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hi Terri,
I’m a 54 divorced male. I had a full suite of STD tests run in preparation for starting
to date again. I wasn’t really expecting anything to show up as I am pretty aware of my
body and to the best of my knowledge have never had any physical symptoms. All other test
results were negative but my IgG result for HSV-2 was 2.89.As far as I remember I have never been tested for HSV-2 before. I was very surprised by
the positive result and there was no discussion when I received my results that this
might be considered a “low positive” with some chance of me actually be negative.
As I have been researching HSV-2 I have only recently become aware that there is some chance
that a western blot test is worth it to get a more definite result. I have not had any protected
or unprotected exposure for 8 months at this point and only 4 partners in the last 25 years.Do you think a western blot test makes sense for my case? Would a negative on one western blot
be conclusive enough that I could honestly say I don’t have HSV-2? (at least today….)During my research I have also seen comments from others along the lines of “the clinician said
(their) test result indicates that (they) have likely had HSV-2 for awhile”.Is there really anyway to know how long when you don’t have physical symptoms and no previous
test results? In my case it could be as long 35 years or as short as 2 years ago unless the
blood tests my ex-wife had when our children were born would rule out anything earlier than
their births.I’ve been mentally preparing that I am positive and know that when/if I meet someone that I
would like to engage with, for my own conscience and out of respect for them, I need to disclose
and let them choose how to respond. In support of that I have been working on what I would
say….could you look thru this list below and tell me if I missed (or misstated) anything you
consider important ?my list….
– I have tested positive for HSV-2 antibodies which means that I carry the virus in my body.
– HSV-2 is basically a skin disease that some people get very painful symptoms from that
can appear periodically and normally decrease over time
– Health experts estimate 20-25% of the adult sexually active population may have HSV-2 and
most of these adults don’t even know as they have never been tested and they either don’t have
symptoms or their symptoms are minor enough they haven’t taken any action.
– Even though I have never had physical symptoms there is still some risk that I can pass this
on to a partner thru a process called “shedding”.
– I can take antiviral medications to reduce the shedding and we can use condoms to reduce the
risk down even more to maybe (2%?) but there is always some chance.
– HSV-2 is almost always genital so kissing and manual stimulation and oral both directions are ok
– there is no known vaccine or “cure” todayas far as the available antiviral medicines go,
is there any significant difference in shedding suppression between acyclovir and valtrex?I think I also read some claim that shedding decreases over time so being able to narrow down
when I acquired the virus could be useful information
– is this decrease real?
– is the decrease significant enough to matter?thank you!
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– I have tested positive for HSV-2 antibodies which means that I carry the virus in my body.
If the positive is a true positive then yes, you carry virus in your body. You are in the low positive range and need confirmatory testing by western blot.
– HSV-2 is basically a skin disease that some people get very painful symptoms from that
can appear periodically and normally decrease over timeCorrect
– Health experts estimate 20-25% of the adult sexually active population may have HSV-2 and
most of these adults don’t even know as they have never been tested and they either don’t have
symptoms or their symptoms are minor enough they haven’t taken any action.Correct again. The actual number is 16% of people in the US ages 14-49 have HSV 2 infection.
– Even though I have never had physical symptoms there is still some risk that I can pass this
on to a partner thru a process called “shedding”.That’s correct Most new infections are believed to be transmitted from people who show no symptoms at the time they transmit.
– I can take antiviral medications to reduce the shedding and we can use condoms to reduce the
risk down even more to maybe (2%?) but there is always some chance.Correct.
– HSV-2 is almost always genital so kissing and manual stimulation and oral both directions are ok
Correct again.
– there is no known vaccine or “cure” today
And correct again, though there are vaccines in the works.
as far as the available antiviral medicines go,
is there any significant difference in shedding suppression between acyclovir and valtrex?NO. There is a nice study by Christine Johnson out of the University of Washington that looks at this specific question. You can Google it.
I think I also read some claim that shedding decreases over time so being able to narrow down
when I acquired the virus could be useful information
– is this decrease real?Yes
– is the decrease significant enough to matter?
Well, if there is still shedding there is still a chance for transmission. Even people with zero symptoms shed, so that’s a tough question in terms of what you really do with the answer.
You seem well informed and well read about herpes. Now all you need is a western blot.
You have two more questions, feel free to follow up.
Terri
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Yes, if you want to get a western blot you an contact the clinic, set up an appointment for a phone consultation to arrange a western blot.
If the WB is positive, the normal doses for suppression are acyclovir 400 mg twice a day or valacyclovir 500 mg once a day. Both are equally effective WHEN TAKEN AS DIRECTED. Some people have trouble remembering to take a pill twice a day.
No, there is no way to know how long you have been infected if the western blot is positive.
No, there is no practical way to know how much you shed, but daily home swabbing is available though very expensive.
Anyone who is immunosuppressed has a slightly higher risk of acquiring herpes from you.You have one more post should you wish to use it to ask another question.
