[Question #4498] Herpes Exposure

27 months ago
  I have had a total of 4 sexual partners in the past, always tested for STD's prior and after each one (never Herpes). With my previous partners i have had unprotected oral sex . With my current partner i have done the same, unprotected oral.  In august and mid-September we made out. Then on 10/18 we made out and had unprotected oral. (I didn't notice any cold sore on her lip that night as it was dark) The following day i noticed she had what appeared to be a sore on her upper lip, i freaked out and told her to get Herpes tested. She got tested on 10/22 and her results came back positive for HSV1 with an index of 1.38H through the HSV IGG test and negative for HSV2.  On 10/25 i got tested for both herpes as well and came back positive on the IGG test with an index of 46.20H for HSV1 and negative for HSV2.  My partner got retested on 11/8 for HSV1 and was positive for HSV1 now with an index of 1.41H. My father has always had cold sores so i assume that i might have had HSV1 for some time as i have never been tested for it till now. I don't recall any outbreaks orally or genitally, although currently as i write this on 11/9 i have what appears to be a cold sore on my lip. My questions are as follows:
1.Is it possible that my partner caught HSV1 from me as her index is low and on her second test it is rising? Could she have caught it from when we made out back in august and September?
2.Is it possible that i caught HSV1 from her orally in august or September and now could have caught it genitally as well from the unprotected oral?
3. Does my high index of HSV1 mean that i have had HSV1 for some time and therefore am at no risk to have caught it genitally from my partner when i received oral sex from her?
 
27 months ago
Some information I forgot to add: prior to our encounter I had her get tested for STD's with sufficient amount time (3 months) from her last sexual partner and she tested all negative. However the herpes test were not included in this panel. In late August when we made out we also had protected vaginal sex. When I took the 10 test panel on 10/25 i was negative for everything except for HSV1 as mentioned. We have had protected vaginal an additional 3 times since, but the unprotected oral only happened on 10/18 as mentioned below.  Should I be worried about the protected vaginal sex for hsv1 genitally , supposing she has it ? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
She could have acquired HSV 1 from you OR she could have it previously OR her low positive could be a false positive (less common with HSV 1 than HSV 2 but still happens). 
It is not possible to know who gave what to whom in this situation, but with your high index value and her very low index value is SUGGESTS that you have longer term infection.  But this is not for certain.  You will never know for certain unless she gets a herpes western blot and is negative for HSV 1 (this was a false positive)
It suggests that you have had this for a while and if that is trued, you are extremely unlikely to  have acquired it from receiving oral sex from her.  After all you did receive oral sex from others previously, without a condom, correct?

You should not be worried about the protected vaginal sex, no, as your index value is so high.  Again, there is nothing anyone can prove her UNLESS she has a negative western blot for HSV 1, shojld she decide to do that, given her very low positive IgG index value. 

Terri
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27 months ago
Thank you for your response Terri! I want to also make it clear I'm not trying to point the finger at who gave who what, I'm just trying to better understand mine and her risk. There's a couple of additional questions i have regarding your response. Some of these are hypothetical, but their for me to get a better understanding of this virus.
1.)  Since i had unprotected oral with her only once and seven days later got tested with a high positive result from the IGG for HSV1, does this mean that , the level of antibodies at 46.20H would be enough to make it highly unlikely for me to have caught HSV1 genitally from that encounter whether i originally caught the virus orally a month ago or years  ago? I'm trying to better understand what the index value means and also my level of risk of HSV1 genitally (supposing i don't already have it from before).
2.) Supposing I'm the one who gave my partner HSV1, is there a time frame i should wait for her body to develop enough antibodies so that she can't be reinfected with the same virus in a new location? We both wish to discontinue condom use and wish to resume unprotected oral now that we both have the virus, but i don't want to put her or myself in additional risk for reinfection in a new location.
3.) You mention that my high index 'SUGGEST' a longer term infection, what is the exception to that? I've read other post of people with a high IGG and usually the professionals on this site confirm that it is indeed an older infection. Could my infection be that recent less than 2 months and have that high of an IGG index? I thought that the higher the levels detected the older of an infection it is.
4.) How long after infection will it take for someone to create enough antibodies to protect them from reinfection?

