[Question #2470] HSV Transmission Question

44 months ago

Hi doc(s)! Just firstly wanted to say thanks for this awesome forum, providing relief to those of us who need it. I have generalized anxiety disorder/OCD, so my psychologist had said this would be a good idea for me to explore. I wanted to ask a few questions regarding HSV/transmission.

I was tested in late January for a full STD panel, my last sexual encounter (unprotected/but we were tested and shared results) prior to that was August, so I’d say 5-6 months post exposure. Typically, I use condoms, I’m pretty strict about that and routine testing. 

When I received my results, everything was negative, but the HSV Type 1 AB, IGG, S test was positive. When my PCP read the results, as he has for the last 5 years, we always expect I’m positive for HSV 1 because I’ve had one cold sore a year since highschool/college (I’m a 26 year old female). Usually the convo goes, “All good, positive for HSV 1 that causes the cold sores, 80% of the population has it.. blah blah.”

Now reading these forums, and learning that HSV-1 could also be transmitted to your genitals, I somewhat started to worry. I’ve never had an outbreak, lesion, or any type of pain, but I know you could still have HSV-1 genital without all of that. I also see that 30% of HSV-2 IGG tests miss the infection. I haven’t been sexually active since that last partner, last August 2016. I did receive cunninglingus from a friend about 5 weeks ago for a few minutes with no visible lesions on his mouth, but nothing bizarre happened after. Us OCD folks can’t help ruminating thoughts/anxiety, so, I always like to be sure I’m safe and taking precautions. My questions are:

  1. What are the chances I have HSV-1 oral and genital?
  2. What are the chances I have HSV-2 and the negative result was wrong?
  3. Do you think I should re-test?

Thanks so much!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Once you have HSV 1 in one location of your body (cold sores) it is extremely unlikely that you would get it in a new location (i.e. genitals).  And your statistic is incorrect.  The IgG test misses 30% of HSV 1, not HSV 2.  And if you have one cold sore per year then even if the test was negative for HSV 1, which it isn't, we would still know you were infected, most likely with HSV 1, as your test indicated.
I think that you are good with the negative HSV 2 IgG and don't need to retest.  But if you caxn't stop ruminating, you can obtain the herpes western blot which picks up 8% more HSV 2 infections.
It might help you to know that worries about STI's and herpes specifically are very common for people with OCD around health issues.  You are not alone.

Terri
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44 months ago
Hi Terri,

Thanks so much for your information and apologies for the incorrect statistic. I did post this question twice by accident, so please disregard the other question. Good to know I'm not alone.  I've just begun to manage the OCD, it's a slow process unfortunately. 

So, safe to say I'm not positive for HSV-1 genital/HSV-2, correct? Is there anyway to know for sure? I assume The Western blot would be my best bet.

I guess, if you were in my shoes, would you even bother to continue testing?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
It's difficult to say what I would do in  your situation, it would depend upon how much certainty I needed to feel relaxed about this question.  The problem is that even if you get the western blot, your discomfort may begin again with each new sexual partner.  To avoid that, I would suggest that you ask partners to be tested prior to sexual contact.  My patients with OCD do this often and it seems to lessen the worries considerably. 
I think with the information that you have, it is safe to say that you don't have genital HSV 1 or 2, yes. 

Terri
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44 months ago
You're right, it probably would restart with each sexual partner, but I think you've provided enough certainty for my situation. I think continuation of proper counseling/medication will be a huge help for the OCD. When I've used condoms in the past, mostly all the time, I never inquired about STDs with my partners, so this OCD is new for me. 

Out of curiosity, if I were ever exposed to a partner with HSV-2 and used a condom, what is the percentage that I'm protected? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Condoms reduce the transmission of HSV 2 from an infected male to an uninfected  female 96% - very effective!

Terri
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