[Question #1949] Risk for infection and transmission

48 months ago
For the past 5 months I have had several encounters with high end escorts with the most recent one about 3 weeks ago.  Encounters involved oral sex as well as sex with condoms (one condom came off - about 4 months ago).
I have had sex with my girlfriend during this period but always either with condom or involving masturbation against buttocks.

My wife is having symptoms that people report with herpes such as headache, flu type (mild) symptoms, and vaginal itching.  I've had some symptoms people describe but no evidence of outbreak.  I am freaking out that I may have infected her and am very anxious.  

I had Herpes IGM and IGG ABS testing this week.  IGM was equivocal and IGG was negative for both hsv1 & 2 (<.91).   Also tested for HIV - negative.  Am I in the clear or should I do more testing later?  Given her symptoms I don't want to wait too long - if I've given her something I'd rather know soon so I can make sure she's taken care of - she has some health issues that could be complicated by this I'm afraid.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Please ignore the IgM test - it is unreliable and has many false positive (or false equivocals).  So if the condom came off with an encounter 4 months, the "input" from that encounter should be reflected in the IgG test that you had this week - we recommend 12 weeks prior to HSV testing, from any risky encounter, so I don't think you were infected then, at least with HSV 2.  The HSV 1 test is no where near as sensitive.  The thing is, neither of you have had lesions or sores, and if you had new herpes, either of you, I would expect sores in one or the other or both of you  There are many reasons a person might have a headache or mild flu symptoms or even an itchy vagina.  Herpes, with no sores, would not be anywhere near the top of my list.  I know you are anxious but I think with your negative testing and no sores, herpes seems an unlikely cause of her symptoms to me.

Terri
---
48 months ago
Thanks.   With regard my more recent exposures (last 1 was 3 weeks ago) which involved oral (no condom) and vaginal (condom) can you tell me what the risk is for these?  
I'm really surprised to see a lot of things out there (including CDC and reputable articles) that say this is still risky and this is why I'm so concerned.  Also, I'm on medicine the suppresses my immune system so this makes me worry.

2nd question - when should I get tested given concerns, symptoms (potential - but not probable as you say), and time since most recent exposure?  The "wait 12 weeks" advice I've seen elsewhere seems like a crazy long wait.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
I'm a little confused about what you are saying about the CDC and reputable articles?  Are they saying that transmission in spite of condoms is a risk?  It is, I have most certainly seen people who have new herpes (documented by positive swab, negative serology) who were using condoms and acquired herpes at the base of the penis.  And we know that the surge in people with HSV 1 genitally is largely due to people who have no HSV 1 receiving oral sex from someone who does. 
I don't think the risk of acquiring either HSV 1 or HSV 2 at a single exposure is great, but repeated exposures, as you might expect, pose more risk.

The 12 week mark is standard - it takes some people longer than others to make antibody.  If you test negative for HSV 2 at 6 weeks out from the encounter, there is a 70% chance your result will stay that way at 12 weeks - perhaps that is a place to start for you?  And remember that the IgG test for HSV 1 misses 30% of HSV 1 infections.

Terri
---
48 months ago
Ok. I incorrectly inferred from your first response that the only encounter with risk was the one where the condom slipped off.   

The other symptom I've had is hemroids.  I've read that heroes  is sometimes mistaken for hemroids - should I get this checked out?  

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Well, when the intercourse became unprotected by the loss of the condom, that was the biggest risk, but not the only risk.  Sorry if I confused you there.
Do you feel a grape like thing at your anus?  That could be a hemorrhoid.   Herpes lesions can be present at the anus yes.  You may wish to have an exam, just to get a bit more clear about this anal discomfort - is it discomfort?

Terri
---
48 months ago
I can't find any evidence of anything externally.  It Just itches and very mild pain. 
Now I've noticed a red crack in the crease betweeen my thigh and groin.  It looks like it may have had a sore but I scratched it before I thought and now it is difficult to see.   I'm usually a sane person but feel like I'm going nut wondering if there can be this much coincidence.  Could this be herpes 3 weeks out?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
That would be very unlikely this far out and it is quite common for men to have red and irritation between the thigh and the groin, and it is most often fungal - that's what I would suspect anyway

Terri
---