HSV2 risk with a potentially exposed partner

[bobsacamanto]

Sorry in advance, this is going to be a bit complicated:

I am HSV1 and HSV2 negative male who is considering unprotected oral sex and protected vaginal sex with a woman who four weeks ago tested negative for both HSV1 and HSV2. However, until two weeks ago she was sexually active (I am assuming unprotected oral sex and protected penetrative sex) with someone who was repeatedly exposed to HSV2 in a prior relationship (I am assuming unprotected sex) with a partner that was “asymptomatic”?
.
Her partner (who was exposed and has been HSV positive) got tested six weeks after the last exposure and came back negative.

I am considering asking her to get re-tested at some point before we become intimate.

My questions are:

1.What percentage of HSV2 positive patients undergo seroconversion by six weeks? What about by 3-4 weeks?

2.I have heard that someone with a prior HSV1 infection is likely to undergo delayed seroconversion following HSV2 infection. Is there any estimate on what the delay might be?

3.I’ve read that during unprotected penetrative sex, women are more at risk and men less. I’ve also read that condoms reduce the risk for women, but have little effect on male risk. Could you comment on the validity of these statements?

4.What is the likelihood of getting oral hsv2 from unprotected cunnilingus with an infected partner? Likewise, what is the likelihood of genital hsv2 from unprotected fellatio with an infected partner?

5.What are the chances of contracting herpetic whitlow with an infected female partner? Do cuts, scratches, and abrasions on the hands increase this risk? By how much?

6.Lastly, I am sure this may be hard to estimate, but would be my chances of contracting HSV2 either orally, genitally, or on another part of my body given the situation I have described above?

Thanks in advance for answering my questions.

[Terri Warren]

1.What percentage of HSV2 positive patients undergo seroconversion by six weeks? What about by 3-4 weeks?
By 3 weeks, 50% seroconvert, by 6 weeks, 70% serconvert.

2.I have heard that someone with a prior HSV1 infection is likely to undergo delayed seroconversion following HSV2 infection. Is there any estimate on what the delay might be?

That is correct. We don’t have exact data on that but my guess would be 1-3 weeks longer.

3.I’ve read that during unprotected penetrative sex, women are more at risk and men less. I’ve also read that condoms reduce the risk for women, but have little effect on male risk. Could you comment on the validity of these statements?

Those are all correct statements, yes. Good for you, you’ve doing your reading!

4.What is the likelihood of getting oral hsv2 from unprotected cunnilingus with an infected partner? Likewise, what is the likelihood of genital hsv2 from unprotected fellatio with an infected partner?

We don’t have statistics or studies on either of those situations. I think both are unlikely but certainly possible.

5.What are the chances of contracting herpetic whitlow with an infected female partner? Do cuts, scratches, and abrasions on the hands increase this risk? By how much?

Cuts on the hands would definitely increase the risk of whitlow – the skin of intact fingers is too difficult for the virus to penetrate since it is so thick. I think the risk of acquiring whitlow is also low.

6.Lastly, I am sure this may be hard to estimate, but would be my chances of contracting HSV2 either orally, genitally, or on another part of my body given the situation I have described above?

Well since we honestly have no idea if she is infected or not we need, for the moment, to assume that she is infected. And if she is infected, then she is newly infected which means that she would be shedding quite a bit more virus during the early months following new infection. Again, we don’t have exact statistics on this but I would guess it is somewhere between 5-10% if she has brand new infection and she is not taking antiviral medicine. That’s a wild guess, however.

You have two more posts you can make here, feel free to do so.

Terri

[bobsacamanto]

Thank you for your quick reply.

Regarding your answer to my last question, is 5-10% the estimate for any one sexual encounter or for repeated sexual encounters with this person over the course of a few months? I am assuming my partner is asymptomatic. And I have read that the chance of transmission from any one encounter is 1 in 500, though I am wondering is this is an assumption based on people who aren’t primarily infected.

I am also guessing that since I am a male, that 5-10% assumes proper condom use (which has little effect), correct?

