[Question #9735] Drs, Please help with STI Risks

29 months ago

Since last neg test:

1. Unprotected oral (dates, SO)(Some dates was a single time, others several. SOs would be most encounters). 2. Protected vaginal sex with dates. (many times) 3. Unprotected vaginal sex (1 encounter with a SO I saw for several months, other with diff SO partner over years) 4. Unprotected oral sex with CSW—briefly and once. 5. Protected oral sex with CSW- (Twice, and one was painful due to teeth) 6. Protected vaginal sex with CSW- (Twice—One time took condom off went back to hand, new condom on and had sex again)7. Unprotected handjob with CSWs (many times)

Please add some metrics/percentages, to help understand what risks for HSV-2 were in each of those categories?

Terri Warren, RN, Nurse Practitioner

29 months ago

well, what we have are statistics for transmission between couples that have been together for a while, not random hook ups or one night stands. We know that the risk for receiving oral sex is HSV 1. You mention oral sex but you don't mention if you were the giver or receiver. The receiver risk is HSV 1.

Condoms reduce transmission by about 65% over all if an infected male is having intercourse with an uninfected female. But again, we don't know what the risk is when we asses casual sexual encounters vs. longer term relationships. We just haven't really studied that.

Handjobs are risk free.

HSV 2 is almost never transmitted through receiving oral sex and lots of your questions are about that so I hope that is helpful.

We do know that many transmissions of HSV 2 occur in the first three months of a sexual relationship

Condoms continue to be your best bet, for sure. Also, it's fine to ask kindly if someone know if they have HSV 2 infection or not.

Hope that's helpful

Terri

---

29 months ago

With the new character limit, much of my question was cut and the context lost. The intent of my first question was to assess the level of risk for HSV-2 from the explained sexual encounters below. I am a male who received oral sex or inserted into females. From your answer, it seems handjob are not a risk and receiving oral sex--even unprotected isn't really a risk for HSV-2. So, if I tested positive for the first time recently (due to a full STD panel, not sores or blister symptoms) what would be the most likely source--given risk levels? Protected sex with a CSW? Unprotected sex with long term relationships that claim to be monogamous or one of the "sexcapades" explained in the first question? Even with condom change and any possible mishaps with the CSW. What was the likely source of my infection given the above based on established risk levels and/or your professional expertise for the random hook ups that might have less "established" metrics. Thanks

Terri Warren, RN, Nurse Practitioner

29 months ago

Sorry I missed this addition to your post. So if you tested positive for what - HSV 2? Condoms reduce transmission from females to males by 65% so they offer quite a bit of protection.

What is the index value of your HSV 2 antibody test? Was it an IgG or IgM test? have you had any symptoms at all in the way of sores in the genital area?

The oral sex is not really a risk for HSV 2.

Remember that there are false positives on the IgG test and LOTS on the IgM tests.

Terri

---

29 months ago

I was having testicle pain and soreness in my foreskin so I took a full STI panel at Labcorps. Was negative for everything except HSV-2 (IgG test 6.8). Pain was lingering so went to ER a few weeks later and again negative for STI. Followed up with urologist, neg STD urine test third time. Took HSV-2 IgG Inhibition assay confirmation test with Quest Diagnostic, positive again. Shows, 8.7 (In range "normal") and inhibition interoperation of 95.0 H (Positive).

Never had any sores or blisters. Just the testicle pain, soreness/sensitivity in penis and slight burn urininating (which still comes and goes 2 months later) Dr said epididymitis (with no known cause).

My mental health isn't good right now. I need to understand where it came from. So, what was the most likely source from the possible exposures I mentioned. I am tracking oral is low risk and condoms reduce by 65%... What about the rest?

Thanks!

Terri Warren, RN, Nurse Practitioner

29 months ago

You are likely infected with this particular index value, but if you want extra certainty because you have no sores ever, you could do the western blot

The desire to know where a herpes infection came from is common - most people wonder about that. But you may never be able to know. I almost certainly didn't come from oral sex given to you nor hand jobs, for certain. It could be regular partners with whom you did not use a condom and who didn't know they were infected or it could be people with whom you used a condom but got infected anyway.

About 85% of those infected with HSV 2 are unaware of their infection so I would advise you not to think that someone transmitted this to you knowingly. At some point, you will move from trying to figure out where this came from to trying to figure out how to live life more fully with herpes. I would encourage you to read accurate sources and consider looking at Herpes Opportunity, an interesting site that talks about acceptance and help with disclosures in the future.

I know this is a challenge. Let me know at westoverheights.com if you want to pursue the western blot

Terri

---

29 months ago

So if I narrow the exposures down to a single protected oral and vaginal sex event with a CSW and years of unprotected oral and vaginal sex with a SO, which statistically is the higher chance of the exposure?

With my number being 6.8 then 8.7 on the assay—what does the increase mean (or different due to being different tests and labs) and can you estimate how long the infection has been present? I would think the number has some value that can be interpreted.

Is still possible sores will appear one day?

Thanks for all the resources you provided.

Terri Warren, RN, Nurse Practitioner

29 months ago

I would say, and this is definitely a guess, a significant other with whom you had repeated encounters would more likely be the source. Because 85% of those infected with HSV 2 don't know it, anyone could be the source, regardless of whether they think they have herpes or not.

Terri

---