Questions about Herpes Transmission

[jennsv]

Hi Terri,

Here is some background information:

I'm a 39 year old female. In November (11/16/09 to be exact), my partner and I had sexual intercourse (unprotected sex). The very next day, I felt some pain during urination and that night I noticed I had heavier vaginal discharge than normal. I also felt some soreness around my perineal area. About four days later my partner informed me that he had also experienced painful urination the day after we had sex. He had gone to his doctor already and gotten tested for chlamydia and gonorrhea (both tests were negative).  I walked into an urgent care clinic that evening. The doctor swabbed the "torn" area. That culture came back a few days later as positive for HSV (it wasn't typed). By 11/22 I discovered two blisters on my labial area. On 11/23 I took blood tests for HIV, Hep B and C, syphilis, and herpes (IgG for herpes). All my blood tests came back negative but my herpes results were delayed, so I went to a Planned Parenthood on 12/1 to get blood drawn again. Both blood tests for herpes were negative so I knew that my infection was recent.  Here are the numbers:

11/23:  HSV1:  0.05   HSV2: 0.03
12/1:   HSV1: 0.04     HSV2: 0.33

My partner also had his blood drawn that same week, and his results were also negative for both HSV1 and HSV2. Which probably meant that one of us acquired HSV recently and infected the other. Unfortunately the lab that processed his test (TPMG Regional Laboratory) did not provide numeric values, and he has not been able to get that information (even through his doctor).

On 1/5/2010 I re-took the blood test and these are my most recent results:
HSV1: 0.05   HSV2: 3.28

My partner re-took his blood test on 3/2/2010 and he is positive for HSV2 (again, no numeric values provided from that lab).

[alexis7336]

I want to add that I also know how jennsv and piscesguy feel. I have just been diagnosed with HSV and was devastated. My situation is very similar to jennsv and neither partner will fess up. apparently i was immaculately infected. I feel dirty and cheap and also stupid. but realize that all my speculation, of which i am still doing, will never get me the answer I so desire...who gave it to me.

[piscesguy]

I know how that woman feels....I myself constantly just think of somehow getting back at the person that gave it to me,,and I dont want to hear that he didn;t "know" he had it,that's why free testing is out there,so people stop telling us to get past this,this is disgusting and gross to have,and it mkes me feel dirty and unwanted.

[sherrielynn1234]

I only ust noticed your response.  Nicely put.  I wasn't meaning one once of disrespect towards you in my previous post.  I only question making something bigger than it actually is.  I guess, it might have been slightly kinder to reassure her that while it the infection is inconvenient, it is pretty mild and well likely become a normal part of her everyday fabric.  That's all.  Also, I've noticed that you often say that the use of anti-virals is a must in questioners who have a different HSV status than their partner.  I think this is great, although I'm not entirely sure it is a must but rather one option, among a few others, to avoid transmission.  It might be better to lay out prevention options (along with relevant statistics) and also reassure committed couples that the infection shouldn't pose a big problem as (if contracted) it is just a skin irritation, not a major health risk.  In the context of monogamy, why get overly anxious/paranoid about transmission over a pretty mild condition....We need to work on normalizing all of this.  We don't get all worked up over cold sores on the lips.  Just a thought.  

[Terri Warren, RN, Adult Nurse Practitioner]

You raise a good point and in general, I try to get people to think less dramatically about their herpes infections.  I don't know that I am implying a major upheaval, but when someone does end up with a lifelong STD, it is, for most people, challenging, at least for a time.

Terri

[sherrielynn1234]

From what I understand,  H isn’t a big deal, more or less, a minor skin irritation.  I also understand that you’ve done a lot of work around normalizing this infection (through this forum and your book).  It sounds like you are trying, for better or worse, to get this woman to accept her fate through such wording as “hard work of acceptance, infection that will be with you for your lifetime.”  Isn’t possible that someone could contract the infection and not go through the major emotional upheaval that you are implying?  Why plant the idea that it is so bad or hard to deal with unless that’s the case?

All respect.  

