[Question #5950] Need urgent clarification!

19 months ago
Hi. I hope someone can help. 
Facts are as follows.
-5 years ago had outbreak in palate(quite painful). Assumed possible herpes lesion- did not swab. Had cold sores on chin as early adult- not presented for long time. I assumed hsv 1.
In long term relationship- have avoided sexual contact for 3 weeks. Attempting for partner to fall pregnant next week at her request! 
- stupidly engaged in sexual act 24 days ago involving kissing, brief cunnilingus(5 seconds), mutual masturbation where stupidly touched my penis for probably 3-5 seconds after touching vagina. Very stressed post this point at what happened.
-2-3 days later minor palate outbreak- noted-swabbed- confirmed hsv2- panicked.
- now day 24. Nil genital lesions.  Watching genital area like a hawk with mirror and magnifying glass.. No real definite symptoms- odd itching. Head of penis and under foreskin red/inflamed from constant checking. All checked by doctor and pcr swabbed(groin: head of penis) all cleared.
- doctor stated no need to start antivirals without confirmation  of genital lesions.- he is confident. Thinking may be a recurrence.
- day 17 blood test- hsv 1 positive- hsv 2 negative. Is this therefore a new lesion? Due for blood test day 28. Now confused. Does this change things?
- told partner about hsv2 mouth lesion/ will see doctor in 2 days with what I assume will be blood test( what if negative?).

Now on a whole lot of antibiotics to treat helicobacter for reflux- quite severe. Odditchiness... penis head feels dry and odd- probably not related?

What are your thoughts?
19 months ago
Sexual act was outside of regular partner
19 months ago
When I said I touched her vagina I fingered her vagina. (Again not my partner) I have been with my regular partner for 10 years
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
If you had a similar outbreak years ago, this is more likely a recurrence than a new infection, especially since you gave oral sex to this person for such a short time.  The IgG test misses 8% of HSV 2 compared to the gold standard western blot so not that uncommon.  Another possibility is that the typing was incorrect -that this is HSV 1 rather than HSV 2.  That is less likely, for sure. But at some point, you may wish to do the blot to sort this out. 
And I seriously doubt that the contact you had with the other person that involved touching her vagina and touching your penis would have any impact on you in terms of genital infection. 

I think your best bet would be to re-do the IgG test when about 6 weeks have passed this since this encounter and see what you get.  It can take up to 12 weeks to become antibody positive (if you don't take antivirals) so that won't be the final answer but it might give you a bit more information. 

I can certainly see with a possible pregnancy looming that this is a significant concern. 
is it possible to ask this new partner to have a herpes antibody test?
Has your regular partner had a herpes antibody test?

Terri
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19 months ago
Thankyou terry so much for your prompt reply! I had no idea that you answered on this forum! I have engaged you on your “Westover heights” forum- excellent service btw.

I also feel exactly as you have described- what u described makes logical sense to me- this is why the igg test threw me off- and you are right I am significantly concerned because of potential pregnancy and the need for unprotected sex in 1 week. ( my regular partner- we have been together for 10 years). I have been avoiding any sexual contact for 1 month!

The other person involved was a sex worker- she stated to me that she is clean- whatever that means. I do not believe I can get her tested. 
I have told my partner about the mouth lesion and she is seeing her doctor- I assume a blood test would be requested- if she is hsv 2 negative what would u recommend?  If she is hsv2 positive what would you recommend?

Her history is that she does have coldsore outbreaks  around her nose maybe once a year- she has had this swabbed confirming herpes(what type I am not sure). No genital lesions that we are aware of( but I understand   It could be asymptomatic - hence my concern with me- but we have never noted anything.)When I got the swab result (approx 7 days after exposure) I was checking  my genital area like mad to the point where I caused trauma! All swabs of areas of inflammation etc came back negative. I don’t feel I missed anything.  My doctor advised against surpression as a result- but he presented as an option.

