new couple pre-intercourse questions

[Red Oak]

Herpes questions for Terri Warren:

Dear Ms. Warren:

I am a biologist who has read your very helpful book carefully and has a fair lay understanding of the issues involved. My partner of three months is scientifically astute, health conscious, and well informed. I am 67, she 72, and we are both healthy nonsmokers. I was widowed 15 months ago and she has long been single. We both wish to have intercourse, and we are confronting a somewhat complex Herpes situation. Our bottom line is that she not acquire genital herpes.

I have had genital herpes for about 45 years. I have never been aware of oral herpes. Recent testing through my NP (Interpath Laboratory, IgG, test type not identified in report) gave these results:

HSV I 30.7, HSV II 6.98. So apparently I am positive for both, and either asymptomatic for HSV1 with genital HSV II; or else asymptomatic for HSV II with genital HSV I. I understand the former is much more likely. I have lesions very rarely (last one, two+ years ago) so a swab is not practical.

My partner has had fairly frequent oral Herpes outbreaks for many years. She has never experienced genital Herpes, to her knowledge, though she was exposed in former years to two infected male partners. Recent testing through her MD/GP (Quest, IgG, type specific AB Herpeselect, presumably ELISA since an index value was given) presented these results:
HSV I >5.00, HSV II <0.90. So she is positive for HSV I, as expected, which affects her orally; and apparently negative for HSV II.

I suppose we should accept her result as negative for genital herpes HSV II, and proceed, using condoms and Acyclovir taken by me to minimize chances of transmission. (She takes it when a cold sore threatens.) However, I am drug and latex averse, and though I am willing to use both if necessary, I would prefer to avoid them if possible. I cannot sustain an erection with a condom in place, and may not be able to achieve an orgasm wearing a condom even if using an erection-assisting drug (I have no experience with these drugs). We would like to achieve as much certainty as we can that she is actually HIVII negative before I commit to taking two drugs, and we resign ourselves to using condoms. Since her test did not give actual numbers as mine did, but just “<.90”, it causes me to wonder whether the number might be close to .90, and therefore potentially equivocal.

Our questions:

1) Should we pursue retesting for her with a different lab, perhaps employing the more definitive Western Blot test? If so, where can we do that, and what is the usual expense for it? (We assume Medicare and supplemental insurance do not apply.) Or should we just accept the “<.90” index value as reliably negative?

2) I conclude from your book that we are safe for kissing on the mouth (as I am HSVI positive, though asymptomatic); and safe for cunnilingus, as I would not transmit my genital HSVII to her genitals from my mouth. Is this correct, according to your understanding?

3) What about fellatio, if she is HSV II negative? Since she has HSV I orally, could she also contract HSV II orally, or will that nerve region accommodate only one type of Herpes?

4) Are the animal-tissue type condoms still considered inferior to latex for prevention? (They are far more conducive to erections and orgasm for me than latex.)

5) Do you have any other advice or questions for us?

6) Should we make an appointment to counsel with you in person? We live near the coast.

Thank you! And thank you for your fine book as well.

[Terri Warren]

1) Should we pursue retesting for her with a different lab, perhaps employing the more definitive Western Blot test? If so, where can we do that, and what is the usual expense for it? (We assume Medicare and supplemental insurance do not apply.) Or should we just accept the “<.90″ index value as reliably negative? I am less concerned about her HSV 2 result - she is likely truly positive - than I am about your result. Can you find out what brand of antibody testing it was? Your HSV 1 is so high that I know it is not herpeselect and I guess I would like to confirm your HSV 2 status by western blot. With rare outbreaks, you could have HSV 1 genitally and wouldn't that be nice? 2) I conclude from your book that we are safe for kissing on the mouth (as I am HSVI positive, though asymptomatic); and safe for cunnilingus, as I would not transmit my genital HSVII to her genitals from my mouth. Is this correct, according to your understanding? Yes, kissing is fine as is you giving her oral sex. 3) What about fellatio, if she is HSV II negative? Since she has HSV I orally, could she also contract HSV II orally, or will that nerve region accommodate only one type of Herpes? She cold acquire HSV 2 orally from giving you oral sex but if she did, it would appear just like a cold sore and would essentially vaccinate her against getting genital HSV 2. 4) Are the animal-tissue type condoms still considered inferior to latex for prevention? (They are far more conducive to erections and orgasm for me than latex.) Those are fine! 5) Do you have any other advice or questions for us? does this seem like a long term relationship for you two? If yes and when yes, it would be good to think about how much it is really important for her to avoid infection. I know this might sound counterintuitive to you, but herpes can certainly be managed quite well and one must weigh all that against the challenging of sexual activity as we age. Trust me, I know all about such things. 6) Should we make an appointment to counsel with you in person? We live near the coast. You could, particularly if you want western blots for either or both of you, which I would recommend, just to be certain what is going on here. You live in Oregon?

