HSV2 positive - need some clarification

[grindcore99]

1) I recently have been given a clean bill of health after a full std test, unfortunately in the UK we don't test for hsv by default, why is this?

I slept with a girl that had the same clean bill of health and was on the pill, but I ended up contracting hsv2 from her. She had it for a while (blood test) but never had noticeable symptoms so didn't know. I so far had a minor rash/dot that is now subsiding. So on the physical side things are okay, but I am mentally very stressed and concerned about my future.

2) now that I have genital hsv2 and now that we know she has it too, is there any danger in us having unprotected sex?

3) if we have oral sex and as far as we are aware have no oral infections or hsv1, can we still transfer hsv2 to each others mouth? What is the likelyhood and how does it compare to other likelyhoods of getting stds? In the future, can I still get hsv1 down there or up near my mouth or am I sort of "protected" against new infections? If not, are the chacnes of receiving a new infection actually just academic or have real world relevance?


4) I read that without an outbreak the chances of passing on the virus are quite low, under 10% for men, much less for passing hsv2 on to somebody's mouth. Is this true?

5) Considering that antiviral therapy is harmless and reduces the possibility of passing on the virus by another 50% or so ... and looking at the actual chances of then passing it on either genitally or orally ... aren't the numbers suggesting (2-4% chance per year?) that it would be more likely to get pregnant when having sex with a condom, then to pass on hsv to a partner? I am trying to establish whether the need to tell somebody when using a condom and using antivirals is really just due to stigma, not to practical requirements?

6) My first outbreak was very mild, with just one dot that didn't even really hurt. If it has been somewhere else I would not have noticed even. Can this happen, can it show up somewhere else? Or will it always be in the same place? If that is the case, will it shed from that are aswell, or more widely from the genital area? The reason for this question is because a condom would completely cover the tip of my penis, and if the shedding only occurs where the sore was, I don't see how it can be passed on?!

7) Lastly, I read everywhere that some people only get one outbreak (or none) and that subsequent ones are much less strong. Considering the mild nature of my first outbreak ... can I draw some sort of likelyhood of further outbreaks from it an also their potential intensity? What I of course want to hear is that chances are very good that I won't see it ever again and that if it shows up it will be even more insignificant than before.


Many thanks.

[grindcore99]

Another actual question, if you don't mind.

The 4 months figure that you gave in your fist reply is something "new" that I have not learned anywhere else. Am I correct in understanding that basically once you have "either" HSV for a while, your system will have enough defense to fight of the majority of potential new infections? So although it is possible to get HSV1 genitally or orally, it is highly unlikely if you have HSV2 already genitally?
Is the vice versa true aswell, if you have HSV1 already oraly (which according to you and other sources is up to 90%?! of the population) you should have some sort of resistance to HSV2 genitally?

I just played through a scenario in my head where I tell a potential partner about my hsv2 down below, they get a blood test and it comes back positive for hsv1 (which is very likely, right?) - would that mean there is even less to worry about that initally thought?

Somebody should make a fact sheet on which infections actually are probable, which ones are academic and never observed (like your colleague stated) ... it can be quite overwhelming, especially when you feel emotionally drained already.

[grindcore99]

Thank you for taking the time to reply again. Despite some of the tension I find this conversation helpful.
Let me re-iterate again that I have by no means made up my mind to not tell people about being hsv2 positive. I simply still fail to see that in all circumstances this is reasonable, appropriate behaviour, and I disagree that a blanket disclosure in all circumstances is the only thing to do.
Also, I am very aware, as you are yourself, as to how much of an impact a positive result can have, as I am experiencing these emotions myself. Strongly. It can feel quite devastating.
Because of this I feel it is even more important to separate fact from fiction and apply reason to what is essentially not a medical problem but a moral problem.

