[Question #2259] Risk assessment-follow up to dr hunter/Hook

48 months ago
Hi Dr. Hook, 
I really appreciate your input and your assurance that I am not infected and to move on with my life which I have started. But I thought why not calculate the risk assessment statistically based on your input and I came up with this number considering all factors ( hopefully). Please let me know if my calculation is utter bullshit. I hope you and dr hunter will reply to this. 

You said my chances of hsv with my exposure ( 1 time unprotected oral sex)  is 1 in 10000 ( based on your estimate). I will start with this.

1. So with no active sores or lessions on her lips, my chance is 0.001%
2. Since oral hsv1 sheds 20% of the days and if my exposure is in that 20%  and one time chance is 0.2 * 0.0001=  0.002%
3. And since I have no symptoms  or blisters in 3 weeks ( considering 50% will have symptoms by 3 weeks as Dr. hunter mentioned in one of the questions in this forum, one doctor  i spoke to said 80% will have symptoms and 2 doctors said 99% will have symptoms  which is hard to believe and all 3 are dermatologists. But I will go with Dr. Hunters experience) is 0.002% *50%= 0.001%
4.  And if I test at 6 weeks and was negative then my risk comes down to 0.0007% ( since 70% will test positive by 6 weeks)

Is this calculation fair or bullshit? If it is fair then I think I can move on with my life happily. Please let me know if at all it is fair and I got some numbers or calculations wrong. Thanks once again doctor.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Hello, Dr. Hook asked that I attempt to answer this herpes question since the two of you have already discussed this at some length.  I think your statistics are about right.  But my overall response would be that a single exposure of unprotected oral sex with no symptoms at all in you is an extremely low risk event.  Yes, people with oral herpes shed virus without symptoms. But I think it is fair to believe that you can move on with your life normally.  The trick will be allowing yourself to do so without further questioning of your every little twinge or sensation or abnormal skin dittzle. Many people who have sexual contact with a person outside of their normal relationship have these worries - you are not alone.  I hope that you will allow yourself to let this go as continued worry will do nothing to change the current picture - your risk will always be extremely low for this event.  And reinforcing that, since the test for HSV 1 is not great at all, you may well already be infected with HSV 1 and thus are no longer vulnerable to infection from this person.  More than half the people in the US between the ages of 14 and 49 are already infected with HSV 1 - those are powerful statistics in term of your current situation.

Please try to keep yourself in check with these worries.  They can become obsessions - I've seen it time after time. 
If you must test again, let it be your last time - an opportunity to once again determine that this encounter did not result in any lifelong concerns that will impact your and your family. 

Let me know what other questions you might have.

Terri Warren 
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48 months ago
Thanks Terri. I will take your advice and move on. But your last sentence left me worried. I thought neither Dr.Hook nor you recommended testing for my exposure. Are you saying I should get tested that too only once and move on with my life? If so is 6 weeks go time to get tested?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
I am not saying you should be tested at all - I was responding to your question about validity of testing at 6 weeks.  personally, I don't think you need you to test, but after all these years, I know that people do test and you mentioned it.  IF you are going to test, 6 weeks would be fine in your situation, but you don't need to - no.

Terri
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48 months ago
Thanks Terri for you detailed input. I think I will get tested at 6 weeks and then move on with my life. I do have a couple of questions.
1. 3 dermatologist I spoke to told me that more than 99% will have symptoms in 3 weeks after infection. Do you think they are lying because when I asked them where they got that number, they said they read in a study. Was there any study like that?
2. I am worried about false positives of IGG test. How often are false positives with IGG considering I got multiple negatives with the same test previously. 
3. Since it's been 4 weeks and if I take IgM test and let's say it comes back negative then am I safe? I know IgM is useless but mostly it's because it will give false positives. What about false negatives with IgM
4. Finally I think deep down I know I did not contract herpes. I know that. But my mind is playing with me. I have started taking counseling 
48 months ago
Also I final question I forgot to ask you. I spoke with STDcheck and TSTD testing facility center. Both of them told me IGG is FDA approved and it is 97-99% accurate from 4-6 weeks. Is it true? Or do they not have proper knowledge about hsv testing? Sorry this will be my final question.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
1.  I actually don't think there is such a study.  What I would say about this is IF someone is going to have symptoms when they acquire new herpes, it will happen within 3 weeks, that I agree with, yes.  Not everyone develops recognizable symptoms with new herpes, particularly if they already have HSV 1 infection - symptoms might be very mild indeed.  However, in your case, I think you are observing very carefully and would most certainly notice anything at all that was abnormal whereas many people might not.  Does that make sense?
2.  In a study we did looking at the range of "scores" where IgG false positives are most common, over a period of seven years, 5.5% of people who tested fell into that range, and half of those are false positives.  That's not written in stone - there are a few exceptions - but that's not a big number.  And the other thing about that is that if a person test results fall into that range, there is a confirmatory test that can be done to clear up any questions.  So it's not like we don't have a way to clarify things if we need to. 
3.  Please please please don't take the IgM test - everyone including the CDC says not to do it.  That test has huge numbers of false positives, and for you, if you got one, I know it would so upset you and it would take a long time to get you to believe it is a false positive, even if your IgG never came back positive.  Save yourself heartache - don't do it! 
Lots of people have the condition of "herpes messing with your mind" syndrome - you are not alone.  But I congratulate you and your decision to seek counseling on this issue - I hope you will see someone who specializes in cognitive behavior therapy as that is the best style of counseling to work on issues like this. 
IgG is certainly FDA approved, I'm not quite as confident about the test sensitivity as that number, however.  I think Dr. Morrow's research indicates 70% at 6 weeks - that's the number I use. 

You are moving toward resolution of your herpes concerns - so proud of your actions so far.  Keep up the good work!

Terri
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