[Terri Warren, RN, Adult Nurse Practitioner]

I agree that herpes should be part of STD testing also.  
I think feeling "suckered" is an thought that will not help you and will  cause you to feel really negative emotions, both about yourself and your partners.  Rather, I think if you felt "re-energized" to practice safer sex and/or get all your sex partners tested for STI's prior to intercourse.  You may also chose to feel regret for making the decisions that you did about these men.  Generally, regret vs. guilt or anger will drive healthier behaviors in the future.

You can't make these other partners do anything.  They have been made aware of the problems here, and if they chose not to be tested, there is nothing to do about that.

Yes, there have been herpes transmission lawsuits filed and some won, some lost.

My advice it to stop trying to sort this out and start focusing on moving on with your life and adjusting to herpes.  I know it can be a challenge, but that is where you really need to go.

Terri

[jennsv]

Terri, thank you so much for your reply. I'm struggling with this because I wish there was more certainty. I can accept the fact that I have HSV2 now but I want to know who it came from, so whoever has it isn't spreading it around to more people. Yes, I wish my partner was more supportive and in this together with me since we can’t figure out who gave it to whom. The HSV2 diagnosis was hard enough to cope with, but the fact that he is withdrawing from the relationship makes it even more difficult for me to deal with the reality of it all. :-(

I am not looking for someone to blame (especially if the source was asymptomatic and didn't know that he/she had herpes), just closure. To me it’s so frustrating that these other partners (X and Y) refuse to act like adults, take some responsibility (for participating in unprotected sex), and find out their herpes status (since it’s only a simple blood test). They could help me and my partner (from wanting to blame each other) or help themselves with this knowledge.  If the roles had been reversed, I would want to know my herpes status so I could either make sure I was in the clear or take precautions to avoid infecting others.  No wonder herpes is spread so easily, because people refuse to find out if they have it!  I'm just amazed by the apathy...

I remember asking my PCP a few years ago for a herpes test, and I recall him telling me that it wouldn’t be useful if I didn’t have any symptoms. But why wait until symptoms break out when it’s too late and you have it? If people are routinely screened for HIV when they get tested for STDs, then herpes should be on that panel of tests, too.

I am usually very cautious when it comes to sexual relationships and I often insist on using protection; unfortunately I gambled in these last two relationships with men who did not want to use condoms, and I’m paying for this mistake for the rest of my life by having to live with HSV2. I feel really suckered in for having trusted them too much (without knowing the full extent of their sexual history, or taking their word that they had no STDs), and I hope other women out there who may be reading this don’t make the same mistake I did.  

I have one more question, have you heard of anyone engaging an attorney or going through the court to force someone to take a herpes blood test? I know it may be a silly question; I'm not planning on doing this - just curious!

There was a case in California last year in February 2009 (Behr v. Redmond) where the Riverside County jury awarded nearly $7 million to a 56-year-old woman who was unknowingly infected with herpes by a 77-year-old man. I know an appeal was filed but I don't know whatever became of that case.

Thanks very much for your words of advice, Terri - it's much appreciated!

[Terri Warren, RN, Adult Nurse Practitioner]

1)  I know you want this to be clear and precise, but it isn't.  Things were happening too close together.  Without testing of your previous partners, there is no way to know who gave what to whom, and at some point, you are going to have to get past this question.  

2)  Yes, all of that is possible, but not too likely, that's pretty close together.

3)  Yes, with primary infection, you can and often will have outbreaks on the cervix, regardless of exactly where you got infected first in the genital area.

4)  I think October is fine.  If you both tested negative by antibody on your first tests, you were both newly infected.  If there were other partners in August or September, you might consider them.

5)  Absolutely.  We recommend suppression for most everyone in our clinic with first infection for physical and psychological reasons

Of course he is protective of his previous partner - he chose her.  He doesn't want to believe that he chose someone who could have had an STD, even though most people with herpes don't know it.  Its about HIS choice.  This is the most common response, you should not be surprised.  

You've asked X to be tested, and you've probably told him why.  If he doesn't do it, you can't control that, you've made him aware, you honestly can't do too much about this from here.  Your task is to make your own adjustment.  

