[Question #9690] HSV - Timeline and Questions.
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30 months ago
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I am a 40 yr. old male in a new relationship with a 34 year old woman; both middle-class, college-educated demographic. We have had unprotected oral/vaginal sex 20-25 times over the last two months. I am confirmed HSV-1 positive, oral. Prior to this, I was in a casual sex relationship with a 37 yr. old woman. We had an evening of unprotected sexual encounters on January 28th, and again on Feb. 10th. I had no signs of genital HSV following these encounters, nor have I had any signs of it in my adult sex life, and it has been years since I had an oral HSV outbreak. She stated I was her first new partner in six months.
My (now) girlfriend and I reconvened on Feb. 11th, and had unprotected sex throughout the weekend. On Feb. 15th, she displayed symptoms of genital herpes. Upon visiting her doctor, this was confirmed via culture. Based on 2021 test results (HSV-1 & HSV-2 negative), we believe this occurred due to sex with me. As of two days ago, I began having illness symptoms. Lower back pain, lights feeling bright, headache, overall genital 'discomfort', some burning on urination. Anxious, of course. I took Z-Pak, Cefixime & Flagyl to eliminate potential STD's, and began dosing daily Valtrex.
- Is it likely that I caught HSV-2 on the 28th or 10th and have yet to show symptoms, but my girlfriend showed symptoms on the 15th?
- Given I dosed Valtrex upon my feelings of illness/her outbreak, would that alone prevent an initial HSV-2 genital outbreak?
- Do my current symptoms sound like a lead-up to a genital outbreak?
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30 months ago
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Forgot to add....had chills yesterday, continued phlegm-y cough, scratchy throat. Not that this is some huge addition to my initial post, but wanted to give the full picture.
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Terri Warren, RN, Nurse Practitioner
30 months ago
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you mention that was was confirmed as having herpes by culture. Did she have HSV 1 or HSV 2? I certainly hope it was typed, and if it wasn't, she should contact her provider right away to ask that that be done - labs keep samples for a bit after they are resulted out.
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You mentioned that you are confirmed as having oral HSV 1 - have you ever been tested for HSV 2? has she? You say negative on 2021 for both HSV 1 and 2 - is that her or you? I'm thinking her
Yes, you could have contracted HSV 2 at the encounter with the other person at either encounter and not displayed symptoms and then transmitted it to your girlfriend. People who have HSV 1 and subsequently acquire HSV 2 often do so without symptoms of the HSV 2 acquisition.
It is also possible that you transmitted asymptomatic HSV 1 to your girlfriend through oral sex. HSV 1 genital infection is a very different disease than HSV 2 to knowing the type is essential.
Your current symptoms are a bit vague but could be HSV and yes, the Valtrex could certainly have reduced symptoms.
Though we normally discourage antibody testing for HSV 2 now because of the high rate of false positives, this is a time when IgG test would be recommended if you want to know what's going on. But if you recently contracted HSV 2, it might be too early for a positive IGG test.
Terri
Terri
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30 months ago
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Not certain the culture type; we can follow back up. Awaiting blood work. I've been tested for HSV-2, but long ago. Perhaps a decade ago. She tested negative for both 1 & 2 in 2021. I am testing for both 1 & 2 iGG, and will re-do them at three months for reassurance.
From what I've read surrounding the encounters I described and the ability to pass HSV-2 on so rapidly. Per data, it has been referenced by HHH that there is a 1 in 1000 chance of transferring HSV-2 to a partner during a single act of sex when there is no active outbreak with a known infected individual.
So we're saying that there is potential that, from the, say, three-to-four individual sexual encounters I had with a presumably asymptomatic individual (assuming that one is not having an evening of sex during an active outbreak).....that I both contracted HSV-2 asymptomatically from one of those encounters, and also passed this along to my partner immediately thereafter during a potential HSV-2 incubation period or initial asymptomatic outbreak based on her diagnosis?
Also.....in the absence of lesions, but w/ symptoms like headache, fatigue, minor urinary burning.......can an initial outbreak truly be asymptomatic from a physical 'expression' standpoint? My understanding (of course, could be wrong) is that most initial outbreaks have *some* sort of physical outbreak - could look like an ingrown hair, pimple, etc.....but *something* occurs on the skin.
Thanks so much for your guidance.
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Terri Warren, RN, Nurse Practitioner
30 months ago
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I think it is unlikely that you acquired HSV 2 and then immediately passed it to your partner but there is enough information missing here that we just can't say for sure.
If either of you had a baseline antibody test, we could know which type, if any, either of you had prior to this diagnosis. And if we knew what type of HSV your girlfriend has right now it would certainly clear up many questions here.
An initial outbreak is often missed because the symptoms are mild or atypical - in fact, 85% of those infected with HSV 2, when diagnosed by a good antibody test, would deny any symptoms of genital herpes.
Again, the first thing we need to know is your partner's type of HSV.
I think a more likely scenario is that she has HSV 1 from you if you were the giver of oral sex to her OR that she had it prior to your sexual relationship
Terri
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30 months ago
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Thank you, Terri. Just a few more questions, and that'll finish things up for me.
- From your vantage point, what is the typical HSV incubation period?
- Is the virus easy to 'pass along' during that incubation period (with no symptoms) or not so much?
- From research/experience, what is the longest period of time that you've seen from acquisition to expression of HSV on the skin?
- If an initial outbreak is asymptomatic or mild, does that typically hold true moving forward/throughout the length of the virus, or does it tend to worsen after that initial time?
Thanks again!
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Terri Warren, RN, Nurse Practitioner
30 months ago
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The average time from infection to symptoms is 5.5 days
Yes, very easy to transmit that early in infection
It can takes years before someone has an outbreak from an initial infection.
The infection can be asymptomatic for years and then start recurring - we don't actually know why for certain. Or it can stay without symptoms. Conditions that suppress the immune system like cancer or HIV would be likely to cause more outbreaks.
Terri
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