[Question #7037] Help evaluating risk level please.

9 months ago
Good morning doctors.

Let me say that I feel lucky to be able to ask you questions to you directly. This is an amazing service.

I don't wish to bore you with a long story but I believe you need to know details before I ask my question.

Background. I'm 30, married for 10 years we are both from south America originally (idk if this details make a difference on prevalence of hsv in childhood) . I have never had an outbreak of herpes in my life, however, on March last year, my wife presented a few blisters that scabbed, I'm afraid this could be herpes altough not initial because it was very mild and also I can be almost 100% sure there was no infidelity from her part,means 1 outbreak in 10+ years.

My question is; I've been involved in an extramarital affair with a girl from work, she and her husband were the only people they kissed or had sex, they were Virgins from China, no outbreaks ever. I've been terribly afraid of getting infected from my wife and pass it to my co worker. I've read about asyntomatic shred being in the neighbourhood of 1,10,000 of no lesions present as my wife seems to not have since 15 months ago.
Questions.
1) if you were somehow in my position, would you continue this activities until my wife or I presented outbreaks then stop seeing coworker?
2) if I were to get infected, would I be able to pass this before I have syntomps making it meaningless to wait for outbreaks?
3)do you consider a sufficient safety measure to wait for lesions either from my part or my wife to stop contact with her?
4) I know this is not a big deal in terms of medical emergency but should I stop this from the risk perspective?

On emore thing, we live in Canada and there's no HSV test approved here.

Thank you
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
When you say that your wife presented with blisters that scabbed, were these oral or genital blisters?   How long did they last?  Were they painful or tender?  Has she ever had something like this happen before?  Have you ever in your life had a cold sore on your lip or in your nose?  Have you and/or your wife had sex partners other than each other prior to being married?   If her blisters were genital, are you the giver of oral sex to her?  Was she seen by a clinician when she had the blisters that scabbed over? 

1.  I think you need more information about what exactly is going on here - you don't know for sure that your wife has herpes and it would be good to know that actually, rather than assuming you're correct before you decide what to do about your other partner.  If your wife actually does have HSV, it would be good to know if it is HSV 1 or HSV 2. If your other partner has even had a cold sore on her lip, then she is likely already infected and if your wife has HSV 1, then transmission is not an issue with this other partner. 
2.  You may well be already infected but again, you need more information about your status.  And yes, if you don't have HSV, the type your wife has, and you contracted it, you could transmit before you have symptoms, correct.  Or you could simply not have symptoms at all with a new infection.
3.  No, not having lesions is not the defining factor here.  What matters is whether you are actually infected or not and that doesn't always correlate with having symptoms.
4.  If you were my patient, I would recommend that you consider not having sex with the other person UNTIL you and your wife figure out what each of you has in terms of herpes.  I have dealt with many, many patients who live in Canada and they are able to obtain the IgG test for HSV 1 and 2, though I think they do that often outside of the regular medical system.  I also think if your wife told her regular health care provider that she had these blisters that scabbed, they might consent to do the IgG test through the regular system. 

I understand that it must be frustrating to not have testing readily available to you to try to sort out what the blisters were, but I think you may want to consider digging a little deeper into testing.  For both of you.  If there was no one else involved in this scenario, you could just wait and see if the blisters come up again and then have them swab tested (which you should certainly do either way).  But there is another person involved here, someone who was a virgin when they married.  If she comes down with genital herpes, this could be a huge problem for her, right? 

I look forward to your answers to my questions.

Terri
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9 months ago
Hi Dr Terri. 

I'm so glad you answered my question. 

My wife had oral blisters not genital. They were not swabbed or seen by a profesional but the description and look made me think it could be herpes, started like pimples, then blister then scabbed, mild and not too painful. Again, one episode like this in 10 years and this episode was 16 months ago, would herpes behave like this? 
I have never had any blister or sore in my lips, regular acne at the most (pimple, white head, nothing close to resembling herpes) 

I do perform oral sex and I get oral sex performed on me with both  my wife and co worker. 

I do understand that it is imperative that ibknow for sure if she has it but it would be suspicious if I push on asking for testing and as for myself it is hard to get tested here I found. 

Given the impossibility of knowing for sure because of lack of testing, what are the chances I could be infected if I never had syntoms and my wife only one in so many years? We did have previous partners. 
My co worker has never had any syntoms genital or oral but you seem to think that a person can be infected but never develop syntoms? I thought almost always initial infection would bring syntoms. 

Given the situation and according to your experience, without the certainty of testing, what would be your best guess on this situation? If you feel this is a potential danger I would stop this in order to protect my co worker. 

Thank you so much doctor. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
Herpes could definitely behave like this, with infrequent recurrences, yes.  I'm thinking that at least from your description, you don't need to push testing, it sounds very much to me like she has oral herpes, as does half the adult population in the US. 
If you and your wife have been together for 10 years, she has HSV 1 and has apparently had two outbreaks, I think you may well be a risk to your co-worker, yes.  It would also be appropriate for you to get an HSV antibody test to see what your status is.  The IgG test is not perfect - it misses 30% of HSV 1 but if you are positive, then you will know for sure.  You can order this test from a number of online services.  At least this will give you more information from which to make an educated decision.

Terri
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9 months ago
Hi Dr Terri. 

Thanks for answering to my question. 

I will like to use my last follow up question to ask. 

My wife actually just had one, not two outbreaks in more than 10 years, probably never had any other ever. My question is, how can I have never presented any outbreaks myself?  
My co worker agrees that getting oral hsv can be explained better as saying that she shares lip balm, glasses forks etc but it would be harder to explain with a genital infection. Should I refrain at least oral sex? 

I read Dr Hook quoting that in absense of sores the chance of infection is 1 in 10,000 do you agree with this? If you do I think we can take the risk, oral is not the end of the world but what we want to avoid is genital, again, I have never had outbreaks. 

Any other word on how to make this safer at least from the genital perspective? How common is it to get hsv-1 on the genital from the mouth with absense of lesions? It is my understanding that hsv1 prefers the lips altough it is possible on genitals as well... Any word on percentages of risk is appreciated to help us make a decision. 

Thanks 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
The thing here is that we aren't certain that what your wife had was an oral outbreak, right?  And sorry I got the number wrong, I thought it was two.  And have you actually tested to see if you have HSV 1 or not?  Don't you think that would be a useful piece of information?
I'm not clear where that statistic comes from, that you quote from Dr. Hook.
In my experience, most mouth to genital transmission happens in the absence of a cold sore - most people with cold sores don't give oral sex and most people who are receiving oral sex would prefer not to receive it from someone with a cold sore on their lip.  But you are correct, HSV 1 prefers the oral area and recurs and sheds more frequently there. 
I think the risk here is you having oral HSV 1, not knowing it, and giving your co-worker oral sex or kissing her.  Her giving you oral sex is far less risky because if you had genital HSV 1, it would shed infrequently.    We don't have research on the transmission of HSV 1 infection, either oral or genital. 
I would simply encourage you to consider her marriage when you decide what to do here.  You are seeking out accurate information and that is certainly a huge step in this process.

Terri

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