[Red Oak]

Dear Terri,

Thank you so much for your first, prompt reply, six weeks ago! (You can tell that we are moving slowly, partly due to some unrelated pain issues of my partner’s that have delayed things, but have improved.) Here are my follow-ups to your full and thoughtful reply:

1) You wrote, ” I am less concerned about her HSV 2 result – she is likely truly positive – than I am about your result.”

We are curious as to why you feel she may be truly positive? This is our main question for now.

2) You asked: “Can you find out what brand of antibody testing it was? Your HSV 1 is so high that I know it is not herpeselect and I guess I would like to confirm your HSV 2 status by western blot.”

I spoke with the laboratory (Interpath, 1-800-700-6891), and found that the brand they used was DiaSorin.

3) You asked, “Does this seem like a long term relationship for you two? If yes and when yes, it would be good to think about how much it is really important for her to avoid infection.”

Yes, we believe it is long-term. We understand your point, but for now, at least, she’d like to try to avoid it. So we plan to employ the antiviral suppression and lambskin condoms for the present, at least, and see how that goes. I am taking Acyclovir 400mg X 2/day.

However, we do want to have the Western blot soon, as you say, ” just to be certain what is going on here.” My partner lives in Astoria and I am nearby in Washington. I checked with your office and your hours don’t match our next trip to Portland (a getaway this weekend that may put our preps to the test). But we’ll try to return to Portland for the test and a talk with you before long. If, as you suspect, she might be HSV II positive despite her result, OR if I turned out to have HSV I genitally, we could then toss the pills and sheaths. And as you wrote, “wouldn’t that be nice?” Yes, it would!

Many thanks, Terri.

Red Oak

[Terri Warren]

I completely misread that or mistyped it at a minimum! It is you who has the positive HSV 2 results – not sure what on earth I was thinking there Sorry about that. My bad. Anyway, I think I’ve got it now! You’ve got an antibody response to HSV 2 that would likely confirm with western blot but it might be worth doing anyway because I’m not wild about that particular test brand.

If you have HSV 1 genitally, it doesn’t really matter if you also have HSV 2 genitally. Right?

We can arrange for a western blot to be drawn in your own city, not a problem at all. But for her, I don’t think it is necessary at this point.

Taking acyclovir 400 mg twice a day and using latex condoms is definitely a step in the right direction.

Terri

[Red Oak]

Okay, thanks, Terri.

So, just to close out this first round of questions clearly in my mind:

1) We should trust my partner’s HSV II <0.90 Herpeselect reading as her being HSV negative.

2) My HSV II 6.98 DiaSorin reading is likely correct as positive, but it is worth doing a western blot to confirm; and I could have it drawn at my small community clinic and sent to you.

3) You wrote: “If you have HSV 1 genitally, it doesn’t really matter if you also have HSV 2 genitally. Right?” Well, it doesn’t matter to me medically; but if I had ONLY HSV 1 genitally, and NOT HSV II, it would matter a great deal to my partner and me in terms of being able to have unprotected sex, since she is HSV I positive.

Since my HSV I number is so high (30.7) and my HSV II relatively low (6.98), and since I am asymptomatic orally, one might think that I had HSV I genitally and HSV II orally, if indeed I am positive for both. But I don’t suppose the western blot can help determine which strain inhabits which site, can it?

4) You wrote “Taking acyclovir 400 mg twice a day and using latex condoms is definitely a step in the right direction.” I am taking the med, but we are planning on using lambskin, not latex, condoms. Earlier, replying to my question about the animal-skin product, you wrote, “Those are fine!” Is that still correct? I sure hope so…they weren’t cheap, and work much better for me than latex. (A lot cheaper than Viagra, though, which was $40 per pill at Freddie’s today! I don’t suppose you have any tips on that?)

5) Does taking the antiviral affect the western blot results? I don’t suppose it should, since the one deals with the virus and the other with the antibodies.

I think that does it for now, Terri. Depending on your answers, I’ll probably call your office to see about a western blot.

Many thanks for all your time and help,

Red Oak

[Terri Warren]

1. Yes
2. Correct
3. And I said “IF” you have genital HSV 2. So that’s where the western blot comes in. If someone is HSV 2 positive, then the odds are overwhelming that you have it genitally. The odds are, statistically, at your age, that your HSV 1 is oral, not genital. The westerns blot cannot tell where infection is, it just is.
4 Yes, lambskin is workable. I think you know it isn’t quite as good as latex but I’m not honestly clear that the difference is anything to be too concerned about.
5. No the antiviral at this point is not going to make a difference. If you had new genital infection, my answer would be different but you’ve had herpes for 45 years. You’ve had plenty of time to make antibody.

Terri

[Red Oak]

Very clear, Terri. Thank you so much.

[Terri Warren]

You are most welcome!
Terri

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