How did I get it??

[Southern Sun]

Terri – I am grateful to have found this service.

My questions can be fraught with a lot of emotions, but I am going to do my best to leave them out of it!

I have been married for 19 years and my husband and I have been monogamous for nearly 21 years – until I had an affair that began in January of 2014. I believe my husband has remained faithful. Neither of us have ever been tested for HSV in the past, as neither has ever had any noticeable symptoms.

I asked this other man about his general sexual health and he confirmed he was “clean” (of course). We had unprotected sex numerous times for about 5 months. We broke it off and then had a “relapse” a couple of months later. Within 3 days of this relapse, I had painful urination; within 2 more days, I had developed a sore (which a doctor diagnosed as an ingrown hair). I was tested for bacterial STDs, which all came back negative. Of course, my painful urination continued and the “sore” evolved to an obvious blister with additional lesions (a cluster of maybe 4 or 5). By this time I had generalized pain in the area, the sores themselves were very painful, burning, general malaise, flu-like symptoms, fatigue. It hurt to even touch my legs. I went back to the doc, they swabbed the lesions, and I was dx’d with HSV 2 via swab culture. I knew it before I even got the results back.

My questions:

Does this seem like a primary outbreak to you? I don’t ever recall experiencing anything like this before. It does to me, but a few things don’t make sense.

Based on timing of my symptoms, it would seem like I got it from this man during our last encounter. But I am wondering – is it possible that I had gotten it months earlier and JUST then had a primary outbreak? Does that ever happen – initial infection, no outbreak, then later a primary (severe) outbreak? Or could the initial outbreak be mild with a recurrent severe outbreak?

Is it possible that he had herpes all along but just happened to give it to me during the last encounter? How could I have avoided it during every other sexual encounter? Or should I suspect that somehow he was infected during our “break up”?

Finally, my husband immediately went and got tested. His results were negative or HSV 1 (rare, right?) and HSV-2 IgG was 3.01. I am perplexed by this. If the other man infected me, and I infected my husband, then that could NOT have been my first outbreak (unless they can be “delayed”, per the question above). But I did not have sex with my husband after the outbreak, and he was tested quite quickly. So if I gave HSV to my husband, then I had it before that outbreak. If I did not give it to him, then this opens up a whole new can of worms. So that means:

Assuming my husband has been faithful, could he have had HSV for 21 years and only JUST infected me? Is that statistically possible? Or probable?

I wish I had gotten an IgG test at the same time as my culture. That would have answered a lot of questions.

The final possibility is that I have actually had HSV-2 myself for years, and perhaps given it to my husband and maybe even the other man. But again, that feels inconsistent with that outbreak. I would really appreciate your opinion on whether my description seems like a primary outbreak and if a PO can be “delayed” from initial infection. Or if a recurrence can be severe like the one I had.

Final question – I have yet to get IgG testing myself. It seemed unnecessary at the time (I had confirmation and didn’t think I needed anything else – regret it highly). I have been on suppressive therapy almost since day 1. Considering the amount of time that has gone by, would an IgG test detect antibodies at this point? I wasn’t sure how long it could delay seroconversion. Then again, if the infection was not new, then that would not apply, correct? Would an IgG test be helpful to me now…i.e., considering I have been on suppressive therapy, if it showed positive, perhaps that means I have had HSV for a long time? I don’t know if I can conclude that however.

Thank you greatly.

[Southern Sun]

Sorry Terri, I should add – the other man said he did not have anything, but apparently this was an assumption on his part. When I advised him of my status, he did not bother to go get tested. So I do not know for certain his status unfortunately.

[Terri Warren]

Yes this does sound like a rather typical HSV 2 first infection, but without a negative antibody test to confirm that you were HSV 2 antibody negative at the time, I cannot be certain. Did you have lesions on both side of your body (right and left) or only one side? Since we apparently have no antibody test to use as a marker, it is possible that you were infected months or even years before.

He could have had another partner during your breakup or he could have had it or years and was just shedding on that last day of the relationship. Has he been antibody tested? If he is negative, that would suggest that you did NOT get it from him.

You could most certainly have gotten this from your husband, yes, years ago. Or you could have had it for a long time and infected him and/or the other man, as you say.

When you say the other man didn’t bother to get tested, does that mean he refused to get tested?

Terri

The problem here is no antibody test. However, if you have bee on suppression the whole time, then your antibody test could still be negative which would once again suggest new infection. How long ago was your first recognized outbreak?

[Southern Sun]

The lesions were only noted on the left side. There were not very many (4 or 5 I believe), but the overall experience was very painful. What does a one-sided vs two-sided outbreak indicate?