Terri
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OK
Terri
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For my own understanding,
When you talk about 10% transmission rate for unprotected intercourse (with no viral suppression meds)
does this mean the typical person is shedding 36 days a year and infection transmission is close to 100%?….
or are they shedding more frequently and the infection transmission rate is (50%, 25%, ??%)?The way that I best understand this is that if there were 100 men with HSV 2 having sex twice per week with 100 uninfected female partners (just one on one sex), with no meds and no condoms, about 10 women would become infected. This is an AVERAGE. Transmission rates will be higher from someone newly infected and probably less likely from someone who has been infected for a long time. Transmission rates will be higher for people having sex more than twice per week. There are lots of variables. These numbers are averages and may not apply specifically to you.
Do you have any advice on how early in a relationship to bring this up?
– there is clearly no point in bringing it up if I meet someone once that
I am not interested in but it also doesn’t feel right to hide it too long
from someone if we are both pretty interested….and for me there is some
risk of rejection at that pointHave you read the Good News about the Bad News? There are two whole chapters devoted to this topic. In summary, I would disclose this after deciding that this is a person with whom you feel comfortable sharing very person information and before having sex.
Besides antivirals and condoms, are there other things either or both partners can do to reduce the
likelihood of transmission?… and no, abstinence is not really an option…LOLin particular, I was wondering about things like
– supplements for immune system
– avoiding contact when either partner is feeling sick
– other???No, none of those that we know for sure. However, developing symptom recognition skills is important
chance of transmission is somewhat higher (10% vs 2-4%?) in male to female than female
to male, correct?Correct
I want to double check one of my earlier statements in a previous post…
I said – HSV-2 is almost always genital so kissing and manual stimulation and oral both directions are ok
Your response was – Correct again.So the risk of me transmitting HSV-2 (genital) to a partner from receiving unprotected oral is almost zero?
The risk of you giving hSV 2 to a partner receiving oral sex from you? Yes, if you have genital HSV 2 you cannot transmit HSV 2 from your mouth, correct.
Terri
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The sections on telling and when and to whom is more detailed in the Good News……
So if a person is the giver of oral sex to you, there is a small chance that could get it orally. If they did, it would look like a cold sore. If they already have a history of cold sores, they would not be able to distinguish an oral HSV 2 infection from a cold sore. Also, it would vaccinate them against getting genital HSV 2, in essence. HSV 2 orally recurs and shed infrequently.I would just try to become aware of prodromal symptoms and avoid sex when you have a those. You can clearly identify things that are less subtle. And remember that there is only so much you can do. Some shedding is completely without symptoms.
Terri
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Yes, I would guess that you acquired HSV 2 a while ago and yes, that does protect generally against HSV 1 infection.
There is no way to know for certain where your HSV 2 infection is, but the statistics suggest that there is a 95% chance it is at least genital (could also be oral but not all that likely). If I were you, I would assume it is genital and behave that way – sounds like you are already on that track.
Yes, five days lead time for suppression to be fully effective.
And yes, to the best of our ability to know, I believe you don’t have HSV 1. We do not yet know the exact sensitivity of the western blot for HSV 1.
I would say it is completely normal for your attitudes about sex to change now that you know you have herpes. But I suspect you will “bounce back” once you’ve had a bit more experience with this and you continue to have experiences with people who are willing to take a small risk of transmission. I would also say that you might suggest that partners be tested to see if they are already positive or not. If you are having sex with someone else who is positive, there will be no concerns at all about transmission.Terri
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1) I test positive for HSV-2
Correct
2) to the best of my knowledge I have never had any outbreak/symptoms (or so minor I did not notice and
I’m pretty aware) which means based on statistics that it is most likely genital HSV-2 (vs oral HSV-2)
and at this point there really is not a practical way to know this for sureCorrect. Remember to look for symptoms from waist to mid thigh, the boxer shorts area
3) to the best of my ability to get tested I am negative for HSV-1 and now since I already have
HSV-2 it is very unlikely that I will ever acquire HSV-1 at this pointCorrect
4) given my sexual history when I was younger and the prevalence of HSV-1 in general, it is quite
possible I have been positive for HSV-2 for quite some time and just never knew because I had no
symptoms and did not specifically get tested until relatively recentlyCorrect or the ELISA test missed it. 9% chance the test missed it.
5) I still have some anxiety around infecting any potential new partner even if I have done “the talk”
and allowed them to choose…That’s completely understandable and that won’t resolve completely probably ever. As long as you are open and share the information that you know fully, I honestly believe that is your sum of your responsibility. Well, that and taking daily medication and being aware of symptoms and perhaps using condoms, depending upon what you and your partner decide.
Yes, the research has looked at the CD8 cells in particular, regarding this topic of LTR partners. It would not be detectable normally in an uninfected partner, that’s a very very specialized kind of testing.
I believe we have once again exhausted our questions but I am here for you if you need more questions answered.
Terri
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