[Question #2747] Did I Infect My Wife?

43 months ago
Hi Doctors,

Today (September 25) my wife told me she is feeling ill, had been feeling sick since yesterday.  Symptoms yesterday were nausea and fatigue, today continued nausea, fatigue, flu-like malaise but no fever.   Today she also said she is late on her period, and is very uncomfortable in the vaginal area but ruled out a yeast infection due to non-responsiveness to anti-fungal ointment.  Said she thinks it may be a UTI or vaginal infection.  Here is why I would like some guidance on this:  I worry I may have given her an STI.

On August 30, I had a massage that ended with a happy ending.  The lady (white, mid-50s) gave me unprotected oral sex for about 20 seconds at the end -- a lick of the shaft of the penis followed by sucking of the unprotected head for about 20 seconds.  About 1-2 days after that, I had a very, very slight sting on urination but nothing more than what you feel when you are dehydrated.  Did not progress from that, and I have been normal since.  No discharge, no lesions.  I would not have even thought about it any more, except for the symptoms my wife reported today.  We had unprotected vaginal sex on September 19.

Is my wife's syndrome suggestive of an STI she caught from me?

Should I fess up and tell her to be tested?  (I mean this question to solicit medical advice, not relationship advice.)

Should I myself be tested and, if so, for what?

Thanks.

- A stupid and worried husband
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question.

You surely recognize that your wife's symptoms are extremely common -- experienced by all humans from time to time, mostly due to minor viral infections. The difference is being "uncomforrtable in the vaginal area", but that's quite difficult to judge without more detail, and not necessarily an STD. Despite not improving with the treatment she had, it still could be a yeast infection or other nonspecific irritation. And there are some non-STD viral infections that could cause genital discomfort along with her other sympotms, like adenovirus.

Equally important, the exposure you describe carried no measurable risk for STDs, certainly none that could explain your wife's symptoms. That said, I cannot say the risk was zero from that exposure:  20 seconds of direct oral sex, witih the head of your penis in her mouth, is not a trivial exposure. But herpes, the only STD from such an exposure that could explain your symptoms, is unlikely without you having obvious new genital herpes symptoms yourself (i.e. blisters/sores of the head of the penis). The other main risks -- gonorrhea, nongonococcal urethritis [NGU] -- would not cause your wife's symptoms.  And even it were to turn out your wfie has genital herpes, it would be more likely that you have had it all along and transmission only now finally happened. Have you ever been suspected of having oral or genital herpes? Did you by any chance have a cold sore and perhaps with oral sex included during sex on Sept 19?

If your wife's symptoms get significantly worse, especially if the vaginal area "discomfort" remains prominent and begins to include blsiters or sores, she should immediately be examined professionally. However, I see no particular value in you being examined or tested until and unless you also develop genital herpes symptoms -- which almost certainly would not happen this long after your massage parlor expoxure 4 weeks ago. As for informing your wife about the massage event, from a diagnostic perspective there is no need at this time. (Whether it would be a good idea from a relationship and anxiety standpoint is a different question and not something I can answer for you.)

I'll be interested in hearing how things go over the next few days. In the meantime, let me know if anything isn't clear.

HHH, MD

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43 months ago
Thanks doctor, this is helpful.   As of last night (night of September 26), my wife had recovered more or less fully from the flu-like malaise, but was still uncomfortable in the genital area.  Described it as itchy and painful.  Not sure about it getting worse - does not sound like it's getting better or worse.

I have not in memory had a cold sore -- if I ever did, it would have been as a child and I don't remember it.  But, before I got married I had a a full-blown STD panel through an online vendor.  It included herpes testing and showed me as negative for HSV 2 but positive for HSV 1 at 1.34.  A couple of years after that, I mentioned it to my general practitioner, and she said that value is pretty low and offered to retest me.  I was getting labs anyway so I agreed, and the second test came out negative for HSV 1.  My doc then told me it's unclear if I have the HSV 1 virus and if so, where I would have it.  I never really thought about it again.  So, in short:  I have no idea about my HSV 1 status but if I infected her on September 19 it would have been a genital-to-genital infection.  There was no oral sex.

