[Question #4388] #4369

29 months ago
Thank you Dr. Handsfield. I appreciate your time and patience with me. I called a therapist this afternoon to really discuss my anxiety. 

My last question to you is do you believe that having a Western Blot would be a waste of time for me?  And when one is swab tested, does it  just check for hsv whether it is one or two?

  I know you are an expert and feel much better after our discussion this weekend. 

I’m ready to delete my account and move on. I just want to make sure that I have covered all my bases. 

Thank you and best regards. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
I am going to respond to this and then let Dr. Handsfield respond as well.
I'm glad you contacted a therapist but it is important to use the research that has been done to select the correct sort of therapist.  The kind you need for this sort of disorder is a cognitive behavioral therapist.  Research shows that this is absolutely the best kind of therapist for anxiety disorders.  And sometimes, depending on a multitude of factors, they might recommend that you consider medication as well.

In terms of the western blot:  If you do the blot and are negative for both HSV 1 and 2, that will really relieve your anxiety.  but if you are positive for HSV 1, you cannot know the location of the infection, which might give you more anxiety.  I think only you can weigh those pros and cons for your self and for each person considering this, the answer might be different.  Try thinking about both of them a bit in a quiet place where you can really think peacefully.  Imagine yourself in the position of receiving positive results and how that makes you feel.  Then, later, again in a quiet place, imagine yourself receiving negative results for both types of herpes.  How does that make you feel?  How much does your anxiety increase or decrease with these two options?  I believe you will be able to come up with the right answer for you.

Terri
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29 months ago
Thank you Terri, your advice has been so helpful. I have dealt with this off and on my entire life. I had an recent hpv scare and it triggered all the old memories. My main concern is that if I do in fact have this, that I could pass it to someone else and would feel deceptive. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
I totally understand your fear and the question is what to do about it.  Have you weighed  the western blot options I mentioned above?  What are your thoughts?  I order about 40 western blot tests per month for people - people who have gotten negative results but don't believe it (primarily about HSV 1), people who have low positives and are following CDC guidelines and are obtaining confirmatory tests, even people who have relatively high positives but have no symptoms and need a confirmation or denial of their test results.  So the question is where do you fit in here?  And what would provide you with the ability to best move on.  This is also something you might want to discuss with a potential therapist to get another perspective.  In general, I think most people do best with full knowledge of what is actually going on with them herpes-wise.  But for some people finding out they are positive causes just too much emotional upset, even if it is only HSV 1.  You'll find your way here - it may take a little time and work.  And I'm sure Hunter will chime in with his thoughts as well.  We are both here to help you through this challenging time.

Terri
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
My two cents:  I agree entirely with Terri; a Western blot, while not 100% conclusive, will probably help you in dealing with the possibility of having HSV1. If negative for HSV1, by itself it will not prove you don't have it, but it would add to the evidence against it (re-read my reply in your previous thread). I continue to believe it is unlikely you have genital HSV1, and would feel the same even if your WB is positive for it. And as we discussed before, if you do have genital HSV1, most likely you will have few or no future outbreaks and probably will be at low risk of sexual transmission to any current or future sex partner. And I'll one more comment about that:  Let's say you do have a sexual relationship with a partner at risk. You and s/he will be aware of the risk and prepared to start treatment promptly in event of new symptoms consistent with genital herpes; and like you, since it is HSV1, that person would be at little risk of recurrent outbreaks or ongoing transmission. In other words, I'm suggesting you re-orient your thinking about how big a deal it is to have genital HSV1. For most infected persons and their partners, it's simply a non-issue! There are exceptions, but those can be dealt with pretty easily with appropriate antiviral treatment. 

Does this make sense? I hope these comments help you move along with less anxiety and worry. Best wishes.

HHH, MD
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29 months ago
You are both wonderful. My anxiety isn’t so much triggered by the possibility of having it symptom wise bc as you know the symptoms I explained cuts and such have basically been a nonissue for me. I recognize the stigma and how ridiculous it actually is.

The major concern is do I have to disclose the potential that I could have it? Bc I would never forgive myself if I gave someone something without their knowledge. I always disclose my past hpv infection.  

So even with the western blot, there is still
Potential for false negative. So how do I move forward? In other words if you were me, would you tell your next partner about this? Or just accept the testing I already had done and drop it forever. 

Thank you a million times over!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Mere suspicion or worry is rarely if ever sufficient reason to disclose any STD to potential partners. In my view, you have absolutely no obligation to disclose the possibility that you have HSV1, whether genital or oral; and in your circumstances, if I were still in the relationship market, I definitely would not do so. If and when a relationship seems likely to become committed and ongoing, many couples discuss their past sexual and STD histories, and you may find you wish to do so -- as a measure of respect and caring, more than because of actual risk. But not in dating relationships prior to commitment. (IMHO.)---
29 months ago
Thank you for all your advice. I definitely would not want to tell someone something that the odds are I don’t have anyway. It’s hard enough talking about the Hpv. Which I also disclose before any sexual relations whether casual or serious. 

If you were me, would you move forward with the western blot? Or be comfortable with the evidence already that  you do not have it? I am in the dating world again and wasn’t worried about this event while I was married.  But I don’t want to put anyone in the situation my ex with the hsv1 infection has done to me. 

Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
I think Terri has outlined the pros and cons of having the WB. I'm inclined to think you should do it, but the decision is yours.

Half of all sexually active persons have had sex with HSV1 infected partners, either oral or genital. That you happen to know about your former partner's infection, whereas most HSV1 is never diagnosed, doesn't put you at any special risk of having it yourself.

I don't know the details of your HPV history, but if you had a positive abnormal pap that returned to normal, or genital warts that were treated and resolved, I also would advise against telling potential partners about it. Almost ever sexually active person has (or has had) genital HPV. Telling partners about your past infection will not have any effect on your partners' risk of catching it again. I feel even more strongly about this than about your HSV1 concerns. Disclosure is reasonable only for people known for sure to currently have an active infection -- but even in that circumstance, a case can be made that disclosure isn't necessary.

Perhaps Terri will have more to say, and she won't necessarily agree entirely with all my comments. But I won't have anything more to say on this thread. Best wishes to you.
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29 months ago
Thank you very much. Also thank you for the information about hpv, I’ve had both abnormal paps and genital warts. I thought there was a chance that was always contagious as well, which is why I disclosed. You have taught me a lot. I appreciate your time and expertise.