Ethical Obligation to Test Further? (Female with New Male Partner)

[scared1029]

Timeline:
01/09-01/16 Protected penetrative sex; both perf. unprotected oral; I swallow semen; touch his genitals then mine; kissing. Neither = cold sore history.
01/14-02/11 Think I have UTI, antibiotics (10 days), have period, labia minora pain
02/12 Go to OB/GYN; diagnosed yeast infection; given gynazole cream; neg. IgM, Chlamydia, Gonorrhea, HIV, RPR, Hep B.
02/13-02/15 Kiss partner; I perform unprotected oral sex/swallow semen; partner kisses vulva (2 seconds; no licking); touch his genitals then mine; no penetrative sex; think I see tiny red bump around penis head/large white bumps in back of his mouth. I have small cut in mouth
03/03 Think see bumps in mouth; urg care doc says nothing herpetic but can have IgM test for “peace of mind” Positive (1.44 Index). Diagnosed herpes.
03/09 Second IgM (2.04), IgG: HSV-1 0.16; HSV-2 0.07. Oral/vaginal exam. Cervix irritated & discharge; diagnosed with yeast infection; given flucanazole. Told nothing herpetic. I stop taking birth control.
03/12 Partner IgG negative HSV-1 and HSV-2. No index #s. Negative Chlamydia, Gonorrhea, HIV. Says last previous sexual contact = July 2014.
03/25 Irritation/redness between labia. Large whitehead painless bump next to vagina, shrinks in two days. Never experienced before.
03/31 OB/GYN exam. Says irritation = psoriasis; bump = swollen sweat gland. Given antifungal/steriod cream. Partner severs contact.
04/01-04/30 Itching, burning, soreness (like skin rubbed on abrasive surface), dryness, sometimes bright redness in painful areas. Fingerprint-sized rash on buttcheek (goes away in ~24hrs). Red bumpy area on labia minora (goes away in <24hrs). Sometimes sudden jolt pain. Cream helps sometimes. Pain often localized to different areas each day. Wear skirt with no underwear to minimize irritation. Terrible anxiety.
04/31 OB/GYN exam. Looks at symptom pictures. Says nothing herpetic. Rules out BV and yeast infection.
05/01–05/11 Symptoms continue; infrequent bruise/burning sensation around bikini line (lymph node?) bright redness between folds of labia minora; redness/irritation in buttcrack; not using cream as much
05/11-05/26 Infectious disease MD/STD specialist says IgMs are almost assuredly false +s, no credible exposure, no ev. of infect., without classic grouped vesicles, I should look the other way. Advises no addtl testing. No obligation to disclose IgMs to future partners. Symptoms continue.
05/27 Three painless red bumps between labia. Take pics. Gone in ~24hrs
05/28 OB/GYN exam. says pics dont look herpetic & bumps could be folliculitis (I’m skeptical bc not located in hair area); suggests IgG for “peace of mind”
Present – Symptoms less but intense before/during period. Tender wearing pants.

I know about IgG seroconv. window, IgG HSV-1 false neg rates, useless IgM, atypical symptoms. Don’t want anxiety of further testing but want to be safe. Would you rec. another test? Which 1? What are odds that I would be + on test if I took it next week?

[scared1029]

FYI, just a bit more information:

(1) Prior to the new partner above, I had not had sex/kissed anyone for 1 year and 1 month.
(2) In January, I noticed what looked like a small, pimple-like bump on the side of my tongue, which went away in less than 24 hours.
(3) In February, my partner kissed the cheeks of my buttocks.
(4) I did not tell any of my OB/GYNs about my positive IgM tests because I was worried they would not be up to date on the CDC’s guidelines regarding its uselessness. I feel pretty guilty about this and wonder whether it would have changed their evaluation of my symptoms.

[Terri Warren]

I think the IgM tests are likely false positives – they are known for that, most certainly, and sometimes it is difficult for people to get past that and move on even when they have negative IgG antibody tests. If your partner tested negative for HSV 1 and 2 and his history is correct, then you couldn’t have new infection, right?

I don’t believe that you have herpes. and I doubt that telling them about the IgM would have made any difference so you can put the guilt away.

I don’t see how a final IgG test at 16 weeks would help you unless you just don’t believe what your partner was telling you. Do you?

