[Question #154] Herpes Transmission Question

38 months ago
Ill be brief and bring you up to speed quickly.  Years ago I was told that I was "exposed"(thru antibody test) to HSV2.  So being confused I consulted with multiple doctors and even an infectious disease specialist.  He told me he never would diagnosis HSV2 from an antibody test, but only by swabbing a lesion and sending it to the lab(he then went on to ball my piece of paper up and throw it in the trash after I told him I never had any lesions, telling me to wear condoms from now on).  For a year or two after the incident I was concerned (and didn't have sex with anyone) but after 4 or 5 years and me not having noticeable symptoms (besides my foot tingling) I became more lax toward the idea of me even being a carrier.  Two months ago I had sex with a friend and most of the sex was condom protected but some wasn't.   I have been really anxious lately so after becoming much more knowledgeable myself I was tested again and the antibody test again said I had been previously exposed to HSV2.   I have read about the transmission stats and even saw a post by Dr. Hook stating that he feels the chances of spreading HSV2 with a one time exposure with active lesions was around 1%.  I was interested in knowing since having lesions would be worse case scenario if spreading HSv2 from your experiences, worse case scenario with active lesions, is in fact in line with what Dr. Hook said and if transmitted are people who don't show signs for months outliers or very common?
38 months ago
was my questions properly stated and paid for or is there something i'm missing?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
No, Mike, you're fine.  We try to answer within 24 hours when possible, it has only been 19 hours. 
If the antibody test is accurately positive, then there is no such thing as being exposed.  You would be both infected and infectious to others.  I would agree with Dr. Hook that a one time intercourse is unlikely to transmit HSV 2 to a partner.  It is difficult to come up with an exact number.  And most people who have HSV 2 infection are unaware of their infection (80%) so it must be true that people might not know they are infected for months or years.  So it is more common to be infected with HSV 2 and not know it than to be infected and know it.  It is true that the greatest risk of infection is having sex when there are lesions present but most new cases of herpes are transmitted from people who have no symptoms and may not be taking the appropriate steps to reduce transmission.  The best steps are regular condom use, daily antiviral therapy that reduces the transmission risk by almost 50%, symptoms awareness, avoiding sex with lesions and telling partners.  It turns out that telling partners both reduces the risk of transmission and extends the time to transmission after beginning a sexual relationship.  Another thing that is helpful is testing your partners, as the CDC says in their 2015 STD treatment guidelines, to see if they might be infected already and not know it.    Is this answering your question?  I'm not positive about your question.

Terri
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38 months ago
Not really...I have been talking to her and from your experiences what is the worse case scenario of spreading HSV2 from one encounter?  She is going to wait a while longer but she has been freaking out in the meantime?  I read a post by Dr. Hook stating from his experiences he feels the chance of transmitted HSV2 even with lesions is probably somewhere around 1%.  How do you feel about this from your experiences?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
What do you mean by worst case scenario?  Do you mean for her, what is the worst thing she might experience?  That might range from no symptoms whatsoever (especially common in people who already have HSV 1 infection on board) to multiple genital lesions that cover both sides of the labia and the cervix and anus.  That more extreme situation seems to be uncommon these days - not sure why, but I haven't seen a severe first episode infection in well over two years.  And I see multiple herpes patients every single day that I work.  I'm not sure where Dr. Hook got that statistic, honestly, but it doesn't seem like an unreasonable number.  I actually think it would be very useful for you to look at the actual test results that you had and post them for me to here to be certain that you had the most accurate type of testing done and that the numeric value associated with that result is high enough that it doesn't need confirmation with another test. 

So are you saying that up until now, the person with whom you had sex has not demonstrated any symptoms, and this was about two months ago?  Most people who are going to demonstrate symptoms do so within 2-10 days, with the average being 5.5 days after the exposure to the virus.  If she has not had any symptoms yet, then there are a few scenarios that might apply.  The first is that you were not shedding virus at the time you had sex and she didn't get infected by you.  Another possibility is that she was already infected prior to having sex with you and that she just hasn't had any symptoms from that previous infection either.  Another possibility is that she already has HSV 1 and acquired HSV 2 from you but demonstrated no symptoms at the time.  Do you know if this woman has actually been tested for herpes yet, by a type specific antibody test?

Is this getting closer to answering your question, Mike?

Terri
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38 months ago
well she is going to get test in seven weeks and in the meantime she is very paranoid.  Dr. Hook stated he feels even in the presence of lesions he think the one time transmission rate is under 1%.  Also it has been seven weeks and she hasn't noticed anything different down there.  I'm trying my best to keep her calm, and since I know you deal with these cases everyday do you think its more likely or less likely she has been exposed, even in the presence of a lesion?  And how frequently do people realize their exposure to herpes after months....Dr. Hansfield stated he believes after 6 months most people actually do notice symptoms that were previously overlooked.  (Sorry about the roundabout questions but these are more direct and convey the messages better) 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
Our research does show that the majority of people who are diagnosed with HSV 2 via antibody test will recognize a symptom associated with herpes within 6 months, that is correct.  I'm sure you can find this article if you do appropriate research - I am actually an author on this paper with Dr. Anna Wald. 
I think the risk of transmission with a single intercourse is really low but I cannot give you an exact percentage and it would certainly be a different risk if you had a lesion vs. no lesions. 
Since 80% of those infected with HSV 2 don't know it, it is very common to find out, via antibody testing, months after infection that it has occurred. 
The problem with her waiting seven months to be tested is that if she is positive, she can never know if she was one of those in the 80% or she got infected by you.  But since this happened two months ago, it won't be possible to know that at this point.  Again, I think her risk of acquiring herpes with a single unprotected encounter with you is low.
By the way, is it possible for you to acquire a copy of your test report?  I would like to know for certain that you had IgG antibody testing and that the index value is greater than 3.5 and therefore does not require confirmatory testing.  You are not reporting any symptoms and that is somewhat unusual for someone with HSV 2 infection (though not impossible).
This was your final post on this subscription, but if you have more questions, you can certainly renew.

Terri
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