[Terri Warren]

That is for repeated encounters over the period of year
Condom use does have benefits but they definitely don’t provide perfect protection
It’s really hard to say for certain about the risk because honestly, all of our studies look at a population that has been together for a while, long enough to agree to do a study together. We also know that most herpes gets transmitted in the earlier days of a relationship and also that when people don’t know they are infected, they are far more likely to transmit. Your situation is quite different than that. There are a few people back who don’t know they are or are not infected. I think your awareness of the situation is helpful, I’m certain.

Terri

[bobsacamanto]

Thanks again for answering my questions. I have a few more.

1) When estimating HSV2 seroconversion rates and testing, were the studies making an estimate from the last exposure or from the time when symptoms developed and were reported?

2) Is it possible to be completely asymptomatic during the first three weeks of an infection and still shed virus? Or is it just that most people aren’t aware of what to look for?

2) I guess I am a bit confused about this point: Is the amount of viral shedding during the initial months different in cases of asymptomatic vs symptomatic infections?

3) I’ve heard people say that HSV1 negative individuals are more likely to be symptomatic during their initial HSV2 infection. Is there any truth to this? If there is, what is the likelihood that someone with this profile would have symptoms relative to someone with a longstanding hsv1 infection?

4)I’ve read on your website that during periods of shedding you recommend people sleeping with thicker clotthing to prevent incidental genital contact (I think). How long does HSV2 reside outside the body?

[bobsacamanto]

Sorry to add on, but I forgot to ask.

What are the estimated transmission rates for Oral HSV2 during a primary infection? If I were to forego genital contact with my partner would that increase my likelihood of initially contracting HSV2 orally?

[Terri Warren]

1) When estimating HSV2 seroconversion rates and testing, were the studies making an estimate from the last exposure or from the time when symptoms developed and were reported?

From the exposure

2) Is it possible to be completely asymptomatic during the first three weeks of an infection and still shed virus? Or is it just that most people aren’t aware of what to look for?

It is possible, yes, to shed virus when you don’t realize you infected. But also most people don’t know what to look for.

2) I guess I am a bit confused about this point: Is the amount of viral shedding during the initial months different in cases of asymptomatic vs symptomatic infections?

It is more common in symptomatic infections.

3) I’ve heard people say that HSV1 negative individuals are more likely to be symptomatic during their initial HSV2 infection. Is there any truth to this? If there is, what is the likelihood that someone with this profile would have symptoms relative to someone with a longstanding hsv1 infection?

there is absolutely truth to that! A person with long standing HSV 1 infection is less likely to notice symptoms of HSV 2 new infection.

4)I’ve read on your website that during periods of shedding you recommend people sleeping with thicker clotthing to prevent incidental genital contact (I think). How long does HSV2 reside outside the body?

I believe what I said was that during an OUTBREAK it might be good to wear underwear to bed, because sometimes sexual contact is so instinctive, that the brain is not in gear yet because of sleep but the penis is wide awake.

We do not have statistics on your last question.

You are now out of questions on this subscription. If you have more questions, please renew our subscription.

Terri

Terri

[bobsacamanto]

Hi Terri,

Thank you for answering my previous questions. I have renewed my subscription and have a few more questions for you.

To recap: I am a heterosexual HSV1 and HSV2 negative male. My current partner (who I have not had oral or penetrative sex with yet) tested negative for HSV1 and HSV2 two months ago. However, until four weeks ago she was having unprotected penetrative and oral sex with a HSV1 positive partner who had been exposed to HSV2 in his previous relationship (assuming the sex was unprotected). Her former partner was tested at six weeks since his last HSV2 exposure and came up negative.

My questionsL

1) What is the seroconversion rate for the HerpeSelect test at 12 weeks? At 16 weeks? Do you have any idea what the numbers look like for HSV1+ vs HSV1 negative individuals?

2) Would it be possible to provide me pubmed links to the studies on seroconversion done with the HerpeSelect test? I am in the biomedical sciences and would be able ton interpret them fairly well I think. And would be less likely to bug you about specific windows.

3) If my current partner’s ex (who is HSV1 positive, exposed, but HSV2 negative at 6 weeks) was tested at 16 weeks and came back negative, and my current partner tested negative at eight weeks, would most clinicians say that my partner is highly unlikely to have HSV2? Would you personally recommend she wait longer?

4) Is there any understood reason for why people don’t seroconvert past 16 weeks or even 6 months in these studies? Are most of the non-converters HSV1 positive? Were some of them potentially on anti-viral therapy?