My main concern from this encounter was for HSV1 Genitally. I usually never have had any symptoms after unprotected oral, but after this one i had a few symptoms. (Could just be my mind playing tricks on me as i now focus heavily on any genital symptoms) About a week after the encounter i had a sort of warm and tingly feeling in my genital area that was on and off for about two days, i checked constantly for any lesions or open sores but only found some little skin colored bump at the tip of my penis which i assume i have always had but never noticed. I also had an uneasy feeling and a headache (could be my anxiety). About three days ago i developed a small rash on my inner thigh that was itchy with little red bumps, no fluid in them. They were itchy most of that afternoon and then subsided.  I also noticed yesterday on my shaft a small little red dot when i pull the foreskin back. It looks to be a single dot. Last week i went to two clinics and two different doctors and they said that it didn't look like i had any herpes sore on my genitals, one doctor took a culture swab of some little white dots i had under the tip of my penis but said that more than likely it's always been there but he would swab it anyway.    Also  its been about 23 days from the unprotected oral , do these symptoms and the time that's passed indicate that i did not get infected with HSV1 genitally from this encounter? (again, assuming i don't already have it from before.) I still get a little tingle feeling at the tip of my penis every now and again. I just want to be clear on my risk for HSV1 genitally from this one time encounter of unprotected oral. Assuming i never had Genital HSV1 could i move on from this encounter and assume my risk was low and not worry about this any longer? Also if i do ever have a genital outbreak what are the symptoms i should look out for?
Thank you in advance for your knowledge and patience.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
1.)  Since i had unprotected oral with her only once and seven days later got tested with a high positive result from the IGG for HSV1, does this mean that , the level of antibodies at 46.20H would be enough to make it highly unlikely for me to have caught HSV1 genitally from that encounter whether i originally caught the virus orally a month ago or years  ago? I'm trying to better understand what the index value means and also my level of risk of HSV1 genitally (supposing i don't already have it from before).

You did not contract HSV 1 from her and then a week later have a positive HSV 1 antibody test result at 46.  That's not how that works.  The soonest I have seen a negative go to a positive is 9 days, and the result there was 1.12.  You've been infected for quite a while, and if you have this orally (you mentioned that you think you had a cold sore) you are almost completely protected against getting this genitally.

2.) Supposing I'm the one who gave my partner HSV1, is there a time frame i should wait for her body to develop enough antibodies so that she can't be reinfected with the same virus in a new location? We both wish to discontinue condom use and wish to resume unprotected oral now that we both have the virus, but i don't want to put her or myself in additional risk for reinfection in a new location.

Remember that I said we cannot be certain that she is infected.  You said she appeared to have a lesion on her lip - are you sure this was a cold sore?  She has a low positive index value and this may be a false positive result.  Does she have a history of cold sores in the past?  If yes, and she is certain they are cold sores, then it is extremely unlikely (as with you) that she would get this in a new location (genitally).  Given that we know you have HSV 1 somewhere, and from your description it is probably oral, I think it would be worth confirming whether or not she has HSV 1 by doing the western blot OR repeating the IgG test three weeks down the road, looking for a much higher value for clarification.  Getting HSV 1 may not concern her but she needs to know there is a chance she is not currently infected.

3.) You mention that my high index 'SUGGEST' a longer term infection, what is the exception to that? I've read other post of people with a high IGG and usually the professionals on this site confirm that it is indeed an older infection. Could my infection be that recent less than 2 months and have that high of an IGG index? I thought that the higher the levels detected the older of an infection it is.

I suppose in 8 weeks you could obtain an index value of 46, yes.

4.) How long after infection will it take for someone to create enough antibodies to protect them from reinfection?

About 4 months.

Terri
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27 months ago
Thank you Terri for your quick responses! I would like to ask a couple final questions as well as a request from you.
1.) Given that my index is very high dictating a well established infection, i should not be concerned about genital herpes from the unprotected oral sex we had on 10/18 correct? (Assuming i don't have it from before)
2.) I received back the swab from the clinic i went to and it was negative It's been 28 days now since the unprotected oral, if i have not had a primary outbreak of herpes between the 2-10 day mark (penile blisters),  can i say I'm in the clear for Primary infection from genital herpes from the unprotected oral on 10/18?
3.) Does my high index value on HSV1 indicate I've had this infection long enough to protect me from reinfection with my current partner? (more than 4 months)

Also i would like to request if you could keep this thread open as my current partner will have a HSV1 IGG test performed again in the beginning of December and i would like your feedback on what her index value at that time means. Also if her index value continues to be low with no significant rise by December, i would like to know how we can go about having a western blot exam done.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
1.  The risk of you getting HSV 1 in a new location (if genital IS a new location) if you have it orally, is incredibly incredibly low.  I have seen it in one patient and read about it about another, in 35 years of practice.
2. You cannot have a primary infection with HSV 1 - you had that years ago, even if you didn't notice it.  HSV 2 oral infection is so rare I wouldn't consider that concern here.
3.  Yes

Sorry, we can only do three questions per posting thread, but if you have further questions, you can always open a new thread and remind me about this one.  I can help you obtain the western blot at www.westoverheights.com or you can work with your own provider and the University of Washington.

Terri
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