[Question #5172] HSV1/HSV2 Risk assessment

25 months ago
Hello Terri!

It's been a long time since I've been here on the forum. I did have an encounter the other day that I'm worried about and need your expertise. I hooked up with a girl the other day i knew since 8th grade and she gave me oral sex for a minute or two and we had unprotected sex for 5-10 minutes and I did ejaculate inside of her. I bought her plan b the next morning and she had no apparent sores or anything and she told me she is negative for STDs, however usually HSV 1 and 2 are not tested for. The reason I'm worried is because I know shes been with 10+ men. Please if you can give me an approximate ratio of what my risk was of contracting genital herpes (hsv1 and hsv2). Before this encounter I've tested negative for HSV1, HSV2, and all other STDS after 6 months of abstaining from all sex to get accurate results. I have kissed a lot of girls in my day [21 year old male] and shared drinks/cigarettes with a lot of people so I do think I might possibly have oral hsv1 even though I've tested negative for it repeatedly after sharing drinks and kissing dozens of girls. I know that 30% of people test negative for it. Does that mean that there is a 70% chance I really just dont have the virus?  Have only engaged in oral sex with 2 partners in my life. Do I have to wait a full three months to test?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
What it means is that the IgG test that you took picks up 70% of HSV 1 infections (and misses 30%) compared to the gold standard western blot. 
The chance of acquiring HSV 2 through one episode of unprotected intercourse with an infected person (which we don't know is true) is probably significantly lower than 1 in 1,000.  The risk here is quite low but it would be helpful for your peace of mind if she would be willing to be tested.  She can do that on the internet without a clinician order and a simply lab visit - you could offer to pay for this as a possibility?

Terri
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25 months ago
What about the  approximate risk of genital HSV1 from this encounter through the oral sex? Since I was a little kid before I ever even started having sex at 16 I've kissed dozens of girls and always shared pipes and cigarettes and drinks with all of my friends. I've only received oral sex from two girls in my life and each time was once. and I repeatedly test negative for HSV1. Would you think it's safe to assume that if I do have an HSV 1 infection that it is oral like the majority? Common sense kind of tells Me kissing dozens of girls and sharing drinks and stuff since a little kid before ever having sex I probably have had HSV1 since I was small. That being said if I did have a preexisting oral infection, it would probably protect me from getting infected generally correct? It's been 4 days since the exposure and I have no symptoms or anything. I know I can't know for sure if I had the HSV1 virus unless I took the WB but with a positive result would it be safe to assume the infection would be oral? Considering all that contact and sharing drinks before ever having sex and only having oral twice?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
The IgG test you are using to say that you test negative misses 30% of HSV 1 infections, compared to the gold standard western blot. The risk from receiving oral sex for a minute or two is minimal - not zero but minimal.  If you did have established HSV 1 oral infection, it is extremely unlikely you would acquire HSV 1 genitally.  Given that you have only received oral sex twice, I think if you do test positive, it is more likely oral than genital, yes, I would agree with that assumption.

Terri
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25 months ago
Since this is my last reply, I'm gunna go through my last questions one by one.
1. Given that since 11 or 12 years old I've kissed dozens of girls and shared pipes, bongs, joints, cigarettes, etc before I even started having sex and I repeatedly test negative despite kissing more and more girls and sharing drinks/cigarettes with more people, do you think it is safe for me to assume I am orally infected like the majority and that the igg hasn't picked up the infection?  Before I was ever sexually active I probably kissed atleast 50 girls and would share pipes/cigarettes with all my friends. Sorry to sound like a broken record. I've also never had a genital breakout or anything like that.

2. As for the oral sex that I received from this girl a week ago, you said my risk was minimal for genital HSV1. Could you define minimal with perhaps an approximate ratio or percentage? Your HSV2 acquisition stats for one encounter really helped me calm my head down. But since it's extremely probable I have an oral hsv1  infection due to all the girls I kissed and all the stuff I've shared with family members and friends, wouldnt that mean  it would be almost impossible to get genital HSV1 due to my established oral infection? In high school I did get something like cold sores in the corner of my mouth next to my bottom lip. So I'm almost certain I have HSV1 oral. Can I assume then that I wasn't infected with genital HSV 1 when I received oral sex from her? It's been a week and no visible symptoms.