5) Are you able to answer any questions regarding testing for other STIs, especially HIV? I have a few questions regarding the Ab test vs the RNA PCR test. If you can’t answer them, do you know of any forum or site with a similar format where I could get my questions answered by an expert, such as yourself?

6) Just to clarify: though both events are unlikely, which is more likely: to get oral HSV2 from giving oral sex to an infected partner or to get genital HSV2 from receiving oral sex from an infected partner? I have read that in 10% of HSV2 genital HSV2 cases there is also infection orally, but oral HSV2 by itself is rare? Is there any known reason for this?

7) Are most cases of whitlow from HSV1? Have you seen many cases in the clinic?

8) It seems like there are many cases where people have large breakouts years after their exposure. Is there any understood reason for this? Are initial breakouts due to HSV2 really that asymptomatic in so many cases?

[Terri Warren]

1) What is the seroconversion rate for the HerpeSelect test at 12 weeks? At 16 weeks? Do you have any idea what the numbers look like for HSV1+ vs HSV1 negative individuals?

I don’t know what these answers are sorted by HSV 1 positive vs. HSV 1 negative. I also don’t have exact numbers for 12 weeks, but I would say they are close to 16 weeks which is 97% of HSV 2 infected people will be detected and 80-90% of HSV 1 infected people will be detected.

2) Would it be possible to provide me pubmed links to the studies on seroconversion done with the HerpeSelect test? I am in the biomedical sciences and would be able ton interpret them fairly well I think. And would be less likely to bug you about specific windows.

I don’t have the specific citation with me, but look for the author Rhoda Ashley Morrow and herpes seroconversion. And also, I am citing the statistics from the herpeselect package insert.

3) If my current partner’s ex (who is HSV1 positive, exposed, but HSV2 negative at 6 weeks) was tested at 16 weeks and came back negative, and my current partner tested negative at eight weeks, would most clinicians say that my partner is highly unlikely to have HSV2? Would you personally recommend she wait longer?

Yes. I would not recommend that she wait longer, but if she wants to be super sure (or you do), then a western blot would be slightly more accurate.

4) Is there any understood reason for why people don’t seroconvert past 16 weeks or even 6 months in these studies? Are most of the non-converters HSV1 positive? Were some of them potentially on anti-viral therapy?

We don’t know why some people don’t seroconvert on the screening tests. Being on antiviral therapy for any extended period of time can certainly delay serconversion

5) Are you able to answer any questions regarding testing for other STIs, especially HIV? I have a few questions regarding the Ab test vs the RNA PCR test. If you can’t answer them, do you know of any forum or site with a similar format where I could get my questions answered by an expert, such as yourself?

We can use the newest antibody test which picks up p24, which can detect infection earlier than the traditional antibody tests. We believe that by 6 weeks after exposure, the fourth generation tests pick up >95% of infections, or even more. We use the p24 test in people who we think could be newly infected.

6) Just to clarify: though both events are unlikely, which is more likely: to get oral HSV2 from giving oral sex to an infected partner or to get genital HSV2 from receiving oral sex from an infected partner? I have read that in 10% of HSV2 genital HSV2 cases there is also infection orally, but oral HSV2 by itself is rare? Is there any known reason for this?

HSV 2 appears not to like the mouth location very well – we don’t know why. I think if I had to guess, and it is truly a guess, it would be more likely to acquire HSV 2 orally from giving oral sex to someone infected genitally with HSV 2 than the other option but that is strictly a guess.

7) Are most cases of whitlow from HSV1? Have you seen many cases in the clinic?

Yes, we have seen whitlow in our clinic and I think we see about a 50-50% split between HSV 1 and 2 being detected from whitlow

8) It seems like there are many cases where people have large breakouts years after their exposure. Is there any understood reason for this? Are initial breakouts due to HSV2 really that asymptomatic in so many cases?

I wouldn’t say there are MANY cases of this but there are sometimes. I think it is more likely due to some immunosuppressive episode in the person rather than something about the virus itself. My impression is that asymptomatic first infection happens, yes, but often, the symptoms of the first infection are missed or are misdiagnosed as something else entirely.

Terri

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