect as you recommend to all. Thanks again for your help doctor and I promise to relax a little.

[H. Hunter Handsfield, M.D.]

Your doctor is exatly right about IgM testing.  The main problem with them is false positive results.  A negative result is more reliable.  Your doc clearly has a more sophisticated understanding about this than most others--which in turn suggests she understands herpes and you can rely on her evaluation and advice.  Stick with her! (And tell her I said so.)

HSV-1 indeed can make the symptoms of HSV-2 less severe, but my reply above (no. 3) still applies.  It's not a guarantee, but when you add up all the facts (low risk your stripper partner had active herpes at the time of the event, low risk of transmission if she did, negative IgM, and lack of symptoms) there simply is no realistic chance you caught herpes.

HHH, MD