[Question #344] Possible Herpes infection

35 months ago
Dear Dr. Handsfield. 
I have read many of your forums on this subject and am looking for some help/counseling on the biggest mistake of my life. 
13 days ago I went to a Asian massage parlor near central coast, CA. Short end no oral was done but she did get on top of me and ridemy genital area and penis. At first I did not think I was in her, but at the end ( this whole episode only lasted 5-12seconds top) the way my penis moved away I can't be sure if I don't slip inside her at sometime. I have been in a monogamous relationship with my wife for 5 years. She is 15 weeks pregnant. This was a onetime single incident that I am so ashamed of and distraught about. I took tests 4 days post exposure and everything came back negative( Chylmadia,gon, hep, herp igg.)I was also prescribed dioxcycline for ten days and was given a shot of something else. Reading the forums I understand my HiV risk to be quite low 1-1,000-2,000. But I'm freaking out over herpes. I have had no symptoms at all and have been examine my genital area every morning and night intensely. In a lot of your forums you say transmission risk for one single incident for unprotected vaginal sex is 1-1,000 for HSV -2 and quite uncommon for HSV-1. I can't sleep and keep wanting to tell my wife what I've done but fear the emotional stress will cause a miscarriage. I'm considering a Igm test at 17 days to see if there was a new heroes infection given my igg were both negative. Can a negative Igm in accordance with negative igg tests be fairly conformting for me or is it a waste. I know Igm have a bad rap on here and thru the cdc. Im just spinning in my head and need some guidance/reassurance or cold hard truth. Thank you for all the time and effort you put into these forums. I hope to find some solace in your words. 

JH
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Hi Jeffrey,
Dr. Handsfield assigned me this question since your main concern is herpes.
Please - do NOT do an IgM test.  There are so many false positives on this test and I think if that happened it would freak everyone out.  I would say that of the IgM tests that I have seen people have (we would never do it), about 90% are false positives - at least.  The IgG test is the most accurate but I don't think you really need to do that.  If you did and it was positive, I would guess that it is either a false positive or it reflects an old longstanding infection you were unaware of, but it would not accurately reflect a new infection from this encounter.  You aren't even certain that your penis was in her vagina at all, so I would say that your risk here is so close to zero you just don't need to worry about it at all. The extremely short time of the contact also reassures me greatly. I hope you can find solace in my words, too.

Please let me know if you have other questions.

Terri
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34 months ago
Terri-

Thank you so much for reps pounding to my question. I have been freaking output for the last few weeks. This was a one time out of character drunken dumb decision that I would do anything I could to take back. But I can't. I tried to be as proactive as I could in testing so as if something came back I could be upfront with my wife. All I want is to love her and be the best man I can going forward. I did do a herpes type specific Igg test and it all came back negative <.90. After educating myself on the Internet the last weeks I know that obvisouly an IgG test that soon would not reflect a new infection. I realize you think given the small amount of time of possible exposure and the lack of any symptoms at 14 days means my risk is "so close to zero". However should I retest at 3 months because the one thing that all I think about is asymptomatic infection and not really knowing. Reading online it seems that most people after a diagnosis realize some signs. But the fact that I am meticulously inspecting my genital area every morning and night means that I would likely see something even if signs were extremely mild? And given time of exposure do you still feel that strongly that it was near a zero risk factor( I know nothing is zero) but I can't stop thinking that I deserve to be that 1 in 1000 person for my actions. I'm sure you get quite a few people that over think and stress about a dumb decision like mine but it's greatly encouraging when someone like yourself takes the time to give factual information and clinical support. Also I know it takes a lot of virus and open wound/secretion for the herpes virus to transmit, assuming i did  actual penetrate her for only a few seconds, does that change your opinion? Thanks so much again. I really appreciate it. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Whether you think you deserve to be infected or not, the science just doesn't support the likelihood that you are infected.  I know you feel incredible guilt about this experience.  I can read it in everything you've written.  When I responded to you, I took into account that you DID penetrate her vagina, yes.  My opinion remains the same - there is virtually no risk here.  I'm glad you got a baseline test so you know your previous status.  And I honestly believe that you will stay way.