3. How would you suggest that I move on, Terri? Honestly after thinking of all the things I have shared with friends and family and all the dozens of girls that I've kissed even before I started having sex it just makes more common sense to me that I probably had contracted an HSV1  oral infection before I even started having sex, if not since a was a little kid. Dont a large percentage of people get it as children? Can I assume that I dont have genital herpes at all considering  the IGG for HSV2 is 92% conclusive and that from my history I most probably just have an oral infection like most people? Have you ever taken the WB?


25 months ago
Whether I take the western blot or not, either way im just going to go with logical reasoning.

If I do test positive for HSV1 with the western blot I would assume it's due to an oral infection, as I've never had outbreaks and I kissed so so many people and shared things with so many people before ever having sex.
If I don't take the WB then I keep testing negative on my iGG and know I probably have an oral infection that just isn't detected as I've never really had outbreaks accept for maybe in high school but I dont know if those were cold sores or cystic acne but they were probably cold sores.  I know not to kiss people or perform oral sex on people with a questionable lesion on my face.

Can I assume I dont have genital herpes with confidence? I've shared so many things with people who have had cold sores before I even started having sex. Thank you so much for all your input and everything you do. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
1. Given that since 11 or 12 years old I've kissed dozens of girls and shared pipes, bongs, joints, cigarettes, etc before I even started having sex and I repeatedly test negative despite kissing more and more girls and sharing drinks/cigarettes with more people, do you think it is safe for me to assume I am orally infected like the majority and that the igg hasn't picked up the infection?  Before I was ever sexually active I probably kissed atleast 50 girls and would share pipes/cigarettes with all my friends. Sorry to sound like a broken record. I've also never had a genital breakout or anything like that.

I do not think it is safe to assume you are infected with a negative result, no.  I don't have concerns about sharing pipes and cigarettes.

2. As for the oral sex that I received from this girl a week ago, you said my risk was minimal for genital HSV1. Could you define minimal with perhaps an approximate ratio or percentage? Your HSV2 acquisition stats for one encounter really helped me calm my head down. But since it's extremely probable I have an oral hsv1  infection due to all the girls I kissed and all the stuff I've shared with family members and friends, wouldnt that mean  it would be almost impossible to get genital HSV1 due to my established oral infection? In high school I did get something like cold sores in the corner of my mouth next to my bottom lip. So I'm almost certain I have HSV1 oral. Can I assume then that I wasn't infected with genital HSV 1 when I received oral sex from her? It's been a week and no visible symptoms.

If you have had no symptoms in a week, either it is very unlikely that you became infected OR you already have this orally.  I don't have a percentage for HSV 1 acquisition but also mabey 1 in 1,000"

3. How would you suggest that I move on, Terri? Honestly after thinking of all the things I have shared with friends and family and all the dozens of girls that I've kissed even before I started having sex it just makes more common sense to me that I probably had contracted an HSV1  oral infection before I even started having sex, if not since a was a little kid. Dont a large percentage of people get it as children? Can I assume that I dont have genital herpes at all considering  the IGG for HSV2 is 92% conclusive and that from my history I most probably just have an oral infection like most people? Have you ever taken the WB?

You have the sensitivity percentages for HSV 1 and 2.  That is what I can give you.  Why would you want to know if personally have ever taken a western blot?  Do you think that's an appropriate question for me?

If I do test positive for HSV1 with the western blot I would assume it's due to an oral infection, as I've never had outbreaks and I kissed so so many people and shared things with so many people before ever having sex.
If I don't take the WB then I keep testing negative on my iGG and know I probably have an oral infection that just isn't detected as I've never really had outbreaks accept for maybe in high school but I dont know if those were cold sores or cystic acne but they were probably cold sores.  I know not to kiss people or perform oral sex on people with a questionable lesion on my face.

OK, this is your body, your life, you can make whatever assumptions you decide you want to make.  If you want to know your actual status the blot is the best test available. Whether you take it or not is totally up to you.  I think you are wanting me to agree with you about all of this but honestly, I don't make those kinds of assumptions here or in my own life.

Terri

Terri




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