[Question #6480] HSV-2

13 months ago
Dear Doctor

I am a sexually active, heterosexual male in his mid-thirties. 

I generally take precautionary measures (condoms) but if I am serious about someone, I always suggest that we get tested for major STDs and have unprotected sex.

Lately however I've grown increasingly concerned about Herpes - specifically HSV-2. 

I was advised not to test for it since I don't have symptoms. I was told that I could have it and show no symptoms. And that a girl could have no sores and still be contagious.

In the past, I simply took a very good look at what was going on down south, and if everything looked "normal" I felt much less worried. Same goes with lip sores: I subtly checked my partner's mouth for any telltale signs.

But now I am worried that none of these precautionary visual checks amounts to much, given the information I just brought up.

Can you let me know if there is a strategy to having unprotected sex AND do so without worrying about catching HSV-2? 

All the best
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
13 months ago
Well, the CDC says that herpes antibody testing should be considered in those seeking a full STD screen.  So I see nothing wrong with you doing this test IF you understand it's limitations.  About 3% of people doing this test will have a false positive result, but usually we can address this by looking at the index value of the positive result and deciding if a confirmatory test is needed.  Also, the test misses 30% of HSV 1 infections and 8% of HSV 2 infections.  This test information applies to you and to partners that you may have in the future.  You are correct that your visual inspections may not be very useful as 80% of those infected with HSV 2 don't know they are infected.  The thing is, if someone tests positive with an accurate test, there is much that you can do to reduce the risk of infection - symptom recognition, daily antiviral medicine, condom use - all of those things can be done to reduce transmission but if you don't know that you or your partner is infected, there is nothing that you would do, right?  Not all clinicians agree on this topic, but I've been doing this for many years and this is my opinion.

Terri
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13 months ago
Thanks for your reply!

How long after a potential exposure should one expect to have an outbreak?
I’ve read that some people don’t have symptoms after infection but, somewhat akin to primary hiv infection, even if they actually do have symptoms but choose to ignore them or write them off as something else. So in other words, the symptoms are often there if one pays close attention in the first 10 days or so. True?



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
13 months ago
The average time from infection to outbreak is 5.5 days with the range being 2-10 days.  I think that often symptoms are missed or confused with other conditions but some people truly don't have any symptoms when infected - that is most common when someone has a history of HSV 1 and they acquire HSV 2.

Terri
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