[Question #1763] Herpes 2

43 months ago
My new girlfriend has herpes 2 on her buttock but not on her genitals. She claims that I cannot get the virus unless I come in contact with the lesion when it is active. I believe that I could contract the disease at any time by any physical contact such as kissing, intercourse or oral sex as her whole body is infected. What is correct?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
From a study out of the University of Washington, it appears that people who have buttocks outbreaks of HSV 2 are shedding virus from the genital tract about 25% of the time, and she is also likely shedding virus at times other than with outbreaks from the genital tract.  However, her whole body is NOT infected.  Assuming she only has this genitally, you will not get this from kissing her and it is very unlikely that you would get this by giving her oral sex.  Intercourse risk can be reduced greatly by her taking daily antiviral medicine and you using condoms with intercourse.  I would also suggest that you get  type specific antibody test to determine if you might already be infected and not know it.  About 80% of those infected with HSV 2 don't know it. 

Please let me know other questions that you might have

Terri
---
43 months ago
Thanks for the info. My doctor said that the test was not reliable. At the time, it was only four days from when we had unprotected sex. That is the only time we have not used condoms. Is that why he thought the test would be inconclusive or inaccurate. How reliable is the test? Finally, does my partner need to take the anti-virals every day or only when we are intimate?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
if the test is positive with an index value of greater than 3.5, it is accurate at about 90%.  But it would not reflect your exposure 4 days ago, if that's what he meant, that is accurate.  If you got a positive value that was lower than 3.5 you would need confirmatory testing.  Here is what the CDC guidelines say about antibody testing:

Type-specific HSV serologic assays might be useful in the following scenarios: 1) recurrent genital symptoms or atypical symptoms with negative HSV PCR or culture; 2) clinical diagnosis of genital herpes without laboratory confirmation; and 3) a patient whose partner has genital herpes. HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition. Screening for HSV-1 and HSV-2 in the general population is not indicated.

As you can see, you meet #3.

It takes about five days for the medication to be fully effective.  So I guess the answer to your last question would need to be answered based on the frequency of intercourse for the two of you.  If you only see each other intermittently, then she wouldn't need to take it intermittently.  But if you are having sex with her about once a week or more often, it seems that she should take it daily for best protection for you if you are indeed uninfected. 

Terri
---
42 months ago
So, how long do I need to wait before the test is accurate? It has been two weeks and I have no symptoms. I assume that I should repeat the test if the number is low. How long should I wait for the second test? How much confidence will I have at that point that I am clear?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
By 6 weeks from exposure, 70% of people who are going to make antibody will have done so, the rest by about 12 weeks.  I would say if you are negative for HSV 2 at 12 weeks, there is about a 95% chance you are uninfected
Thanks for your questions. 

Terri
---