[Question #64] herpes

39 months ago
Hi, We are a monogamous and married couple who have been together 16 years. A month ago, at the age of 43, my husband had a painful herpes-like outbreak at the base of his spine/buttocks. By the time he went to a clinic, they could not tell if it was herpes or shingles. Neither of us has ever had any previous outbreaks. When the doctor mentioned women are usually asymptomatic and men have a very mild initial outbreak, my husband said he vaguely remembered years ago having a pimple on his penis, but he can't remember if this was before or after we were together. 

My question is: if we have been together having unprotected sex for 16 years, is there any chance that I do not already have the virus? Is there any point in using abstinence, condoms or anti viral medication now? Also is it worth getting DNA tested (both of us) to find out what the virus was and whether or not I already have it or am immune? Do you know where we could get this type of test as our hospital does not offer it and will only test an active sore, which he does not currently have. Yes we plan to remain married for the remainder of our lives, but nothing in life is certain, so either of us could unexpectedly find ourselves dating again at some point in the future.

I should probably mention that before we knew the outbreak was some form of herpes, we probably were intimate one or two times during the outbreak.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Good morning Emily,

Interesting situation.  Usually, shingles would not present in this way but rather as a painful rash across an area of the body, stopping at the midline of the body, staying on one side only.  I supposed shingles could present as a single lesion at the base of the spine, but that area and that presentation sounds much more like herpes simplex to me, as it did to your doctor.  I very frequently see patients who have outbreaks there.  Though herpes comes into the body through the genitals, it can come out on area supplied by the nerves that supply the genitals - thigh, buttocks, anus, base of the spine, belly below the waist.  Let's assume for the moment that this is herpes. Should you find out if you also have it or if he even has it?  I'm not seeing anything in your post that makes met think you need to do that, honestly, and I am a big believer in finding out if you have herpes so you can prevent the transmission to someone else.  But in your case, you are in it for the long run, you aren't having symptoms that are concerning to you (and yes you could be having sex for many years and not get his herpes),you don't seem concerned about him having another new partner,  his outbreaks (if that's what they are) are infrequent enough that he likely does not need treatment, right?  Some of that could change of course and if it does, then testing may well be useful.  But as things are now, I just don't see the need.  If you do decide you want to know, there are many online services where you can order antibody testing without a clinician's order and they are the same tests that I might order through my clinic - IgG type specific antibody testing.  Since virus can be given off from the body even when there are no symptoms, having sex prior to the outbreak is probably no more risky than sex you have been having all along with no outbreak.

So in summary, no, I don't think testing is important at this time from a clinical point of view.  If you decide down the road that you really want or need to know, the option for antibody test is always open to you.

Please feel free to ask me any more questions about this that you might have.

Terri
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39 months ago
So if I understand, you are saying that there is a chance I do not have the virus even though we've been together 16 years. (if we assume it is herpes). I guess I need to know what you are recommending I do in the case that he has it and I don't.

If there is a chance I do not have it, I would like both of us to be tested so that I know for sure what it is and if I have it. Our doctor recommended that we abstain before, during and just after outbreaks and that he take the anti-viral meds during an outbreak (which he did for this one occurrence).   I don't like feeling paranoid that there is something I could do to prevent myself from getting herpes and feeling like he could be on the verge of an outbreak and thus more contagious at any moment. For example, several weeks after the occurrence he had a "spot" near the area but not the same location that never became weepy like the first one so he went back to the doctor and he tried to take a culture but it tested negative so that could have been eczema or anything. If I knew for sure that I already have it this would be a big relief. 

If I don't have it, I guess I don't really understand what I should do. Does that mean I just resign myself to getting it or would you recommend we use condoms and abstinence if he feels any tingling anywhere. Am I only at risk during intercourse or can we not do anything if he suspects he is on the verge of an outbreak? Our doctor said we should just act as if nothing happened and forget the entire incident  as it could be another 16 years until he has another outbreak or he might never have one or he could have one next week. I'm not really comfortable with that

 Would he even know if he were going to have an outbreak? What symptoms would he have?

Does it happen that someone has no symptoms to the age of 43 and then suddenly they start having breakouts several times a year and then give it to their spouse and they both start having frequent outbreaks?

is the IgG type specific antibody testing the DNA testing? am I correct that there are false negatives but false positives are rare?

As I mentioned, life is unpredictable so there is a chance in the future one or both of us would be in the position of possibly transferring it to someone else. Thank you for your time and consideration.
39 months ago
I guess I don't understand what I should do. I don't like feeling paranoid that he could have another outbreak at any moment. Our doctor told us to abstain during an outbreak and for him to take anti viral meds if he has another outbreak.  My husband took a course of antivirals with this first outbreak.

The doctor did not say it was more likely to be herpes or shingles, he didn't know.

As an example of paranoia, a few weeks after the first outbreak he had an "itchy spot" that the doctor tried to test. This one was not in the same location but near and never became painful weepy and oozy like the first one and of course the test came back negative.

I would like both of us to be tested. It would be a relief to me if I knew that I already had it. Otherwise, I will always feel like I could be doing something to prevent myself from getting it. Is the test you mentioned the DNA test? If it indeed turns out he has it and I don't what should I do? Am I at risk only during intercourse or can we do other things? Should we be using condoms? Am I just resigning myself to getting it? What do you recommend I do in this situation? does it happen that someone has no symptoms for 43 years and then suddenly starts having frequent outbreaks and then also gives it to their spouse? Is it more likely that I simply already have it and am asymptomatic? Do you have statistics for this that would be helpful.

As I mentioned life is unpredictable and one or both of us could at some point be in the situation of possibly transferring to another person.
39 months ago
I accidentally sent two replies because I thought I hit reset instead of submit and rewrote my reply. I hope you will count them as one reply since they say the same thing. I apologize. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Emily, if you want to know if you have herpes (both of you), what you want is an IgG type specific antibody test.  You can use healthcheckusa.com for this or any number of online testing service.  An outbreak does not need to be present for this to happen.  It can be done at any time.  You want testing for HSV 1 and HSV 2.  Once you have the results, you compare what is between you - see what is different and what is the same.  The thing is, when people get tested and find out they have herpes, they start to recognize outbreaks when before they never did.  Outbreaks can occur on the buttocks or thigh or belly or abdomen, not just genitals. 

If he is infected with  herpes virus that you are not, then him taking daily antiviral will reduce the risk of infecting you by almost half.  Condoms will also reduce the risk of infecting you.  How many things you want to do to protect you after all these years of not being infected is certainly your call.  Some people would do everything, some nothing. 

The antibody test is not a DNA test, it is an antibody test.

Avoiding sex around outbreaks is useful of course, but people shed virus in between outbreaks, even with no symptoms, so that doesn't always work, to be honest.

Terri
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