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Should I disclose?
I am a married female and recently had an encounter with someone whom I found out was positive for HSV 2, no hx of OB's. HSV 2 IgG = 4.29, HSV 1 = Neg, IgM = Not detected.
Upon discovery, at 8 days post exposure, I had a baseline HerpeSelect which was weakly positive for HSV 1 (2.16, no hx of cold sores) and neg for HSV 2. At 2 weeks, I retested at 1.44 for HSV 1 and neg for HSV 2. I have had no classic herpes symptoms, although I did have some soreness from day 8-10, that I would, under normal circumstances, attribute to rough sex the night before. I would like your opinion around the quantification of risk, relative to whether I have an ethical obligation to inform my husband of the exposure while I await retesting at the 12 week mark (or do you think I need to test even further out?) I do not have a realistic way of either preventing sex or having him use condoms, without disclosure.
The encounter consisted essentially of mutual masturbation. Possible risk points that occur to me are: kissing,, about 2 minutes of receptive oral sex, his placing of a condom on himself and then fingering me, all of which I understand to be remote. My biggest concern centers on the perhaps 10 seconds of condom protected, skin to skin contact when he climbed on top of me, before I said “No,” and moved away .
Outside of my main question, I do have two others: 1.There seems to be a lot of discussion about how herpes is inefficiently transmitted, but if so much of the population is positive for oral herpes, doesn’t it seem likely that it is passing pretty easily – based on non symptomatic, brief, social kissing? 2. I have read that once diagnosed with genital herpes (HSV 2?), most people will then become aware of outbreaks that they were misattributing before. But what about people (myself), who test positive for HSV 1 and yet have never had a cold sore? Doesn’t it seem that those people really are asymptomatic? Do the virus types act differently?
Upon discovery, at 8 days post exposure, I had a baseline HerpeSelect which was weakly positive for HSV 1 (2.16, no hx of cold sores) and neg for HSV 2. At 2 weeks, I retested at 1.44 for HSV 1 and neg for HSV 2. I have had no classic herpes symptoms, although I did have some soreness from day 8-10, that I would, under normal circumstances, attribute to rough sex the night before. I would like your opinion around the quantification of risk, relative to whether I have an ethical obligation to inform my husband of the exposure while I await retesting at the 12 week mark (or do you think I need to test even further out?) I do not have a realistic way of either preventing sex or having him use condoms, without disclosure.
The encounter consisted essentially of mutual masturbation. Possible risk points that occur to me are: kissing,, about 2 minutes of receptive oral sex, his placing of a condom on himself and then fingering me, all of which I understand to be remote. My biggest concern centers on the perhaps 10 seconds of condom protected, skin to skin contact when he climbed on top of me, before I said “No,” and moved away .
Outside of my main question, I do have two others: 1.There seems to be a lot of discussion about how herpes is inefficiently transmitted, but if so much of the population is positive for oral herpes, doesn’t it seem likely that it is passing pretty easily – based on non symptomatic, brief, social kissing? 2. I have read that once diagnosed with genital herpes (HSV 2?), most people will then become aware of outbreaks that they were misattributing before. But what about people (myself), who test positive for HSV 1 and yet have never had a cold sore? Doesn’t it seem that those people really are asymptomatic? Do the virus types act differently?
MEDICAL PROFESSIONAL
That a few questioners on this forum have had the rare bad luck to catch herpes after a particular exposure does not raise the chance that another person with the same exposure will also have bad luck. (If the world worked that way, we would be at elevated risk of being hit by lightning after reading a story by someone who was struck.)
Asymptomatic shedding of oral HSV-1 appears to be less common than for genital HSV-2, so that many (most?) HSV-1 transmissions occur from people with overt cold sores. During such an outbreak, the level of virus is very high -- and indeed casual kissing, shared drinking or eating utensils, etc may explain a fair number of infections. Among young children, it's probably often via toys and other objects that go rapidly from mouth to mouth, e.g. in daycare.
Most people who have asymptomatic HSV-1 infections, as you do, probably are not efficient transmitters of infection and need not avoid social kissing unless they are having an obvious outbreak of oral herpes.
Asymptomatic shedding of oral HSV-1 appears to be less common than for genital HSV-2, so that many (most?) HSV-1 transmissions occur from people with overt cold sores. During such an outbreak, the level of virus is very high -- and indeed casual kissing, shared drinking or eating utensils, etc may explain a fair number of infections. Among young children, it's probably often via toys and other objects that go rapidly from mouth to mouth, e.g. in daycare.
Most people who have asymptomatic HSV-1 infections, as you do, probably are not efficient transmitters of infection and need not avoid social kissing unless they are having an obvious outbreak of oral herpes.
Thank you. You have answered my main question.