To be candid, the "big ticket" STDs worry me a lot more than herpes.  From your comments, do I understand correctly that syphilis and HIV are not concerns, but gonorrhea may be?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
The HSV1 blood tests are less reliable than those for HSV2. Up to 30% of infected people have negative test results, at least some of the time. So your positive test suggests that, like half the US population, you probably have HSV1 -- i.e. your positive result outweighs the negative one. Your doctor misunderstands the test, however -- or you misunderstood her. The numerical value of a positive result says nothing about how long an infection has been present or how active it is.

With this information, I'm more concerned that there is a reasonably good possibility your wife is experiencing new genital herpes, likely due to your HSV1. If your most recent sexual exposure with her included cunnilingus, it could have been the source; or vaginal sex if your HSV1 is genital. It is typical for systemic symptoms (flu-like, malaise, etc) to clear more rapidly than genital pain and sores. She should be examined for diagnosis and probably treatment, unless pretty much clearing up before she is seen. If she has genital herpes, I would predict it's more likely from your apparent chronic infection, whether oral or genital, than from your recent non-marital exposure.

I'm going to ask Terri Warren, the forum's herpes expert, to weigh in.
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Thanks, Hunter, I will weigh in at your request. 
I agree that your wife needs to be seen and evaluated for any possible problem that might cause her pain in the genital area. 
Your previous HSV 1 testing is confusing - first positive at a low positive value and then negative.  you may or may not have HSV 1 but the IgG test for HSV 1 really is poor.  It may be useful for you to find out for sure about your status in case this blows up and she does have HSV 1 genitally.  The best test is the herpes western blot done at the University of Washington.  You can google this to find out how to do it. 
I also think that it is unlikely but not impossible, that you acquired HSV 1 from 20 second of unprotected oral sex.  Sometimes things just happen at the same time without a cause and effect relationship.  I hope this is the case with you and your wife, but I agree with Dr. Handsfield - if she does have HSV 1 and you are positive, it is more likely that she acquired this from you, if you are the giver of oral sex to her.

Terri
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43 months ago
Thanks to you both.   This is quite informative.  I had no idea herpes is such an enigma.  Seems like diagnosing it is as much art as it is science.

Here is where we ended up with this.  My wife's symptoms cleared up after our GP gave her an oral antibiotic and an oral anti-fungal.  He did not do a visual examination.  He simply said both medications in combination should address most sources of the problem.  Looks like he guessed right; she felt better.  We actually had intercourse about a week after the onset of symptoms.  You know better, but I am guessing a new herpes infection would not have cleared up that quickly so the fact that she was able to have sex a week afterward suggest the antibiotic-antifungal cocktail cleared up whatever was ailing her.

Meanwhile, we discussed the possibility of HSV 1 infection.  It did not perturb her enough to go back to seek evaluation.  I tend to agree; after reading up on this in the many questions in this forum, it seems that HSV 1 is no worse than an occasional nuisance in most cases.  Our plan is to get testing if she starts having this type of episode on a frequent basis.

I think I am ready to close the books on this incident, but please let me know if any of my final thoughts are not correct.

Thanks again for all your help on this.  I especially appreciate the willingness of you both to help me through this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I'm glad to hear your wife is getting better. Your thinking is on the right track. The natural course is entirely consistent with the possibility that her symptoms would have continued to clear anywya, i.e. the antibiotic and antifungal may have not been the reason for her improvement. OTOH, since it would almost certainly be HSV1, which may never recur and hence not cause ongoing problems, probably no harm will result.  I would suggest she check it out with symptoms to suggest a first recurrent outbreak -- which typically would be less severe and more localized -- without waiting for "frequent" recurrences. But even that is optional. All in all, your understanding of the issues and plans are more or less perfect. I wish more forum participants would have the sort of objective understanding of genital herpes as you and your wife have! Best wishes to you both. Thanks for the thanks about our services.---