[Question #2250] Follow up to Dr Hunter

47 months ago
Hi doctor,
Thanks for your reply. It really did help me. But I just have the following questions:
1. Will the viral shedding of hsv1 orally be constantly around 20%. Let's say the girl I had unprotected oral sex with got hsv1 when she was a kid. And now she is 28 years old. Will the viral shedding be 25% of the time for rest of her life?
2. What percentage of people will have blisters or sores within 3 weeks for exposure for genital hsv1 &2?
3. Also I was thinking if oral-genital hsv1 is so common then almost all the  people in the world who are sexually active will get ghsv1 right? If you look at the number of porn videos online almost everyone will be having unprotected oral sex and especially porn stars? I am just trying to convince my self that I did not contract hsv so looking for facts or your guess since you are expert in STDs. I saw your interviews and your profile.
4. I am unable to take herpes of my mind even though I have no symptoms and multiple asssurances from 8-9 doctors. And the only way I think of is to get tested. Currently I am at 4 weeks. Should I get tested now or at 6 weeks?  
5. Is IGG type specific good test at 6 weeks? 
6. Also when someone contracts herpes the virus travels and settles at the nerves ending in lower spinal cord. Why can't we just take the spinal fluid and test for virus DNA itself instead of waiting for antibodies? Lot of people like me go through hell in this waiting period. Is this kind of test available? If so can you tell me where I can find it?

Sorry for the long post. Hope to hear from you soon. Thanks
47 months ago
Also for the second point, considering they do not have hsv 1&2 prior to the exposure
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome back -- sort of. Sorry to see how obsessed you are about HSV1. There's really no need.

Let me start by saying that genital herpes due to HSV1 is a minor problem, with few if any recurrent oubreaks, little asymptomatic shedding, and therefore rare transmission to partners -- all very different than HSV2. While nobody wants genital herpes, if it happens, HSV1 is generally a minor or even trivial problem, or no problem at all. Lots more information about the differences between genital HSV1 and HSV2 is available from CDC (www.cdc.gov/std), ASHA (www.ashasexualhealth.org), and the website run by Terri Warren, our herpes forum moderators (www.westoverheights.com). (On the ASHA site, you can even catch a video with my own discussion, including the important differences between HSV1 and 2).  

The point is that even if your worst fears were realized, this is really nothing to be nearly as worked up about as you are. And anyway, all the evidence is that you don't have it. 

1) First, not all viral shedding means infection can be transmitted. The DNA test to detect HSV is extremely sensitive; even when positive, in most cases the likelihood of transmission remains very low. Certainly oral herpes is not transmissible anywhere near 20% of the time -- uner 1% is a much better estimate. In any case, shedding diminishes dramatically over time. A person with oral HSV1 acquired in childhood probably rarely has transmissible virus in the oral cavity.

2) Roughly half of newly infected people develop symptoms. Sometimes they are subtle, e.g. with small or difficult to notice sores, rather than the classical blisters, ulcers, etc.

3) The data are what they are. Your mindset about this is guiding your thinking down irrational pathways. The fact is that no more than about 60% of the population acquires HSV1 by age 60 or so, and this frequency is unrelated to the number of sex partners people have had. You can try to intuit why this might be different, but that's the way it is.

4,5) This is mostly a restatement of the basic psychological problem you are having with all this. It's not normal to be "unable to take herpes of my mind even though I have no symptoms and multiple asssurances from 8-9 doctors". Maybe being tested will help -- but given all you have said, I fear you'll still be worried even if you test with negative results. Still, testing might help you get this off your mind. Feel free. The time to development of positive IgG results has been well studied for HSV2, for which about half develop positive results by 3 weeks, about 80% by 6 weeks, and close to 100% by 3-4 months. However, HSV1 has not been carefully studied. Whether roughly 80% is "good" at 6 weeks is in the eye of the beholder.

6) Again, your state of mind plus lack of medical/scientific expertise is drawing you to mistaken conclusions or assumptions about herpes infections. HSV DNA is not present in spinal fluid of infected people, except in the rare person with herpetic encephalitis or meningitis, both of which are very rare complications.

In summary, it is clear that the main problem here is emotional. I suspect there is nothing that will resolve your obsession with all this until and unless you seek professional counseling. I suggest it from compassion, not criticism:  I truly think it's the best path to get this off your mind. In the meantime, I'll just add one quick word of pop psychology:  Do your best to separate your likely shame, guilt, and anxiety over a sexual decision you regret with the medical consequences of that decision. They aren't the same. Deal with the former as you need to (counseling?), but try to stop worrying about the latter. Do your best to believe the repeated science-based reassurance you have had.

HHH, MD
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47 months ago
Thank you doctor for this detailed explanaation. I will take your suggestion and put all this behind and move on with my life. Just I would like to hear from you this once again. Given my exposure and no symptoms in 4 weeks, I can consider myself that I did not contract hsv and need no test right? This will be the final time I will be asking this question to any expert or my self. 
47 months ago
Also I did not understand what you meant about hsv1 testing
47 months ago
Ok so according to your experience 80% of people will have antibodies for hsv1 by 6 weeks? Is that what you meant?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
A negative result can never prove for sure you were not infected, because the blood test remains negative forever in some people with HSV1. However, of all people who develop positive HSV1 blood tests after infection, somewhere around 80% will have positive results at 6 weeks.

It is conceivable that your transient urethral pain with urination was an HSV1 infection of your urethra. Probably not, since it cleared with doxycycline, which has no effect on herpes; because herpes urethral pain usually is much more severe than you seem to have had; and initial herpes usually takes at least 10 days to clear up. But for the reasons explained above, it would not matter very much even if you had it. Feel free to have blood tests at 6 weeks if you wish -- but if you do it, you should also be tested again at 16 weeks. If those are negative, you can be even more certain you didn't catch HSV1. But unfortunately there is no way to know for certain, unless someday you have a recurrence of genital symptoms. But that is not likely to happen, and you should go forward in your sex life as if nothing had happened.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last; future new questions about this exposure, testing, and your fears about herpes or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.    




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