[Question #4026] Prevention

33 months ago

I’ve suffered with OCD/Anxiety my whole life and have a main contamination/disease fear. I am receiving treatment for my ocd, but I have some questions on how i can best protect myself. 


I recently tested negative for all stds, including herpes at 16 weeks from my last sexual encounter. I have recenlty started seeing someone new and we have been using condoms. Its a little late to have the convo, bur moving forward i want to be as safe as possible. My partner does not believe he’s ever gone to get tested specifically for stds, but has a physical each year. He has never shown symptoms. But as you know, online can be a very scary place, so i want to make sure we are being safe and that i am protected.


1. The cdc and most doctors (from what i can tell) do not recommend testing for hsv without symptoms. Is this correct and if so, why? What do you recommend without symptoms? 


2. I have seen that condoms do not protect against all stds, like herpes, hpv, etc. How effective are they at protecting one from such stds? Do they decrease the risk substantially? 


3. Is there any other way i can protect myself? I know that taking prep can reduce your risk of contracting hiv, so is there any similar thing for other stds? 


4. Any other advice you would give someone who is trying to protect herself as much she can?

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome to our Forum.  I'll be glad to try to help.  Congratulations on seeking care for your OCD, that is a big first step in addressing the concerns you mention.  I hope that the information I provide here will help as well.

Let me start by suggesting that it might be good for both you and your new partner to go (together if at all possible) to go for a sexual health check which includes screening for STIs.  This is not an accusation but simply acknowledgement that both of you appear to have had other partners in the past, that many STIs can occur without symptoms, and that while it is unlikely that either of you are infected, knowing this based on mutually negative tests will provide a measure of confidence and trust as your relationship moves forward.  We routinely recommend this for new relationships and suggest that such testing should include testing for gonorrhea, chlamydia and for the woman and sometimes the man, depending on the test performed, tests for trichamonas using either vaginal swabs of for the male a urine test.  Testing for HIV and syphilis, while far, far less likely can be easily added with a blood test if desired.  We specifically recommend against blood tests for herpes unless one partner has a history of the infection as they have relatively frequent false positive test results and can be misleading. In the US confidential testing can be obtained for little cost at health departments.


My other general recommendation for you (and if possible, your partner) is to be sure you have been vaccinated against HPV.  The vaccine is highly effective and safe. 



1. The cdc and most doctors (from what i can tell) do not recommend testing for hsv without symptoms. Is this correct and if so, why? What do you recommend without symptoms? 

Please see my comment above.  I strongly recommend against testing in this situation.


2. I have seen that condoms do not protect against all stds, like herpes, hpv, etc. How effective are they at protecting one from such stds? Do they decrease the risk substantially? 

Condoms remain the most effective means of reducing risk for acquisition of all STIs if one is exposed.  The amount they protect varies depending on the STI we are speaking about.  For STIs spread in genital secretions like gonorrhea, chlamydia, trichamonas and HIV, when used throughout sex without breakage, they provide well over 98% protection.  For the so-called "lesion" STIs like syphilis, HSV and HPV they are somewhat less protective, reducing risk in the range of 60% or more because the lesion may not be covered by the condom.


3. Is there any other way i can protect myself? I know that taking prep can reduce your risk of contracting hiv, so is there any similar thing for other stds? 

If your partner does not have HIV, I would not recommend chronic PrEP and see no need for PEP for most people with regular sex partners. 



4. Any other advice you would give someone who is trying to protect herself as much she can?

Finally, the other way you can "protect" yourself form the effect of your OCD is to stay off the internet.  It is a terrible place for a person with CDC to got for information.  Go only to trust, proven web sites such as those run by the CDC or the sponsor of our Forum, the American Sexual Health Association.


I hope these comments are helpful.  EWH


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33 months ago
Hello,

And thank you for your help. I sincerely appreciate it. 

I feel you may have misinterpreted my question about pep. 

I was wondering if there is a similar preventative pill for other stds such as herpes. Like if you were to take valtrex to prevent getting an infection. If there was a similar form for other stds than hiv?
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
There are no data on the utility of taking anti-viral medications for prevention of HSV. OTOH studies do show that persons with HSV who take daily anti-HSV suppressive therapy are more than 50% less likely to transmit infection to uninflected partners.  EWH---
33 months ago
Thank you, Dr. i did not think there was but felt a good idea to ask. I also should have mentioned i did recive the hpv vaccine when i was about 12 or so. Would this still be effective or must you retake it?

Lastly, like i said, i recently recieved all std testing negatives. I recieved a fourth generationat 4 months post last sexual exposure, that was negative. Also a hsv2 negative igg test at 18 weeks. Are these reliable/conclusive?

Also on my hsv test, i recieved a negative for hsv1, althought i thought i’ve had a cold sore before. It is possible what i thought was a cold sore was a pimple as there was pus. But how reliable are hsv1 igg tests? And would the outcome of type 1 test affect the outcome for type 2? For example, if my hsv1 test was a false negative, would that affect the accuracy of my hsv2 test result? 

Thank you for all your help. I truly appreciate all you have done and continue to do for so many others. 
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Thanks for the additional information.  I'm delighted you have gotten the HPV vaccine, one less thing to worry about.  It will still be highly effective.

Your HIV test at 4 months is absolutely reliable.  The blood tests for HSV are not perfect.  They can miss up to 25% of HSV-1 infections and so that explains the fact that you have had a cold sore and have a negative test.  The test for HSV-2 is better but does still miss a few infections.  In persons with strongly positive tests for HSV1, there can be a borderline or weakly positive test for HSV-2 but if your test is not positive, this is not something to worry about. 

I hope my responses have been helpful.  Our Forum permits up to three responses to each client's question and this is my 3rd response so this thread will be closed later today without further answers from me.  Take care. EWH
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33 months ago
Hi sorry i know this is my last question!!

Would you say if i have a negative igg hsv2 test at 18 is reliable? Regardless of my neg hsv1 result
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Yes. You should believe your test results - they are reliable

End of thread.  EWH
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