[Question #6826] Diagnosed with HSV-2 last month

10 months ago
Hello,
My wife and I had a threesome with a friend who didn't know he had herpes, and now we have both tested positive for HSV-2 (via urine test, blood test, and also sores & dysuria). I've read conflicting info online and want to make sure I understand: 
1. I read that there is a possibility of autoinoculation (transmitting my genital herpes to my mouth or eyes) during the first 4 months after contracting it. Is that true? Or is it only for catching HSV-1 in the first couple months while our body builds up antibodies?
2. I had also read that my wife and I should avoid giving/receiving oral sex for these first 4 months to prevent transmitting HSV-2 orally. Is that true, or have enough antibodies built up in the past 3 weeks since we caught it?
3. If we bring our friend back to the bedroom again (or anyone else with HSV-2), are there any risks to us or to them now (within these next few months) or in the future? 
4. I read that the initial outbreak will be the worst, and lessen over time. Will future outbreaks have similar symptoms (so for me, I don't have any sores, but my skin feels more "tender" to the touch, and I have dysuria. My wife has genital sores and dysuria. So is this what we should expect in the future? Will we likely ever get cold sores?)
5. There is a daily medication and medication for when symptoms flare up. Why choose one over the other since it's low risk? Wouldn't it be best to just take the daily medication to prevent/lessen any potential outbreaks?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
1. I read that there is a possibility of autoinoculation (transmitting my genital herpes to my mouth or eyes) during the first 4 months after contracting it. Is that true? Or is it only for catching HSV-1 in the first couple of months while our body builds up antibodies?

I think the four-month figure is around because by 4 months from a new infection most everyone will have made antibodies.  I think more accurately now, it should read three months.  The majority of people who become infected have mounted an immune response that prevents almost all autoinoculation by 8-10 weeks out, with a few exceptions.  What was the index value of your antibody test?

2. I had also read that my wife and I should avoid giving/receiving oral sex for these first 4 months to prevent transmitting HSV-2 orally. Is that true, or have enough antibodies built up in the past 3 weeks since we caught it?

I doubt three weeks is long enough for an adequate immune response.  I think I would suggest you give it at least six weeks.

3. If we bring our friend back to the bedroom again (or anyone else with HSV-2), are there any risks to us or to them now (within these next few months) or in the future?

No

4. I read that the initial outbreak will be the worst, and lessen over time. Will future outbreaks have similar symptoms (so for me, I don't have any sores, but my skin feels more "tender" to the touch, and I have dysuria. My wife has genital sores and dysuria. So is this what we should expect in the future? Will we likely ever get cold sores?)

If you've not had oral lesions yet from this case of HSV 2, you likely won't in the future.  Usually, the first infection is the worst and future outbreaks will be more limited and less uncomfortable. 

5. There is a daily medication and medication for when symptoms flare up. Why choose one over the other since it's low risk? Wouldn't it be best to just take the daily medication to prevent/lessen any potential outbreaks?

The daily medicine can reduce the frequency of outbreaks and of giving off the virus if you were to have sex with someone who is not infected.  If you are not concerned about that, and you won't know how your future outbreaks will be for a while, you could treat the outbreaks as they come up.  If you are having more than you want to, you can start daily suppression.
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10 months ago
So just to clarify the time frames that you mentioned regarding autoinoculation and oral sex: We should hold off from oral and be careful about touching susceptible areas for AT LEAST the first 6 weeks, but realistically 8-10 weeks, but IDEALLY 3-4 months to ensure we have the most antibodies? I apologize for my confusion, I just expected one flat number for all of it. Haha!

Since I'm not having any sores (and neither did the guy we were with), what exactly do I need to be careful of (regarding autoinoculation)? Just touching the genital area and then a susceptible area? For example, should I use a separate washcloth when showering, and a separate towel when drying off for these first couple months?

My wife had one small painless sore that looked like a canker sore appear on the roof of her mouth for a couple days and then disappeared - is there a high likelihood that she will have external mouth sores now?

