[Question #4015] Sanity check - is this HSV?

32 months ago
Here are the facts of my situation:
- I had unprotected anal sex, without any lubrication with a girl I had just met.  I've never had anal sex before.  It was really hard to get it in and felt like sandpaper while I was doing it.  It lasted about 3 minutes and there was no other contact of skin.
- Hours later, I had anal sex again without any lubrication with a different girl who I know very well and have had a long term relationship with.  This time much longer but I remember it feeling very rough and uncomfortable.  We had normal sex a few more times after that over the next 36 hours.  There was also a lot of hard grabbing of my penis during this time and I felt sore
- The next morning, I had 6 small little blisters on my penis.  They didn't hurt at all.  By about 3pm the same day that I had noticed them, they had dried up and had scabs on them.  Never seemed to burst or ooze or anything and were never painful in any way.  I never had any other symptoms - no headaches, flu-like, achy, nothing.  I felt fine.
- After googling  I was sure it must be HSV.  So I got a Valtrex RX from an online Dr. and I got a blood test which came back negative - I know it is too early to show up but I wanted to confirm that I didn't have it an never knew it.
- I contacted the girl that I had been with first, and she said she had never noticed any symptoms, but she went and got tested and tested positive for HSV2.  Said she had some bumps that she thought were razor burn.

While I wait in agony for 12 weeks for a test, what are your thoughts?  Sound like HSV?  Just wishful thinking that it may not be?  What are my next steps between now and a test?  Keep taking Valtrex?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
Yes, it sounds like herpes to me.  I'm sorry, but the symptoms are really consistent with herpes.  When you said you got a blood antibody test, was it IgM or IgG?  The IgG test is the only one that you want to take - the IgM is not accurate.  Can you check on that?  It would have been best to have the blisters swab tested and that way you could know if this was herpes AND which type it is - HSV 1 or HSV 2.  If you continue to take Valtrex now, it can interfere with the antibody test.  It would be useful to know if you definitely have herpes AND if you have HSV 1 or 2.  If you were my patient, I would recommend that you come off Valtrex and either have another outbreak and have it swab tested OR wait 12 weeks and have an IgG test.  If it is  negative at that time, it could be that you have HSV 1 OR that it isn't herpes.
Please let me know other questions that might have.

Terri
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32 months ago
Ok thanks.  I was afraid of that.  I had the IgG test and it was negative...but again it was done 5 days post likely exposure.  I'm concerned about stopping the Valtrex due to fear of transmission...but at the same time I do want my body to build antibodies to fight it.  If I stay on Valtrex does it just take longer to show a positive on a blood test?  Like would it be accurate after a year?

Can you help clarify for me the statistics on odds transmission to others?  I'm a little confused by what they are actually saying.  For example, I've seen that for an infected male to uninfected female, if no sex during outbreaks AND on anti-virals the risk of transmission is about 4% per year of regular sex. 

Is regular sex in the research defined as 2 times per week?  

Does that mean that the risk of transmission per sexual encounter is 4% as well or is it a fraction of that?  

Does that then mean that the risk changes if you have less sex?   For example if regular sex of 104 sexual encounters (twice a week for 52 weeks) over 365 days would give you a 4% chance of infection then 12 sexual encounters over 365 day would give you a very, very small chance.  Is that logic correct?

Then assume your partner did get it, if 70% of people are without symptoms (or so mild they don't notice), then that makes the odds that I transmit the virus to my partner AND doom them to a life of noticeable outbreaks almost statistically insignificant?  Just thinking about communicating to a potential life partner...if they never plan on being with another person then what would become a very relevant question around what are the chances that the endpoint is frequent, problematic outbreaks....

Are the chances greater in the early phases of infection?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
Your statistic is about right but if you add condoms, the risk is way lower.  And yes, the less sex the less risk, the more sex, the more risk.
And yes, it is more likely that you will shed virus more often in the early years of having this infection, that's correct. 
if you use condoms with every single intercourse and take daily antiviral medicine the risk of transmission is around 2%.

Terri
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32 months ago
Thank you Terri.  If I am on suppression therapy, is 1G daily more effective than 500mg daily? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
Studies do you not support that I gram is necessarily better, but I have had people have better luck with reducing the frequency of recurrences on 500 twice a day rather than one a day - the studies do not really support that it makes much of a difference in shedding virus.

Terri
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