Terri

[scared1029]

Thank you. I think I could have a new infection if my partner (1) contracted herpes in the 3 month IgG gray area (Dec-Mar) then infected me during ~16x sex contact; ~10x rec oral; ~13x perf oral; (2) tested falsely neg for HSV-1 on the IgG, which misses 10%-20% of + cases. Re (1): I have no evidence that he was lying about his history, but he could have been. He did not hesitate to get the IgG but was very opposed to my getting further blood tests/visual exams. Re (2): this terrifies me – HSV1 is my biggest risk bc of its prevalence and the unprotected oral. I struggle with compulsive reassurance seeking, but I think I’d be able to stop testing without guilt if it were not for (a) IgMs (which aren’t ALWAYS false) and (b) my symptoms, which only started after I had sex with my partner. This situation is horrible. I examine my genitals over 10x/day, and going to the bathroom/taking a shower have become hugely anxiety producing. I need to stop running to doctors every time I see a speck on my vulva, but a + IgG would destroy my mental health. Questions:

(1) Do you think my fear of scenario (2) justifies further IgG testing? If I do test again, I’d like to get the IgG, but do I need to get the western blot because of scenario (2)?
(2) Does the fact that I tested IgM + twice make it less likely that these were false positives?
(3) Do my symptoms increase the likelihood that I would test positive? Do they sound consistent with herpes? If not, can you think of anything else they could be?
(4) Friday I noticed a small bump on my labia minora with a pinhead-sized whitehead on top (still there). It’s painless, but it appeared in an area in which I had been having soreness/redness and had applied a lot of cream. I’d like to avoid going to the OB/GYN twice in two weeks, but does this sound concerning?
(5) My STD expert believed there would be some IgG index increase three weeks after infection. Do you agree with this? If so, are my low index numbers 22 days after last possible infection at all reassuring? Does the fact that my HSV-1 index is more than 2x my HSV-2 index mean anything?
(6) Can you quantify the odds that I would be HSV1/HSV2 + if I took a test at 16 wks?
(7) Did my partner briefly kissing my vulva and my touching his genitals then mine put me at risk for genital herpes in Feb?
(8) If I do take the test and am HSV1+, is there any way to know the location? My symptoms suggest a genital infection. But, the fact that I tested IgM neg 1 month after my main genital exposure but + 22 days after predominantly oral exposure suggests an oral infection. Do you agree or could I just have delayed IgM seroconversion? Or maybe I happened to be having a genital “OB” in Mar but not in Feb?
(9) I’ve read about ppl with symptoms like mine (e.g. abrasive soreness) who never test + then have a subtle OB months later which they get cultured. When is it OK for me to stop examining myself? I want to be safe for future partners, but I need my life back.

[Terri Warren]

(1) Do you think my fear of scenario (2) justifies further IgG testing? If I do test again, I’d like to get the IgG, but do I need to get the western blot because of scenario (2)?
I would only recommend the western blot after appropriate timing has passed. but the western blot could certainly be positive for HSV 1 when the screening test is not and that might send you off on more anxiety, so perhaps not. You could not know if the HSV 1 was oral or genital.
(2) Does the fact that I tested IgM + twice make it less likely that these were false positives?
No, not really
(3) Do my symptoms increase the likelihood that I would test positive? Do they sound consistent with herpes? If not, can you think of anything else they could be?
No really consistent with herpes, not. Don’t know what this could be

(4) Friday I noticed a small bump on my labia minora with a pinhead-sized whitehead on top (still there). It’s painless, but it appeared in an area in which I had been having soreness/redness and had applied a lot of cream. I’d like to avoid going to the OB/GYN twice in two weeks, but does this sound concerning?
Not to me, but I”m not there to see it so honestly can’t say
(5) My STD expert believed there would be some IgG index increase three weeks after infection. Do you agree with this? If so, are my low index numbers 22 days after last possible infection at all reassuring? Does the fact that my HSV-1 index is more than 2x my HSV-2 index mean anything?
Only half of the people who are going to be HSV 2 positive would be positive at 3 weeks so no, I don’t necessarily agree. The difference between the two cannot be interpretted.

(6) Can you quantify the odds that I would be HSV1/HSV2 + if I took a test at 16 wks?
No

(7) Did my partner briefly kissing my vulva and my touching his genitals then mine put me at risk for genital herpes in Feb?
No, I don’t believe so.

(8) If I do take the test and am HSV1+, is there any way to know the location? My symptoms suggest a genital infection. But, the fact that I tested IgM neg 1 month after my main genital exposure but + 22 days after predominantly oral exposure suggests an oral infection. Do you agree or could I just have delayed IgM seroconversion? Or maybe I happened to be having a genital “OB” in Mar but not in Feb?
No, there is no way to know the location if you are HSV 1 positive. I think the IgM result is meaningless.

(9) I’ve read about ppl with symptoms like mine (e.g. abrasive soreness) who never test + then have a subtle OB months later which they get cultured. When is it OK for me to stop examining myself? I want to be safe for future partners, but I need my life back.

I think if you test negative at 16 weeks for both HSV 1 and 2, you have done what you can with the exception of getting the western blot. I think that is enough.