I will refrain debating on the numbers/facts of the disease is not an exercise I should undertake with somebody as yourself - you appear to have dedicated your life to researching into the matter so I must concede that your are more informed than I am, obviously. This of course doesn't change the observation I have made though that numbers such as transmission/shedding rates and factors of protection appear to be displayed differently on different websites. There is a discrepancy even between the official US numbers and for example the NHS numbers in the UK. There is a certain bias in how the information is presented - very matter of fact with conservative, out of context statements, or more progressive, helpful yet factual websites. One that I came across that was so much more nuanced and useful than any others - and I am sorry to say - maybe more helpful than your response:

http://www.herpes.org.nz/patient/facts.htm

Now that I have written this I am conceding, again, that I might be overreacting to responses as I am in emotional turmoil about my diagnosis. But I hope you can recognize on some level, even only personally, that this official government information is much more useful to a newly diagnoses person than for example the UK NHS website.

As for the moral discussion, I think a part of me will always disagree with the notion that full disclosure even during protected, first time sex, is the only way to go. I have spoken to a gay friend of mine who turns out  also has herpes, although never had symtoms again after an initial episode. He says in the gay community it is not a big deal at all, and he doesnt tell people until they get serious/decide to take off the condom.  He saw no moral issue with it as it is more likely that the other person has it than him passing it on, and if it is passed on it is widely considered "no big deal".
I would never have a relationship with somebody without telling them, but I would have sex with somebody with protection without telling them that they could still get pregnant. Also I am sure we all kissed people although they or ourselves once had cold sores, without disclosing such a thing? I mean are we really supposed to live in a world where because I had a cold sore 10 years ago (I didnt, but let's assume) I need to warn everybody before we kiss?
Would we not all be happier, less stigmatized and also less traumatized by a diagnosis if it was more normal to have herpes and not such a big deal was made of it? If we accepted that having sex can result in it, and if we took precautions that are sensible given the odds at stake ... would that not be a better world to live in? Instead of pretending that I am now a danger to any potential partners? They might be, statistically, more of a danger to me (HPV, other std's) than I am to them. Again - the difference, or shall I say the curse, is that I know, as opposed to being blissfully unaware like 80% of people.

I just don't see how your approach is the ONLY helpful one. I don't see that as a carrier it is your sole responsibility to disclose a risk that otherwise is blissfully ignored by people at all times. Especially when I do everything reasonable to actually protect my partner.

Difficult times, difficult decisions. A week ago life was easier.

[catinbarefeet]

You would be wrong to believe that I am in the minority in my view that everyone deserves the chance to determine whether they want to take a risk to their sexual health. I am not a health professional - I am a college professor with two decades of research into the virus, as well as a 19-year veteran of HSV with decades of running support groups for people with herpes. I've experienced firsthand the devastation a new diagnosis creates in patients, and for many of them, it's the betrayal of trust that causes a huge chunk of the emotional fallout. I have been told firsthand by newly-diagnosed patients that they want to take their own lives, to end the emotional pain of having herpes, and because they feel they are doomed to a life without love.

An important alert: not all sources of medical information that claim to be reliable are indeed reliable. The fact that a website contains the words "health," "herpes," "STD," or the like has the credentials to be considered reliable, nor do they always give accurate information.

The official statistic for protection from a condom is 30%. Here is Medscape's (WebMD) report from the 2009 NIH/NAIAD studies:

http://www.medscape.com/viewarticle/705724

I'd be happy to have you point out where my information differs from Dr. Hook's and others. Please provide links to reliable sources.

I did not give you any statistics regarding shedding, therefore there are no contradictions on those topics.

Statistics are meaningless. As you've admitted, there is not a zero risk, even after taking all the steps to reduce the risk. There is a possibility you will transmit it, in spite of your caution. That's all that counts. You imply that I should discount the worst case scenario, when doing so constitutes turning a blind eye to the possibility that it will happen to you. This is not scare-mongering, my friend - the worst case scenario exists. It is why we must disclose every time, out of respect to our partners. It is why Dr. Hook told you it was the right thing to do. Not doing so is lying. Insulting me and others who believe in sexual responsibility will not change that.

