[Question #1883] Test and Outbreak Timing

43 months ago
New partner shared that he tested positive for Herpes2, and that he was undergoing his first outbreak (with very minor symptoms) after feeling run down for several months. He has been on 500 mg Valtrex daily for three weeks. 10 days after he discovered the outbreak, I felt a burning sensation and got tested. My test was negative, though not zero (.17, his was 4.3).  Assuming an initial outbreak occurs 1-2 weeks following exposure I was concerned about the itching. Our "safe" petting wasn't always with a condom, and there's even a chance that the itching was caused by a latex irritation.

Questions: 
-Was it too soon for my test - do I need to be retested as it wasn't zero? 
-If he was monogamous in the month prior, can we assume that this was not his first outbreak and that his previous outbreak(s) went unnoticed? 
-Shedding after first outbreak lasts up to three months but in subsequent outbreaks 10 days? 
-Is it common to feel run-down, almost flu-like symptoms prior to outbreaks? (all or just initial?)
-Is there a swab test we can do at home to measure shedding?
-Am I safe to give and receive oral sex? (neither one of us has Herpes1)

Unfortunately, condoms really don't work for us. We are hoping to manage this with his suppressant treatment and watching the symptoms and shedding times carefully, without using condoms.  Appreciate your advice.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Thank you for seeking out our forum for information about genital herpes. The first thing I notice is that you describe that your partner was experiencing his first outbreak of herpes with minor symptoms but his index value on the antibody test of 4.3 indicates that this is not his first real infection. It takes a while to reach an index value of 4.3 so he's had this for a bit. It's difficult to say if the itching that you are experiencing has anything to do with his herpes. You are correct in assuming that you tested too soon after your exposure to him for an accurate result. Could you please describe for me what you are describing as "safe petting"? 

When people do the antibody test, the results are almost never zero. They always are something, Some value, but what you want is a value below 1.1. Your value is well under the level of 1.1.
Yes, we can assume that his previous outbreaks have gone unnoticed, As I described above.
There is no specific time that viral shedding lasts. I don't know where you got that information but it's incorrect. Viral shedding occurs with everyone who has HSV-2 infection and the duration varies from person-to-person. Some people shed often and some people shed infrequently. The average number of days that someone sheds with HSV-2 is about 15 out of 100. With antiviral therapy, that number decreases to about 7% of days for seven days out of 100. We know about these numbers from people who do studies swabbbing their genitals every day for an extended period of time.
I am unclear if his feeling rundown for several months has anything to do with him having herpes. Some people, prior to having an outbreak, do you feel kind of achy or flulike but not everyone. It would be very unusual, Almost unheard of, for this to last four months.
There is no swab test that you can do at home to measure viral shedding. Many people would love to have that available but it is not available yet.
In terms of your question about oral sex, the test for HSV one misses about 30% of HSV one in infection so it may or may not be true that neither of you have HSV one. If you give him oral sex, there is a small risk of you acquiring HSV-2 Orally.  We don't have research on exactly how often that happens. Assuming that he does not have HSV one, it is fine for him to give you oral sex. There is no risk there assuming he has HSV-2 only genitally.
I'm sorry that condoms don't work for you two as that would be an added layer of protection. However, if you know that he's infected, would you do, and are willing to take the small risk of acquiring herpes from him, then it is your call about the condom use.
In my opinion, it is difficult to find a very compatible partner in life. The fact that you have found one who has genital herpes can be a minor problem or if you are really worried about this possibility of infection, a major one. As you may already know, genital herpes is not a serious medical problem. It is very manageable but does present a small risk of transmission to sexual partners.
Please let me know what other questions you might have about your situation and I will be happy to try to help you answer them.

I am now dictating my responses for this forum and the dictation System is not perfect. If you find weird words or spellings or punctuation, please ignore or ask for clarification.

Terri

Terri
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42 months ago
Terri, thank you very much for your thorough response.  And yes, he is a very wonderful and compatible partner which I why I want to learn what we need to do manage the situation.  When you said there could be shedding on 7 days out of 100, would it be correct to assume that those days have a much higher likelihood of occurring immediately following an outbreak?  Also, when would be the optimal time after possible exposure for me to get another blood test?    

Again, thank you for your response.  You've been extremely helpful.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
Half of asymptomatic viral shedding  Occurs before and after an outbreak but the other half occurs randomly and you cannot know when that's happening. That can be  the most frustrating thing about either having herpes or being a partner of someone who has herpes–that you cannot know when shedding is happening. That's why it requires a commitment to taking a small risk of acquiring herpes on your situation. Your partner can only do so much to protect you and I think you understand this and probably are willing to accept some level of risk. Falling in love and being in a relationship as a risk, Right? This is a different kind of risk but one you may find pays off in the long run.
When to do an antibody test in your situation depends completely upon you.  You already have your baseline test and how frequently you test beyond this depends upon how often you want to know your status. In my practice, I suggested that discordant couples test every couple of years or if they broke up and the uninfected person wanted to know if they have become infected during the relationship. Another thing that might drive you to test is symptoms. If you're wondering is something you are experiencing might be herpes you would certainly want to have a swab test and possibly and antibody test as well. Or you could opt not to test at all. These decisions are individually made.

It sounds to me like you have your head on straight about the role that herpes Will and will not play in your relationship. If you have other questions, we are always here to help

Terri


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