Hi Doctors

Welcome to our Forum and thanks so much for your thoughtful questions.  I will try to help but before I do let me also congratulate you in your discussion (at least I presume it was a discussion you started) of the possibility of STIs with your current partner and decision for both of you to go get tested.  Great move !!!  I'll try to address your questions but please follow-up if I am unclear (we allow 2-3 brief follow-up exchanges per question.

This is all about your sexual health and all of us who answer questions on this forum, as well as the sponsor (American Sexual Health Association- ASHA) view sexual health, like other general facets of the larger concept of "health" as something to be promoted, not avoided.  STIs happen and, in some instances are almost a "fact of life as we know it" (like HPV for instance - for persons who have not taken the HPV vaccine current estimates are that over 85% of sexually active, unvaccinated adults will have or have had HPV) and thus are something to be vigilant about, just like other health-related problems such as hypertension, high cholesterol or for women, breast cancer which should be routinely screened for, even in the absence of obvious symptoms or apparent risk with the goal of early if identification and management if discovered.  This is just common sense and self-preservation.  For us to not include STIs which can often be asymptomatic, is not good thinking and is, perhaps, hindered by the general climate of stigma and embarrassment that seems to inappropriately surround the topic of sexual health.  Thus, based on available evidence, while I would not worry about it, regular (not necessarily annually although that is the recommendation, at least for chlamydia) testing for STIs is a reasonable expectation and plan.  Presumably you would feel just as good about negative chlamydia tests done as a routine basis as finding out you do not have hypertension when your health care professional takes your blood pressure.

With regard to your questions about risk for acquiring STI infections through non-sexual means, this is not a major concern.  The bacteria and viruses that are sexually transmitted tend to be fragile and while transmitted by DIRECT sexual contact, are almost never transmitted by contact with genital secretions in the environment (i.e. on toilet seats) or even by transfer of material from person to person when one person touches their genitals, with their hands, then touches another person or an inanimate object (like a glass) with that hand.  I would urge you not to worry about contacting typical STIs through casual kissing, being "sprayed" as someone talks or sneezes, or sharing glasses etc.

I hope this comment is helpful.  EWH

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Thank you for the response Dr. Hook. I have had some what of a traumatic event a few years ago with having a very Low / committed sexual monogamous relationships. I had never been tested because I was only with one person and then we broke up. A male gyn suggested I get a routine screen done. Not knowning anything about testing I did it and it came back positive for Igm herpes. Horrified bc I never had symptoms I never went back to get the igG  type specific tests done. Finally I got the nerve to do it and they both have been negative twice. I waited well over 12 weeks. From Terry's posts and i believe yours as well I had a false positive test and know that IGm tests have a high false positive rate. So as you can see there definity is some anxiety with herpes. I feel I am very responsible with my sexual health (also have the HPV  vaccine) so I am constantly worried about contracting stds llike I mentioned before in the general public. Things I think Of now are far fetched - such as i bought a pair of leggings went home and didn't think about it and was putting an outfit together and didn't have underwear on. (The store was next to my apartment). I stressed for the longest time about not contracting herpes this way. I believe I found a forum with you saying there was no risk. Here is an example of what happened to me last night....I ran into a friend and I was with someone. The person was out back smoking or had finished smoking and my other friend shoot his hand and then I did snd he followed my handshake with a hug. He had a cold sore and it made me feel uneasy. Worried I was going to get it some how. He didn't but i randomly thought - what if he had kissed the side of my face or neck while hugging me with a cold sore? If he was smoking by shaking hands with someone could the virus be transferred? (Again he shook my friends hand before mine). I want my anxious thoughts to go away and know if I ever got another std test that it would all come out with negative results. My new gyn thinks I'm crazy for asking questions but what I want to be is informed and be able to think logical and continue to be smart but know the facts. You and your team seem to be heavily educated so that is why I submitted the question. Thank you. 

Hi Dr. Hook

I apologize for the delay in answering your question- I missed your response and appreciate your bringing it to my attention.  In that herpes appears to be your primary concern, I will focus on that but most of what I have to say about herpes holds for all other STIs as well.

First, you are correct. The IgM test has frequent false positives and we recommend against using it.  This test has caused huge amounts of misery through its relatively common false positive results.

Second, as regards to acquisition of HSV, including HSV-1, the virus that causes most cold sores as well as HSV-2 which causes most genital herpes, in nearly all cases the virus is acquired through direct contact with an infected person, not through transfer on inanimate objects such as shared glasses, eating utensils, etc.  You cannot get herpes by wearing clothing that was previously worn by someone with herpes either (or toilet seats which were previously used by persons with HSV).  Spit, coughing, oral "spraying" in the course of speaking likewise do not spread HSV to any appreciable degree.  Note that I have not said never because in all of science, one can never say never- our research and studies helps to estimate probabilities but there are exceptions to virtually every rule.  Perhaps someone, somewhere got HSV from a "spray" of the sort we have spoken about but if they have I have not heard of it or seen it proven conclusively and it is not something I would worry about.  Just as I do not worry about being struck by a car when I cross the street as long as I take reasonable precautions. 

Further, with regard to direct contact such as the "what if he had kissed your cheek with a cold sore while hugging you", even in such situations it would be more likely than not that you would not become infected.  Most direct contacts with persons infected with STIs, including herpes, DO NOT result in infection.  For herpes there are no precise estimates of the per contact risk for infection but I am confident, given what we do know about how common HSV infections are and how relatively uncommon it is for uninfected persons to become infected that it occurs less than 5% of the time (this figure is an estimate). 

Finally, once again pointing to just how common HSV infections are, I would urge you to remember that, should you happen to acquire HSV as you live your life, it is NOT the end of the world.  Many, perhaps most of the adults you know have one type of HSV or another and I would guess that this has not ruined them or their lives.  These things happen, are bad luck when they do, and other than taking reasonable precautions of the sort you have already described like avoiding direct contact with lesions, I would urge you to try not to worry too much.  You've made it to adulthood without HSV- odds are that if you continue with reasonable caution you will not.

I hope these comments are helpful. EWH

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Thanks Dr. Hook for your responses. Just need to ease these unnecessary concerns. I may have to pay for another question instead of adding to this thread but would you feel confident with negative tests results (a whole panel) after 5 weeks/33 days just in general? 

Yes, I would feel very confident in negative test results for STIs including gonorrhea, chlamydia, syphilis, HIV, and hepatitis.  EWH
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Thank you. What about herpes if there are no symptoms? I've seem to gather than information from others questions?

This will need to be my final response.  forum rules allow three follow-ups and we have reached that point.  If there are more questions (and I think there should not be that need) you will need to open a new thread.---