What you seem to be saying is that in spite of admitting the risk is not zero, you nonetheless want to insist that there is no way you will transmit the virus to a non-H partner if you take all the steps. I urge you to ask yourself what you will do if you do indeed infect someone who you failed to disclose to. If you can live with the possibility, then I have no more to say. Your behavior is your call. My opinion is of no consequence - only your own self-respect matters.

[grindcore99]

Lastly, I specifically asked Dr Hook about the shedding and your information contradicts his and many others. Also you claim 30% protection with a condom, others state 50%.my point is not a debate about the numbers, it is that there is a spectrum in which these discussions operate and you apply worst case thinking to all cases. I had one dot st the tip of my Penis for about 5 days. That's it. According to doctors shedding occurs mostly or completely where the outbreak occurs and a condom would cover me. Do you despite lack of practical evidence also suggest to not share towels etc?

It is almost scaremongering. Hsv is being mostly ransferred asymptomatic because people don't have sex when they have an outbreak. The idea that it happens frequently is of little relevance to the dangers involved, it just states when people have sex and when not.

[grindcore99]

This is a typical and unhelpful response because it is ideological despite the facts. I find it shocking that such rigid views are expressed by health professionals.

At no point was I claiming there is no risk. In fact I specifically said there always is a risk. When two consenting adults have sex they both consent to that risk, and accept that unknowns might occur. Unknowns include the real world fact that one of them might be carrying hpv or herpes and not be aware of it. It includes pregnancy as a possibility. There is reasonable behaviour or as Dr Hook called it 'appropriate'  behaviour to limit the possibility of these outcomes,  such as the use of condoms. There is unreasonable behaviour which is for example to wear a latex suit or never ever have sex.  A balance needs to be found.

The risk of me passing on hsv2 when no symptoms are present and while I wear are condom and possibly even am on antiviral drugs is lower than all potential unknown risks that occur when two people have consentual sex. Yet you state with no flexibility that it is my responsibility to let the other party make an informed choice. Well,  it isn't.
If I was asked I wouldn't lie.  Also in most cases,  if appropriate and possible I would probably state it. But the idea that hsv carriers are bad people unless they tell everybody on their first moment of intimacy seems otherworldly to me and continues the perpetual stigma that this is a terrible,  dangerous,  super contagious disease that can not be controlled.

We are going to have to disagree. I have no issue with that. But I'd appreciate it if you and others if your conviction also took into consideration the context in which these moral questions are asked. I am not amoral,  I just like to think.

[catinbarefeet]

Dr. Hook's answers are not contradictory to mine. Also, not once does he call the statistical risk in any situation "zero percent." All it takes is one time for the factors to align - for that "less than 1% probability" to be happening at the point of sexual contact - for the virus to transmit.

The condom does not cover every area of possible shedding - we can shed anywhere between the belly-button and the mid-thigh. In fact, I get half my outbreaks near my tailbone. The suppressive meds only reduce the risk about 50%.

Here is something else Dr Hook says in his responses to you: "...when possible and appropriate, disclosure is always the best practice."

Though HSV is a non-fatal, mild skin condition for most, a percentage of HSV+ patients have adverse reactions to the virus. It's not possible to determine who will and won't beforehand. HSV also can cause neonatal herpes, which can be fatal to newborns. Though rare, it happens.

Because all these possibilities exist, everyone has the right to be allowed to make decisions directly related to their own sexual health. I'm at a loss to understand why you think your non-H partners don't deserve that choice. It's their right. Lawsuits have been started and won by newly-diagnosed folks who were purposely not informed about their partner's STD status before sex. This should be a warning to you.

If you're looking for an endorsement to behave irresponsibly and knowingly put someone at risk, I'm afraid you won't get it from me. I hope you make the responsible choice.