[Question #9155] Risk Assessment

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35 months ago

I am a 40 yr old female and AA. My ex-partner is 54, AA. We discussed testing and STIs. I shared my test results for all STIs including HSV and HPV. My ex-partner also got tested and shared his results. His doctor did not test for HSV.  His doctor said without symptoms, there was no reason to test. He does get cold sores from time to time, however, he claimed he never had sores on his penis. We limited kissing and oral sex if he had a cold sore, which was two occasions in 10 weeks.

 We have engaged in sex a total of 11 times. 8 instances were protected with unprotected oral. The first instance of unprotected sex occurred because he thought he was in the clear with his test results. The next morning, I bought Plan B and I informed him that I am unwilling to have sex without condoms. He complied. I began a regimen for birth control in July.

 Two days ago, I was intoxicated and we engaged in sex. He admitted that he did not wear a condom, twice, he is only sleeping with me and he is negative for several STIs. I broke up with him because I feel disrespected.

I am just in need of a quick assessment of my risks for both pregnancy and HSV from the last two occurrences of unprotected sex. I did take an additional regimen of Plan B. I am experiencing vaginal itching on my labia major, not on my labia minor or in the vaginal opening. I have not seen any suspicious bumps; however, I was told that HSV does not always present symptoms. I really did what I could to avoid being irresponsible. 

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Terri Warren, RN, Nurse Practitioner
35 months ago
It sounds like you've been so careful about both pregnancy and STIs.  Very impressive indeed.
I'm assuming he was the giver of oral sex to you?  Do you ever get cold sores?  Do you know your HSV 1 status?  I ask because his cold sore history indicates that he has HSV 1 orally, and that could be transmitted to via you receiving oral sex. This is a small risk when he does and when he doesn't have a cold sore.   it is not a big risk, but you are asking for a risk assessment, and that's part of your risk.

The three instances of unprotected intercourse also present a small risk of acquisition of HSV 2 if he is indeed infected with HSV 2, which you don't know, I'm guessing.
Would he be willing to test for your benefit?  I think it is possible, it would be worth asking him.

If he does have HSV 2, is certainly doesn't mean that he infected you.  Depending upon how long he's been infected, if he is, he may be shedding virus often or infrequently.  But if he is infected, he is not giving off the virus every day - it would be only intermittently. 

In terms of pregnancy, plan B should take care of that risk.

Itching of the labia could be yeast or bacteria or sensitivity to soaps, etc.  It does not, by itself, indicate HSV  infection.  When was the last time you had intercourse with this fellow?

Terri Warren
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35 months ago

Good Morning NP Terry, 

I looked you up on Google and perused your Westover heights site. I read a story where a woman had unprotected sex about 4-5 times and developed HSV. It scared the crap out of me. I thought oh man, this is me. This must be me. https://westoverheights.com/forum/question/test-results-interpretation-please/

 

Per my medical history, I was tested for both HSV I and II and HPV this past May. I had not had sex in over 15 months; however, I went to the doctor because I continued to have these weird itchy and red flareups on my labia majora and minor. Along with some discomfort in the vaginal opening. The NP in the OBGYN office was thorough with testing for HPV, HSV I and II, trich, BV, yeast, and a UTI screening. The UTI and Yeast came back positive. The NP said this was an ongoing infection, I did confess that I had been having problems for over a year, but my GP did not see anything concerning. The NP believed the UTI and Yeast infection was caused by not being able to use the bathroom as needed with my demanding job working with at-risk youth. I can't leave students unattended until my shift was over.  The antibiotics relieved the pressure for the UTI, I did not have intense pain, just consistent pressure, and mild discomfort. The Yeast infection was treated with two Diflucan pills. It cut the itching quite a bit. Not 100%. I was told to give my body time to heal. 

 

Suffice it to say, I did start having sex in June and we did exchange test results. My ex-partner and I only had sex on the weekends because he has his young son during the week. He had not been tested in three years and was negative for the majority of STIs, his doctor did not test for HSV I or II was he did not see any concerns on his penis. I have heard that many doctors avoid HSV testing, not sure why. 

 

 I did reach out to him, however, he is pissed that I broke things off. I was shocked because he had sex, without a condom, twice, while I was passed out from too much alcohol. 

 

My main symptoms have been consistent itchy spots on my labia major, especially within the top crease. The itching happens in different spots at different times throughout the day. The labia minor is sometimes red. Sometimes there is a mild burn during urination. I don't want to keep running to the doctor, however, could the yeast infection really have not been knocked out with Diflucan? Realistically, do I need to run back to the doctor for another HSV I and II test? I know in some instances that HSV I and II can be mild and mistaken for other things. Aside from persistent itching in different areas of my labia, those are the main symptoms that have plagued me this summer. PS-total amounts of unprotected sex (three times) along with unprotected oral between both parties. No presence of sores on my lips or labia. No noticeable discomfort near the vaginal opening. Keep me posted. 

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Terri Warren, RN, Nurse Practitioner
35 months ago
It is possible that the yeast infection was not cured by the Diflucan, yes.  And generally speaking, HSV doesn't cause prolonged periods of itching without sores.  What you need here is a swab test of the area of concern and it should be either a NAAT test or PCR - they are the same but can be called different things by different labs.  This is far more sensitive than the old style culture.  
Did you ask him to be tested for HSV?  Did he refuse or agree?
While three episodes of unprotected intercourse could give you herpes, yes, it still isn't too likely in my mind.  
I would get back to your NP and have that area that you describe evaluated in person.

Terri
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35 months ago
Good Afternoon, 
No, he does not want to get tested. He is pissed that I broke up with him after his sneaky stunt of performing an unprotected sexual act while I was blacked out from alcohol. He continued to say that he is fine and I am overreacted. I am not willing to go back. I will follow up with an NP once I get settled in Spain, I took another job outside of the country. I will have health insurance by October 1st. Right now I am using Miconazole for the next 7 days, hoping it will kill any yeast externally and internally. I realize this is my last chance to reply. Thank you for your assistance. Really quick, because I am 40, I also wonder if I am perimenopausal and if that is causing vaginal irritation as well. I will look into it. 
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Terri Warren, RN, Nurse Practitioner
35 months ago
That is certainly possible, but the person who sees you for care in Spain can also help with finding out if you are entering menopause or not. 

Terri
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