Is vaginal sex okay right now since we both have genital HSV-2?

What are the chances of catching HSV-1 now (or even after the 4 month immune buildup)?

To answer your question about our IgG index values, I wanted to mention that we had the threesome on March 21st and were already experiencing symptoms within 2 days, so we had the blood & urine tests on the 26th, so I expected our numbers to be pretty low. For HSV-1, I was 0.57 and hers was 0.06. For HSV-2, mine was 0.15 and hers was 0.12 with an IgM of 1.23. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
The IgM has many false positives so I would ignore that.  Why do you think you have HSV 2 if you've not had sores?  Your wife had sores and was swab test positive, is that right?  But not you?  Are you basing your diagnosis solely upon the IgM?  You don't mention a positive and typed swab test?
It's hard to know what that was on your wife's mouth - maybe not even herpes?
Vaginal sex is fine IF you are both positive and I'm not sure about that at this point.  You mention the urine test?  I hope you weren't diagnosed with a urine test - maybe that was for other STDs?

Terri


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10 months ago
We were both positive from the urine test and the IgM test, but had the low numbers for IgG. I have had one sore near the base of my penis that lasted maybe 24 hours, but has already disappeared. Neither of us have any sores at this point, but I'm having sensitive skin on the genital area. I have also had a lot of tingling in my legs over these past 3 weeks, and am on a second round of Valtrex... With all of these symptoms and positive tests (although not a swab test or the Western Blot), do you feel like these symptoms could be something else instead of HSV2? We planned to get re-tested for all STI's at the 3-month mark, at which point, I expect our IgG numbers to be much higher. And if we have any sores at that point, we'll opt for the swab test... 

Circling back to my questions: Did I understand your timeframes correctly? Are there things that we should do to prevent autoinoculation? And is our chance of catching HSV-1 significantly lower now?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
There is no urine test for herpes, that I am aware of.  Can you please share that information with me in written form? And the IgM is unreliable.  What was your number for the IgG? I just don't think that this is definitive for herpes at this point.  Normally, a herpes lesion does not last for 24 hours only.  I'm just not sure at this point and I think that it would be worth confirming, for sure, with a later test.  I'm not saying you aren't infected, I'm just hoping you can get some confirmation. 
Does either of you have any herpes tests in the past to rely upon for a previous negative? 
I think that by three months or an IgG of over 3.5 should be adequate to stop being concerned about autoinoculation.

Terri
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10 months ago
In reply to your question about an HSV urine test - our doctor ordered the Pathgroup Labs "Transcription-mediated amplification" (TMA) urine test for 5 STI's, including HSV-1 & 2. Here is the link in case you are interested in more information regarding the test: 
https://pathconnect.pathgroup.com/testmenu/#/testinfo/U1RJRFA%3D 

Regarding your other question as to whether or not we have had HSV-negative tests in the past: We have been tested in the past and the results were negative (but I've never kept any paperwork to know the IgG indexes on them since the results were always negative). 

We don't plan to do anything with anyone during the COVID quarantine, so we'll plan on waiting 3 months from 3/21 before doing another IgG blood test and confirming whether or not we actually have HSV-2. (Fingers crossed that all of these tests were false positives!) I guess we'll just try to prevent possible autoinoculation by washing and sanitizing everything since you haven't mentioned specific actions to avoid... Thanks again for clearing up a lot of the conflicting info for us!! :)
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
So here's the problem with a test like that (and I worried that might be the case).  Herpes is active only intermittently.  So if the test was negative, it would not tell you that you were not infected, it would only tell you that there was no virus in THAT sample.  But what you're telling me is your urine test was positive so that concern is not present.  The CDC does not recommend this urine test, BTW.  And that's probably for the reason I list above. 
I don't think you need to go too crazy about avoiding autoinoculation.  You're washing your hands after using the restroom anyway, these days, that's all you really need, honestly
Thanks for providing me that information.  I was worried that somehow a test like this would hit the market and apparently, it has.  Was there any disclaimer about herpes testing in the result packet?

Terri
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