So this is my dilemma- do I just resume as normal or do I surpression it do I avoid sex until confirmation? To me I am content  that I have type 2 hsv virus-I know a swab is accurate- just with blood tests it may confirm whether something was incorrect I guess... but I assume it’s impossible to clarify the exact location from blood test!
Interestingly I have a friend who is a mouth medicine specialist. ( don’t know if u have the those in the USA)He states that he sees type 2 hsv lesions all the time in the mouth- not necessarily with genital association (whether that is accurate how would U know I guess?) some of these lesiknsbin the mouth would be easy to just leave and not bother- I guess I did previously.

I am happy to do all the blood testing on my behalf( I have one scheduled 4 weeks this Friday) I’ll do one at six weeks and will let u know. I guess at this stage I would just ask what would u do in my situation in terms of interaction with my partner? I have even discuss artificial insemination/ ivf to eliminate thevrisk( my partner thinks this is over the top)

Let me know what u think and ty for your prompt reply!



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
I think the first thing you need to do is to either explain that you had the mouth sore swab tested and what it revealed.  To keep this secret is pretty big and I don't think it's right in the long run.  You can let her know that you were really surprised by the results.  You don't necessarily have to disclose the other partner, given the low risk of that contact - I am not concerned about any sexually transmitted infections given what you've told me about that.  I am assuming that you have had other sex partners in the past and this could have come from one of those previous partners, if your regular partner turns out to be negative.  And that is actually the likely truth.  But her getting an antibody test is essential. 

Now the more difficult question is what to do now.  We know that 95% of people who test positive by antibody test for HSV 2 shed virus from the genital tract at some point.  There are a few exceptions, but if I were you, I wouldn't count on that.  If she is negative for HSV 2 and you remain negative by antibody test after 6 weeks and again at 12 weeks, I would recommend the western blot to eliminate the possibility of a swab test that was erroneously typed.  If the blot is positive and she is negative, then I would suggest that you go on suppression and avoid intercourse in the last trimester of pregnancy to avoid the risk of her acquiring herpes in the third trimester. You said she thinks artificial insemination is over the top - why was it discussed?

Terri
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19 months ago
Great advice Terri.

It was discussed Terri as a fleeting thought by me to totally avoid transmission at least during pregnancy...  I was thinking maybe considering wearing condoms during pregnancy post conception( + surpression as you have advised?)we have been trying for 1 year and seen fertility specialists and it was presented as an option( there are absolutely no fertility issues that they have detected and I was unaware of hsv2 swab at that stage- this was 3 months ago )

I already have disclosed the mouth lesion with her and yes she is seeing her doctor to discuss- I will advise her to have an antibody test and we will take it from there.  And yes, I have had at least 5 partners prior to our 10 year relationship.

I will get tested  at 6 weeks and 3 months . If she is positive obviously she will need to go on  surpression and then  we don’t need to worry about “ new” transmission? Would she need to get tested with a blood test every 3 months during pregnancy? Post pregnancy, if I test positive, should I then stay on surpression?

I spoke to my doctor about a western blot test  and he was aware of it and he said the tests that  are run here are “very similar” known as a pcr test- it tests for DNA?  I didn’t understand that.  

Can a western blot test be done overseas?  or is it only done in US. Is it possible for people test negative after a 3 month period?

I believe surpression therapy is Valtrax and it’s one 500mg tablet a day. I believe it is very effective?

Thx again
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
western blot and PCR are completely different tests.  PCR for herpes should be done from a swab from a lesion - it should NEVER be done as a blood test as herpes is almost never in the blood.  The western blot looks for antibody, not virus. 
Good idea to get retested at 6 weeks and 12 weeks but just so you know, the IgG test misses 8% of HSV 2 compared to the western blot so if it is negative, you still won't know for sure what the heck is going on here.  And yes, we do blots for people who live away from the US all the time and I can help you with that at westoverheights.com. 

If you are both positive for HSV 2, there is no need for suppression.  And I would suspect that if she is negative, they will want to do another antibody test late in her pregnancy to know how to handle this issue at delivery.

Condoms and suppression sound like a good plan during the pregnancy.

Terri
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