[Question #3341] Confusion over treatment and transmission

40 months ago
My college age niece discovered herpes like lesions on the upper inside of leg/groin region---none in vaginal/labia area---- this past month.  She had had protected sex (condom) with male partner and received oral sex ~ 14-18 days prior to breakout.  She tested positive for HSV 2 (both from culture and later blood test)--needless to say she is devastated and convinced she will never be in a relationship again (which is another matter).  Unable to tell anyone she went to gyn MD alone and was so distraught she was unable to ask all the questions she needed answered.    I am trying to help her as she has confided in no one.  1) Given that the original lesion was outside of the vaginal region--her doctor told her she could still transmit herpes to a partner's groin area even with condom use--and to cover a suspected outbreak area with a liquid bandage or bandaid if she ever has sex in the future.  Is this accurate?  2)  when she asked about medication to control outbreaks she was told by MD he didn't believe it was healthy for a young woman to be on medications daily, that it could cause "resistance" problems in the future, and that she should call for a prescription with a suspected outbreak if ever needed in future?? This is confusing as she read daily antivirals could decrease shedding of virus.  What would you advise?  3)  Given no symptoms is it possible to transmit HSV 2 to another partner if she receives oral sex?  4) Could she have contracted HSV 2 from a prior relationship but just never exhibited symptoms?  Even months later?  Thank you so much--this service is so valuable for stressed individuals.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
It is likely that there were also some original lesions genitally as the primary site of infection - she may have missed it and depending upon the timing of the antibody test, this may have been an older infection.  Obviously I know nothing about her sexual history so I can't really Address that. Antibody is developed over time and if for example she had an antibody test done a week after the lesions appeared and it was positive and this indicates older infection, and Not new infection. But I don't have enough informationTo address this completely.  People who have what we call extra genital lesions, that is outside of the genitals specifically, also shed from the genital area I don't think there's any benefit in covering this area with something well having sex. The upper leg does not shed virus in less there is an outbreak present because the skin is too thick for a virus to get out. So it wouldn't do any good anyway to cover it with something. That's kind of a random suggestion in my opinion. I could not disagree more with her clinician who told her that daily medicine was a bad idea. In fact, for her, I think it would be an excellent idea both to reduce the frequency of recurrences and to reduce the risk of transmission to a new sex partner. Daily antiviral therapy reduces the risk of transmission by about half over no medicine at all. In addition, we do not see resistance developing to the antiviral medicines that we use when taken by healthy, immune competent adults. It is possible that someone could acquire herpes in their mouth by giving her oral sex but that rarely happens. HSV-2 does not like the oral area and when people do acquire it orally, it looks just like a cold sore and would rarely if ever recur. Yes, it is possible that she's had this for long time as I mentioned earlier. I'm so sorry that your niece is in distress.  I hope that she will do all that she can to learn more about the virus.  . There are plenty of people who will be willing to have a relationship with her so I hope you will encourage her to View that issue differently. She is fortunate to have an aunt who is helping her to deal with this.

Terri
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39 months ago
Thank you so much for answering her questions and clarifying.  I gathered more history.
I asked her about history prior to this January contact (with protected sex), and she did have a relationship with a person who cheated on her in the fall of this past year.  Prior to, she had her annual physical in August 2017 and all STDs (with blood work) were clear for HSV 2, but she tested positive for 1.  It would make more sense that the the infection of HSV 2 may have occurred in the fall relationship (unprotected) and not in the recent relationship (with protected sex).  The confusion was over the timing---her outbreak in January occurred within the typical outbreak period, but as you brought up, it could be a prior contact.  
So her question is this---is it likely/possible that a female could contacted HSV 2, and not exhibit symptoms for several months?  Thank you again and this website is a blessing to all afflicted and so burdened by such matters.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I agree that the infection more likely came from the encounter that was unprotected, yes.  And yes, it is possible that she either missed the symptoms of the initial infection or mixed it up with something else (like yeast or a UTI) and then not had any more symptoms until months later.
I'm glad we can be of help to you and your family.

Terri
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