The other man simply brushed it aside, saying he didn’t think he had it. I suggested testing and he said he would rather not. I found that to be a bit suspicious. We are no longer in contact and as far as I know, he never did anything about it. I couldn’t figure out if this was pure ignorance, arrogance, or the fact that he actually thought he probably had it and wanted to stick his head in the sand. Notably, he was eager to have further contact in spite of my dx. But perhaps I am reading too much into it.

With my husband’s IgG at 3.01, would you suggest further testing? Either another IgG or Western Blot? Or does his negative HSV-1 mean that his positive HSV-2 is more likely to be a true positive?

The first recognized outbreak was about 7 months ago. I have been on suppressive therapy the entire time. So if I go now and get antibody testing, if it is negative, that would indicate a new infection? And if it is positive, it would indicate an older infection?

Thank you.

[Terri Warren]

If it is still negative then I would suggest that it is likely first infection. If it is positive you won’t be able to know how long you have been infected, unfortunately.

Your husband has about a 75% chance of actually having herpes and a 25% chance he does not. If he was our patient, we would do a western blot on him.

Your other partner sounds very suspicious to me, really. Hmmmm

Terri

[Southern Sun]

Yes, Terri, he does! I have learned the hard way.

So I’m hoping this still counts as part of my two questions, as I am trying to clarify the original ones.

Since the outbreak/lesions were one-sided, does that tend to make it more likely it was NOT a primary outbreak? I’ve not heard of that before.

Are primary outbreaks ever “delayed” from initial infection?

I am assuming it is highly improbable that my husband could have been infected for 21 years, and I only recently was infected by him…right?

I am going to get the IgG done. That will at least tell me something. If I show up as negative we will probably confirm my husband with WB. Thank you!

[Terri Warren]

Usually recurrences happen on one side only but with a lot of HSV 1 antibody on board you could also have a first episode infection unilaterally as well
Yes, first recognized outbreaks can occur years after first infection.
I think it is unlikely that your husband just infected you, but if you are positive ,there is just no way to know.

Terri

[Southern Sun]

Hi Terri – I just purchased 3 additional questions, as I just got my test results back and wanted to run them by you.

I got ELISA IgG testing, results as follows:

HSV-1 – 0.16
HSV-2 – 1.44

To recap, I have been married for 19 years, but started an affair a little over a year ago. Never any signs of HSV for me or my husband. I ended the affair initially about 9 months ago, and we stopped physical contact for approximately 6 weeks. Then there was a one-time relapse. Within 3 days, I had the symptoms described above, received my HSV diagnosis via swab culture within 7 days, started anti-virals immediately, but never got antibody testing. So while I thought this was my primary outbreak, I never really knew. Now it seems like the testing confirms this was likely not a pre-existing infection. Would you agree? Granted, it’s positive, but a very low positive.

After I told my husband, he immediately got tested. He was negative for HSV-1 and positive for HSV-2 at 3.01. Based on these results, I think there are two possibilities:

1) This outbreak was indeed my primary outbreak and I was infected during that last encounter. Since I did not have sex with my husband between that encounter and his testing, his result is a false positive.

OR…and I think perhaps this is the more likely scenario…

2) I was infected maybe within the couple of months prior to the last encounter and did not notice any initial symptoms. That outbreak was the first one I was aware of. I perhaps infected my husband during this time, giving him time to create antibodies and test positive at 3.01. Perhaps I didn’t create antibodies as quickly and then when I started the anti-viral, it stopped it in its tracks.

Does this make sense? How long does it take someone to begin to produce antibodies? And would taking antivirals actually LOWER the number of antibodies or just prevent me from generating MORE than I already have? I’m not sure if I’m saying that right.

Thank you!

[Terri Warren]

I think the second scenario is more likely, or that you acquired this from your husband years ago and were just now having your first recognized outbreak. There is simply no way to know. Some people just have a low index value and it stays that way. If you retest in 12 weeks let’s say and your value is now greater than 5, the first scenario is more likely. And yes, taking the antiviral therapy could have greatly slowed antibody development if it was a new infection. I think without a second antibody test down the road, it will be harder to know what’s going on here.

Terri

[Southern Sun]

So you’re saying if I go off the antiviral and then re-test in a few months and have a much higher number, that would be indicative of a more recent infection? Rather than my husband giving it to me years ago?

Also, can the med REDUCE the number of antibodies when you start taking it or only prevent them from increasing? Like if I had a baseline IgG at 2.0, could I go down to 1.65 with antiviral? Or is that impossible?

[Terri Warren]

Yes, that’s what I am saying
If you had a baseline of 2.0 and had 1.65 subsequently, this would be considered a very normal variation in values. I often see variation with a whole number difference and that is also normal. Medicines could very much slow the rate of antibody development but it would not make them go down.

Terri

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