[Question #184] Unprotected sex w boyfriend who tested negative after 3.5 months

37 months ago
I am obsessing over my risk of stds. My boyfriend who is very shy up until 5 months ago slept with $300 escorts for about 7 years. He slept with 1-2 escorts a month.  He always used a condom. We waited 3.5 months to be intimate. I didn't realize 4 months was recommended. He was tested on hep c, gonorrhea, clymedia, hiv, hsv1 igg and hsv2 igg. He came out negative on all of it. I realize there is no hpv test for men. I have had hpv 15 years ago and have had 2 of the gardisil shots for the 4 hpv strains.  We have had unprotected  sex 4 times. And I am obsessing about hsv1 and hsv2 and my risks and even hpv. I didn't realize we should wait 4 months for hsv tests. And I am concerned about false negatives and the fact we tested at 14 weeks. I was also tested and was neg on everything except hsv1 which I am 99% sure I got this year from my 7 year old who had a oral herpes sore. I tested negative in 2013 and haven't been w anyone since May 2013 and even then was only given brief oral. I am concerned w all stds but primarily herpes and hpv. what is my risk of hsv1 and hsv2 genitally? Since we tested at 14 weeks does that reduce the accuracy of the hsv tests significantly? I read in a post the accuracy went down to 80%. Plus I am concerned about the number of partners he has had.  I know one post said that should be taken into consideration but I didn't know if that was just with equivocal results or negative results. And do I need to give you the actual values for you to tell.  Please help me stop obsessing. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
Actually using the screening test for HSV (vs. the western blot test), 12 weeks is usually adequate except for the person who already has HSV 1 - they might take slightly longer to become positive.  Perhaps 13-14 weeks.  I just reread all the research on this because I wanted to be extra clear.  At any rate, I think you are fine with the 14 weeks.  The only thing is that the antibody test for HSV 1 misses about 1/4 of infections.  The HSV 2 test captures 98% of infections.  If you have the specific index values, the might be helpful for me, yes.  When was the last time you boyfriend had sex with a CSW?  Five months? 

I think you've done just about everything you can about the HPV situation except to finish your Gardasil series.  It is unclear what a person should do who has had the Gardasil 4 now that we have Gardasil 9.  There is no official recommendation about that yet.  If you were my daughter, and she had only had two of the Gardasil 4, I might have her get two of the Gardasil 9.  Insurance may not pay for that, however, but there would be added protection.  That is just an opinion, nothing official at all. 

Did you boyfriend also test positive for HSV 1? 

Terri
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37 months ago
My boyfriend did not test positive for hsv1.  And the last time he saw an escort was may 26th.  He was tested on sept 10th. I went with him and insisted on all this and specifically asked for igg tests. He was vaccinated already for hep a and b so he didn't test for that I think.   Plus he knew he would have to get tested if he wanted a relationship.  We were friends first before we started dating so that's why the timeline is weird. I don't think he saw a csw for a couple months before the last encounter in May. He is gonna check that. 

Also when I say we had sex 4 times. I meant in two diff sessions.  So the exposure in one session probably would be the same I assume.  

I will get the third shot of gardisil but I am over the age group and do have to pay.  I got the last one 2 months ago so I will have to wait another couple of months to get the next shot. I have read though that the effectiveness doesn't seem to change with the third shot just the longevity of the immunization.  I don't know if that's true. Maybe you can answer that but I am going to get the third shot regardless. Gardisil 9 is not available where I live that I know of.  

So do you think we should start using condoms or do you think my risk is minimal?  Would it do any good to use condoms now ? 

I know that. I got hsv1 orally because my daughter had a cold sore a few months ago and I tested positive right after that.  I tested for hsv1 igg in 2013 and was negative after waiting 3 months from exposure to oral sex. 

Also what is the rate of vulvar and cancer in your head from hpv? Is there a real concern there or is it pretty minimal as well. 

Sorry to ask so much but I am trying to get the most out of my posts to allay my fears. 

The most important thing I would like to know is if my risk is minimal and if you think we should use condoms in light of all this.  I can give you his igg numbers later when I see him again.  
37 months ago
I thought it was one in 10 that hsv1 missed. 1 in 4 sounds really high to me. And I have read your other posts.  I am not sure if I am limited to the number of replies on here but I would like to get his igg Numbers and have them sent to you. 

Also, if I have oral hsv1 isn't it unlikely that I will get genital hsv1? Should I be concerned about that ? 

37 months ago
One more question about your answer. I didn't understand this comment : 12 weeks is usually adequate except for the person who already has HSV 1 - they might take slightly longer to become positive.  

What does that mean? If it takes longer than 12 weeks for someone who is positive then by that logic at 12 weeks you could get  a false negative. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
The last statement means that it takes a little longer for a person with HSV 1 already to become positive for HSV 2 if they become infected with HSV 2 - not a lot, but a little, maybe two weeks. 
Yes, if you have oral HSV 1 is it extremely unlikely that you will subsequently get HSV 1 genitally.
A recent study that our clinic completed and presented at an international meeting in Brisbane Australia last month found that, compared to herpes western blot, the HSV 1 screening test misses one out of four infections.
I think your risk is not only minimal but very minimal and I'm not clear that condoms would make a difference at this point.
About 60 % of oral cancers are now thought to be related to the HPV strains that also cause cervical and anal cancers

Terri
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