Terri

[scared1029]

If I get the test and am positive, I will have chosen to make my life painful. There are so many unaware HSV+ ppl dating without restriction, and I will have martyred myself because of a compulsive need for reassurance. Drs seem to think I’ve done my due diligence. My partner tested neg. I had 5 gynecological exams in 3 months and nothing looked herpetic. No med professional has actively advised further testing, except for “peace of mind” (this is the phrase the dr who gave me the IgM used, since he was so sure I’d be neg, so I don’t find this convincing). The test is not part of standard screenings, so most asymptomatic people don’t know they have it. If I am HSV1+ (probably my greatest risk) I wouldn’t know where it is. I’d have to tell men, “I have this highly stigmatized, contagious virus. I don’t know where it is, and I don’t have obvious symptoms, but I could give it to you.” If a man rejected me after that, it wouldn’t mean he’s cruel or unreasonable – especially because it would have to take place before he invested significantly in our relationship. He knows he probably won’t be with me forever, so he might need make the disclosure to his next girlfriend, and ruin the spontaneity and excitement of a new relationship. Of course, he or his next girlfriend could have HSV, but they won’t get tested so they’ll never know. And he’d probably rather be with a partner who might have a disease than one who definitely has it – which is understandable.

I’m not saying HSV+ people always get rejected. However, polls have shown that most people would reject a partner for having herpes, and optimistic individual case studies don’t make that fact any easier: if I had brown eyes and brown eyes were stigmatized, I wouldn’t think I was dirty for having them and I wouldn’t think the stigma was justified, but I would do anything to change the fact that I had them. Even if my partner looked past my herpes, I’d always worry that I was infecting him – without symptoms, how could I maximize safety? The other option would be to get into some HSV+ dating group. I’m sure there are wonderful people in these groups, but it’s so painful to know that my dating pool is that severely restricted – especially since women are often more prone to this than men. Finally, rather than checking my genitals 10x/day, I’d check them 20 – searching obsessively for any sign of a breakout (because at least I’d know that’s where I have it). I don’t want to be old, lonely and anxious: hating the young me for giving myself an unfair burden when, absent symptoms, it wasn’t necessary.

On the other hand, a neg test result would give me so much relief. When I start a new relationship, I’ll feel guilty that I made the choice to stop testing. I’ll feel like I’m hiding the genital pain and positive IgMs from future partners. I’ll still feel like I have to inspect myself constantly. And what if I pass it on to someone and he gets symptoms? Could I truly tell him I didn’t know I had it?

[scared1029]

Sorry, I forgot the questions. I wish I could clear my mind of this herpes knowledge and be blissfully unaware again – this is honestly all I think about all day. I feel hopelessly terrified and isolated, but you must have encountered patients who faced the same dilemma. What did they do? Should I feel guilty for not getting further tests? Should I ignore the IgMs and the genital symptoms? Also, do you have a sense of the IgM false positive rate?

By the way, I went to get the whitehead checked out, and the OBGYN said it didn’t look herpetic. Thank you very much for your help, Terri.

[scared1029]

Hi Terri,

I’m just following up on my questions. I noticed that many people, even those who asked questions after me, have been answered, so I just wanted to make sure my questions were not overlooked.

Thank you again, and I look forward to your response.

[Terri Warren]

Your subscription ran out after three posts from you and three answers from me. If you have need for more questions to be answered, please feel free to renew your subscription.

Thanks
Terri

[scared1029]

I purchased more questions. Could you please read my two entries from June 10, 2015 at 8:16 pm and respond? Thank you.

[Terri Warren]

You are asking me questions for which I have no black and white answers. Basically we are talking about further testing to determine if you have HSV 1 or not, right? Since the majority of the population has HSV 1, I don’t feel you should be obliged to test for this specifically if it makes you feel this uncomfortable, no. I would definitely suggest that you ignore the IgM tests. They are wrong so often, I feel they are completely unreliable. In my experience, they are wrong at least 7 out of 10 times if not a whole lot more. And it really really makes me angry that providers put their patients in this position to have to worry about this. The CDC definitely recommends against doing them in their STD treatment guidelines, 2015. If you believe your latest partner, then HSV 2 is not an issue here.

Whether you test further or not has to be a decision that you make based on 1) what you believe you can handle emotionally and not be a total wreck, either way, 2) what you can afford and 3) what you can live with long term. No one can make that decision for you, not even me who is an expert in this field. Would I take a western blot if I had your symptoms, strictly to find out about HSV 1? I’m not clear that I would, no. I think if you enter a new relationship, you can let future partners know that you have tested negative for HSV 2 and you don’t know if you have HSV 1 or not, but you don’t think so.

Terri

[Author]

Posts