Contraction Scenarios

[jbd2011]

I’m a 27 year old gay man recently diagnosed with HSV2.

My ex and I were monogamous since mid-July, having unprotected sex throughout.

On 9/20 my ex cheated and had unprotected sex with a couple, and we had unprotected sex the next day. Three days later my bowel movements started to hurt, my groin area was hot/itchy, and I had an on/off mild fever. 3-4 after this, I noticed a cluster of sores on my butt and two on my penis. I went to the DR and a swab test confirmed HSV-2. Noticed the swollen lymph nodes in my groin. All this time I assumed my ex was a long-time asymptomatic carrier and passed it on to me, but he just admitted to the cheating.

Other information:

-Ex has never had a genital breakout but had cold sores. After my outbreak he got blood tests that showed: HSV 1 IgM Antibodies (neg), HSV 2 IgM Antibodies (neg), HSV 2 IgG (neg), HSV 1 IgG (positive). Tests performed on 10/5.
-I spoke to the couple. They are not aware of having HSV2 and are waiting on bloodwork.
-I was stressed the week of my outbreak because I suspected the cheating
-I’ve never had cold sores, that I remember
-My ex says the night of 9/20 was the only time he cheated

I’m writing to get your take on how certain we can be about how I contracted HSV2. Can anything be confirmed or ruled out from the couple’s test results, my ex getting tested again after more time passes, or me getting tested for antibodies now?

Two reasons for this: 1) If I likely contracted because my ex cheated and lied, he wants to make amends and scenarios like covering all healthcare costs related to this are on the table, and 2) if test results can confirm I didn’t get it from my ex, or my ex via the couple, that means I’ve had HSV-2 for the whole relationship and didn’t pass it on through three months of unprotected sex and no valtrex. That would be encouraging for future partners.

Eager to get your take and let me know if there’s other information that would be helpful. Your handbook was a godsend!

[Terri Warren]

You can be sure that you have HSV 2, yes. Your symptoms are consistent and swab test confirmed it. When and how you got it remains a mystery. You could have had it a long time OR you could have recently gotten this. The negative IgG strongly suggested that this is a new infection, I will say. Positive swab, negative IgG always suggests new infection but it can’t be 100% certain since the IgG test misses 8% of HSV 2 infections.Your partner may have been newly infected and tested too soon for an accurate test. I would suggest that your partner get retested about 8-12 weeks out from the concerning encounter. And I’m guessing that your partner had sex with another couple so their status will also help sort this out.

Terri

[jbd2011]

I think there was a mixup: I’m sure that I have it, given my swab and my symptoms. I’m wondering what other peoples’ tests results can tell me about where/when I got it. The only test I’ve had was the swab. The other results I listed were for my ex (apologies if I framed in a confusing way!).

To clarify test results:

Me: positive HSV2 swab
My Ex: Two weeks after my outbreak, he had these blood tests done: HSV 1 IgM Antibodies (neg), HSV 2 IgM Antibodies (neg), HSV 2 IgG (neg), HSV 1 IgG (positive)
The Couple: Not aware of having HSV2, but waiting on blood work

The question is, if my Ex’s blood results stay negative, can we say with certainty I didn’t get it from him? Since he already has HSV1, is it possible HSV2 would be harder to detect in his system?

If the couple’s results come back positive but my Ex’s stay negative, is it possible that because he had unprotected sex with them and then me in a 6-8 hour window, he passed it on without contracting himself?

Would having my ex or the couple do other tests, like Western Blot, or get retested at a later date provide more clarity?

Again, asking primarily because if we can rule out this came from my ex, or was transmitted through him via the couple, that means the earliest I picked it up was from a sexual encounter ~6 months prior. If it’s possible to establish that this is the case, that would be encouraging news because it means I didn’t transmit anything over the course of four months of unprotected sex.

Thanks again!

[Terri Warren]

YOu can way with 92% certainty (the sensitivity of the IgG results compared to the gold standard western blot), if his IgG is negative that he is not infected, correct if he waits 12 weeks for a final test from his last encounter with the couple.
No, he would not have infected you if he was not infected.
The western blot is simply more sensitive (picks up more cases of HSV 2 and HSV 1) than the IgG test, correct.
Until you have a final result from the couple and your ex, there isn’t really any way to get more clarity about all of this and whether you infected others or not.

Terri

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