I know you are honestly struggling with this, but to some degree, I think your interest on who gave what to whom is a distraction.  Your mind is keeping very busy with sorting this out.  It seems important right now.  But I must tell you that to some degree, all this is a truly just a distraction from focusing on the real stuff - you've been infected with herpes that will be with you for your lifetime.  That's where your work needs to be.  But my guess is that you'll keep struggling with this issue for a while and then get to the most important task of adjustment and acceptance.  It would be so much easier if you and your partner were closer right now, huh?

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

1)  I know you want this to be clear and precise, but it isn't.  Things were happening too close together.  Without testing of your previous partners, there is no way to know who gave what to whom, and at some point, you are going to have to get past this question.  

2)  Yes, all of that is possible, but not too likely, that's pretty close together.

3)  Yes, with primary infection, you can and often will have outbreaks on the cervix, regardless of exactly where you got infected first in the genital area.

4)  I think October is fine.  If you both tested negative by antibody on your first tests, you were both newly infected.  If there were other partners in August or September, you might consider them.

5)  Absolutely.  We recommend suppression for most everyone in our clinic with first infection for physical and psychological reasons

Of course he is protective of his previous partner - he chose her.  He doesn't want to believe that he chose someone who could have had an STD, even though most people with herpes don't know it.  Its about HIS choice.  This is the most common response, you should not be surprised.  

You've asked X to be tested, and you've probably told him why.  If he doesn't do it, you can't control that, you've made him aware, you honestly can't do too much about this from here.  Your task is to make your own adjustment.  

I know you are honestly struggling with this, but to some degree, I think your interest on who gave what to whom is a distraction.  Your mind is keeping very busy with sorting this out.  It seems important right now.  But I must tell you that to some degree, all this is a truly just a distraction from focusing on the real stuff - you've been infected with herpes that will be with you for your lifetime.  That's where your work needs to be.  But my guess is that you'll keep struggling with this issue for a while and then get to the most important task of adjustment and acceptance.  It would be so much easier if you and your partner were closer right now, huh?

Terri

[jennsv]

Terri,

Thank you for your response.  Yes, I had sex with my former partner (X) a week later than when my current partner had sex with his previous partner (Y), or so he tells me.  I do not know if he is recalling his dates/time frame correctly or if he is hiding other information from me (i.e. whether he had other partners in the picture).  I have some follow up questions:

1) Just a clarification, do you mean that my current partner is more likely (than my former one) to be the source of the HSV2 infection?  Or my former partner? (I understand it’s only “more likely” and can’t be sure until both X and Y take blood tests).  I’m a little uncertain as to how it could have been my former partner since about 18 or 19 days had elapsed from the time I saw him (10/29) to the time I had the first symptoms on 11/17 (painful urination, vaginal discharge). I understand that the incubation period can take up to 2 weeks or longer but I thought the symptoms usually appear sooner.  That was the case with the current partner - I found blisters on my labia 6 days (11/22) after we had sex.

2) If my current partner’s previous partner (Y) was the source, is it possible that he had a mild primary outbreak which went unnoticed and then a recurrence with me?  Is is unusual for both partners to experience symptoms simultaneously as was the case with us? Curious as to why he started having symptoms (painful urination, etc.) the day after he and I had sex, which was already a few weeks – maybe 3-4 weeks - after his last encounter with Y (if he was telling me the truth about the time frame).

3) I had blisters on my cervix during my primary outbreak, and I was trying to rule out partners in the past with whom I had protected sex. I know that condoms don’t reduce the risk of transmission 100%, but if you do use condoms will blisters appear on the cervix, in the event HSV2 is transmitted? I thought direct skin-to-skin contact was necessary and that blisters often appear at the site of infection.

4) Since both my partner and I are newly infected with HSV2, how far back should we go to contact any former partners about this? Anyone in the 2-3 months prior to our exposure/encounter (11/16)? The nurse at Planned Parenthood told me that anyone in the previous month (October) would be sufficient (or could have been likely sources).

5) Would it be okay to go on Valtrex (suppressive therapy) for the first year only (since most people get 4-6 recurrences that first year) and then gradually go off treatment?