For clarification - this question posed to you earlier this year around HSV acquisition without penetration seemed similar to my situation.
http://www.medhelp.org/posts/STDs/Social-Concerns-and-HSV/show/1244891 ;
Also, I believe you misunderstood the question I asked about kissing. I was not talking about HSV 2, but about oral HSV 1. It just seems to me that for such a large part of the population to be positive based on the fleeting type of kiss an aunt gives a child at a funeral, which is what so many sources I read seem to claim, it must be pretty easy to transmit. An academic point, but of course, fuel for my anxious mind.
For clarification - this question posed to you earlier this year around HSV acquisition without penetration seemed similar to my situation.
http://www.medhelp.org/posts/STDs/Social-Concerns-and-HSV/show/1244891 ;
Also, I believe you misunderstood the question I asked about kissing. I was not talking about HSV 2, but about oral HSV 1. It just seems to me that for such a large part of the population to be positive based on the fleeting type of kiss an aunt gives a child at a funeral, which is what so many sources I read seem to claim, it must be pretty easy to transmit. An academic point, but of course, fuel for my anxious mind.
MEDICAL PROFESSIONAL
I forgot to answer your question about disclosure to your husband. The chance you were infected was sufficiently low that I see no need. No distant expert can guarantee you weren't infected, but if I were in your situation, I would continue unprotected sex with my wife and would feel no ethical obligation to say anything.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
First, having not had unprotected vaginal sex, you really were not at risk. Transmission of genital HSV-2 is theoretically possible with genital apposition (without penetration) and perhaps by hand-genital contact, but it is extremely rare. In 30+ years in the STD business, I have never seen or even heard of a patient with genital herpes who had not had insertive vaginal, anal or oral sex.
Second, even with insertive sex, the risk is low for any particular encounter. Among monogamous couples in which one person has HSV-2, who have unprotected vaginal sex an average of 2-3 times per week, transmission occurs in about 1 in 20 couples per yer; i.e., after 10 years only half the partners get infected. That tells you how low the risk is for each exposure.
For these reasons, unless you also had symptoms to suggest you caught genital herpes (presumably not or you would have said so), testing for HSV-2 really wasn't necessary. Had you come to my clinic, we would have advised against it. But no harm done, and the test results so far indicate you weren't infected.
Those comments answer your main question. To the others:
1) HSV-2 simply is not transmitted by kissing. The high proportion of the population infected is not because each sexual exposure is high risk; as I just explained, it is not. But when you're talking about a lifelong infection, even a low risk for each exposure translates to considerable lifetime risk of catching HSV-2 somewhere along the line.
2) It is true that "most" people with newly positive HSV-2 blood tests come to recognize genital symptoms that they previously missed. But it's around 60%; the other 40% are truly asymptomatic. For oral HSV-1, probably an even higher proportion are asymptomatic. Also, most HSV-1 infections occur in childhood -- and obviously an adult may not recall any particular sore throat or sores around the mouth that occurred at, say, 3 years of age.
Since you're already on the path of testing after this exposure, you probably should go ahead with your plan for a final test at 3 months. For the reasons above, you can expect it to be remain negative.
Regards-- HHH, MD
First, having not had unprotected vaginal sex, you really were not at risk. Transmission of genital HSV-2 is theoretically possible with genital apposition (without penetration) and perhaps by hand-genital contact, but it is extremely rare. In 30+ years in the STD business, I have never seen or even heard of a patient with genital herpes who had not had insertive vaginal, anal or oral sex.
Second, even with insertive sex, the risk is low for any particular encounter. Among monogamous couples in which one person has HSV-2, who have unprotected vaginal sex an average of 2-3 times per week, transmission occurs in about 1 in 20 couples per yer; i.e., after 10 years only half the partners get infected. That tells you how low the risk is for each exposure.
For these reasons, unless you also had symptoms to suggest you caught genital herpes (presumably not or you would have said so), testing for HSV-2 really wasn't necessary. Had you come to my clinic, we would have advised against it. But no harm done, and the test results so far indicate you weren't infected.
Those comments answer your main question. To the others:
1) HSV-2 simply is not transmitted by kissing. The high proportion of the population infected is not because each sexual exposure is high risk; as I just explained, it is not. But when you're talking about a lifelong infection, even a low risk for each exposure translates to considerable lifetime risk of catching HSV-2 somewhere along the line.
2) It is true that "most" people with newly positive HSV-2 blood tests come to recognize genital symptoms that they previously missed. But it's around 60%; the other 40% are truly asymptomatic. For oral HSV-1, probably an even higher proportion are asymptomatic. Also, most HSV-1 infections occur in childhood -- and obviously an adult may not recall any particular sore throat or sores around the mouth that occurred at, say, 3 years of age.
Since you're already on the path of testing after this exposure, you probably should go ahead with your plan for a final test at 3 months. For the reasons above, you can expect it to be remain negative.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