Terri
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33 months ago
Dear Terri, 

I wanted to wait while before I did my final response. So it's been 7 weeks and I have had no symptoms at all (burning,itching,tingling) or sores. I have been looking myself over every morning and night for anything. I had a few days of random sensations near my tip of the shaft but nothing remotely like any signs or symptoms and I attribute that to my line of work and tight clothing. I'm going to have blood work done now to check and see and to confirm the other tests I had done 3 days post possible exposure. I also am going to have a HIV p24/AB Combo test done to rule out HIV. Everything I read online from Dr. hands field and others states that at 6+ weeks that particular HIV test is basically a 100% conclusive. Just want your thoughts on that? Lastly, if my HSV 1-2 results (IGG type specific) come back negative at 7+ weeks possible post exposure, how much confidence should I have in that to stay true to 12 weeks? And at 12 weeks when I get tested would you consider those results, IF negative again as conclusive? I understand that low totals( .91-2.0) have a false positive rate and require further testing but is negative results at 12 weeks good enough? Based on my one time possible exposure situation that I have stated above, what do you think the answers are to my questions? 
Thank you again for this service you provide. It's very comforting to get information from experts in the field. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
Hunter is the expert about HIV so I'm totally in agreement with him. The confidence at 6 weeks is 70%.  So that means with 70% accuracy, your results will remain the same. 
I think the odds in your favor!

Terri
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33 months ago
Thanks Terri,

Thanks again for your quick response and expert opinion. I am hopeful my results will be negative and continue that way. I know I'm done on my responses but was wondering if you could follow up on one of the questions I had in the last response I posted regarding 12 weeks HSV (both types) test results as being conclusive? I just want to know if at 12 weeks, if both come back negative, is that conclusive and can I carry on unprotected in my monogamous relationship. Just a lot of wild opinions online and just wanted to hear from you. Thanks again and let me know if I need to pay to have this question answered. Your words have comforted my fears, so thanks a bunch. 
33 months ago
It's been 2 days, does that mean I need to buy another question for my reply to be answered. Sorry to bug, just curious. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
Hi Jeffrey,

The 12 week test for HSV 2 is certainly reliable with 98% certainty compared to western blot.  The HSV 1 screening test isn't great - it misses 25% of infections compared to the gold standard, western blot.  I'm not sure where your subscription stands - did you pay for more questions?  I might have not closed out your initial thread of three questions.  Let me know if you did not renew and I'll close this down after your next response,
Best
Terri
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33 months ago
I did purchase another question. I thank you for getting back to me and responding. Just to clarify, based on this one time incident, your saying at 12 weeks my HSV-2 Igg test is 98% accurate and my HSV-1 Igg test is 75% accurate? So for maximum safety and precaution, should I order a western blot HSV 1-2 test at 12 weeks to be conclusive? Btw my 7week 4day HSV 1-2 Igg test came back both negative. Thanks for getting back to me Terri, and let me know if I'm ok on this question amount thing. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
Hey Jeffrey,
the western blot requires 16 weeks to be accurate - I know the waiting is difficult!
But here's the deal - your original experience was really low risk.  So please be reassured that even if your HSV 1 results come back positive, you cannot know if this came from this encounter (which I think is EXTREMELY unlikely) or you've had it since childhood, you know what I mean?  I just don't want you jumping to the wrong conclusions.

Terri
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33 months ago
Thanks for getting back to me Terri, I know I say it a lot, but thank you so much. 
So here's my last question to clarify this: 
If at 12 weeks I don't test positive for HSV 1 or 2 with an Igg test, I should still get a western blot at 16 weeks to verify? Or should I only verify with western blot if one of them comes back positive. Sorry for the repetitive nature of questions, I'm just a little confused. I've never had cold sores and both of my recent Igg HSV tests have come back negative. Thanks again. Your expertise is second to none. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
You're very sweet, Jeffrey, thank you so much. 
I personally don't think you need a western blot, really I don't.  And I'm worried about it coming back positive for HSV 1 and you believe it came from this encounter.  But if you need to do it to be more reassured about HSV 2, then yes, you can do it at 16 weeks.  You can do it through the University of Washington or through our clinic as part of a research study (your identify is completely confidential). 
Best
Terri
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33 months ago
Thanks again for he quick response!
I should mention in or around July 2012 I took and Sti panel and all came back negative , including HSV. So with the fact I've had 3 HSV tests come back negative, and as long as my 12 week HSV 1-2 comes back negative, I think I'll find that conclusive and not get a western blot. I can't imagine 4 HSV tests coming back negative and missing the antibodies 4 times. The main reason I'm worried about stuff is because my wife is pregnant and acquiring a new HSV infection in pregnancy is very dangerous. We're abstaining until my 12 week results and see what comes from them. Just to check with you, I should only use western blot as a means to clarify a previous positive test correct? And again, thank you so much and I hope you have a wonderful start to the year. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
You don't need to clarify a positive test result unless it falls between 1.1 and 3.5 for HSV 2.  I reread your first post and it looks like the main concern was genital to genital transmission, not oral to genital transmission so the biggest concern is HSV 2, not HSV 1.  I honestly don't think you acquired herpes at this encounter, Jeffrey.  It's OK to take the 12 week test for reassurance though if that makes you feel better.

Terri
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