I’ve been trying to sort out the source because he seems to believe I transmitted it to him, as the symptoms happened the day after we had sex.  We haven’t blamed each other openly, but I sense that he is rejecting me by withdrawing from the relationship.  On my part I’ve accepted that we both have HSV2 now and I would like to continue the relationship, but this may not happen.

Also, he seems to be rather protective of his previous partner Y and thinks it couldn’t possibly have come from her, since he claims she has only had a handful of partners (to him, I appear to be the promiscuous one - I have had more partners in my past, but I mostly used protection, always got tested, and never had an STD until now). I'm upset he seems to think I caught it first due to my sexual history; I know you can have one partner only and catch it from that one person.

Even if he and I do not stay together, I feel I need to know the source of this infection for closure or for my own peace of mind – that is, if HSV2 didn’t come from me or if I didn’t transmit it to him.  If I did indeed have it first (through my former partner X) then I wouldn't want X to be spreading it to others.

We asked X and Y to get tested but both have been resistant to doing this. I believe that between the two of them, whoever is carrying the herpes virus is asymptomatic.

Sorry for the long-winded explanation of why this has been bothering me and why I'm trying to track down the source!

Thanks again Terri, for your advice!

[Terri Warren, RN, Adult Nurse Practitioner]

From your description, it isn't possible to know who gave what to whom because it sounds like both of you had sex with other people around the same time, though if I am reading this correctly, yours was a week or so later than his other partner?  That might make it very slightly more likely that your partner had HSV 2 and transmitted than the other.  The average time from infection to symptoms is 5.5 days, with the range normally between 2-14 days.  The fact that you were both antibody negative for HSV 2 and then both became positive indicates that you were both newly infected with the virus.

The severity of the symptoms, in this case, really doesn't help us sort out the source.

Blisters are often present on the cervix with primary infection; it doesn't say much about the unprotected sex part.  

I think you should give up trying to sort out the source unless there is some important reason that you're not telling me that you want to know.  There are just too many people involved to sort this out.  The fact is, that you are both infected with HSV 2 now and both need to come to terms with it.  The good news is if you stay together and are both infected, the virus need not complicate your sexual relationship.  You will not trigger outbreaks in each other or pass the virus back and forth; you both have it and each of your immune systems will handle the virus in its own way.

Does that help at all?

Terri

[jennsv]

I apologize, I exceeded the maximum number of characters before I could post my questions:

1) Both my partner and I initially tested negative for HSV1 and HSV2, yet both of us broke out with symptoms the day after sex. Both of us had other partners in October (regretfully, we were having unprotected sex with the other partners). I had sex with X (former partner) on 10/29, which was about 17 days before I had sex with my current partner. My current partner thinks he had sex with Y (his previous partner) around the 3rd week of October. As far as we know, both X and Y have not shown symptoms or have not said they experienced any. We're still trying to ask them to get tested. Given the time frames, is it more likely that HSV was transmitted to me by my current partner or by X?  I was still negative for HSV2 (acc. to my 12/1 blood test) which was a little over 4 weeks after I was with X. This "not knowing who gave it to me" part is driving me crazy!

2)  I experienced the classic herpes symptoms for a primary outbreak (painful urination, sores in the perineal area, a few blisters in the labial area, fever, vaginal pain, etc.). My partner experienced painful urination for several days but only saw one blister, which didn't hurt. Unfortunately, it had scabbed over before he could get it cultured. He also experienced some urinary hesitancy and also severe pain in his legs, buttock area, testicles, etc. (the shooting pain in his legs went down to his feet as well). It was painful for him to walk. For him this "nerve pain" was the worst symptom - it lasted several weeks, and he was prescribed acyclovir for it.  The nurse who saw me at PP said I had a primary outbreak while she doubted that my partner was experiencing a primary. In your opinion who might have acquired herpes first? Could he have gotten herpes first? Since he only had one blister does this sound like a "mild primary outbreak" or recurrence (could he possibly have had an initial outbreak earlier - before sex with me - that was so mild that he wasn't even aware of it? I've read that this can happen).

3) If blisters are found on your cervix, is it most likely from unprotected sex? I wonder about this because I have had protected sex with other partners too in my recent past.

Thanks Terri for your time.