Oral to Genital HSV-2 Transmission Probability

[westbrook]

Dear Dr. Warren,
firstly I want to apologize for any english errors. I live in Germany and English is not my native language.
I am a circumcised male and have had oral herpes since childhood.
In November 2022 and January 2023 I had unprotected oral sex with two women whereas both women performed oral with their mouths on my genital. These are the only sexual intercourses I’ve ever had.
Since I have already HSV-1 on my lips since childhood, I assume that I am not at risk of getting gential herpes caused by HSV-1 also.
Now, around 6 months after my last encounter, I recently found out the STI screening I received one months ago (and all came back negative) did not include HSV and therefore I am now very scared that maybe I contracted HSV-2 on my genitals from one of my two encounters.
I do not have any genital herpes symptoms whatsoever, but I am still very scared and just want confirmation that I do not have contracted anything. Since I have OCD, this is really not helping my mental health.

1.What are the odds that someone has oral HSV? This could help me asses the probability that one of these two women had oral HSV.

2.Let’s assume one or both of these women had oral HSV-2. What are the odds of contracting HSV-2 on my genitals from receiving oral sex from them?

My general practicioner adviced against a blood test because of no symptoms from my side and a lot of false positives.

If I’d be in the US, I would just take a western blot right now just to be sure but unfortunately there is no possibility in Germany to get the western blot for HSV.
That means the igg is my only source of confirmation and no other confirmatory test is available.

3.Would you agree with my practitioner that I should not get tested because of the high false positive rate or should I get tested still?

4.Is the probability of getting a false positive igg value for HSV-2 higher due to the fact that I already have HSV-1.

Thanks a lot Dr. Warren and greetings from Germany!

• This topic was modified 3 months ago by westbrook.

[Terri Warren]

1.What are the odds that someone has oral HSV? This could help me asses the probability that one of these two women had oral HSV.
Well, many people have oral HSV 1 – about half the population between 14 and 49, but since you already have this, it is very unlikely you would acquire it genitally

2.Let’s assume one or both of these women had oral HSV-2. What are the odds of contracting HSV-2 on my genitals from receiving oral sex from them?
That would be highly unusual and if they did, HSV 2 oral infection is rarely shed

My general practicioner adviced against a blood test because of no symptoms from my side and a lot of false positives.
I agree

If I’d be in the US, I would just take a western blot right now just to be sure but unfortunately there is no possibility in Germany to get the western blot for HSV.
That means the igg is my only source of confirmation and no other confirmatory test is available.
And I wouldn’t even advise that you take that due to false positive.

3.Would you agree with my practitioner that I should not get tested because of the high false positive rate or should I get tested still?
I totally agree with your provider!

4.Is the probability of getting a false positive igg value for HSV-2 higher due to the fact that I already have HSV-1.
Yes

Terri

[westbrook]

Wow, that was a quick reply, thanks!

I forgot a 2 after the HSV.
My initial question was, what are the oods that someone has oral hsv-2? How many of all HSV-2 infected have oral HSV-2?

Sorry about that.

So I can be sure that I don’t contracted any HSV-2 because the risk in my encounters were very low. Is my assumption right?

I found two labs, one in the UK and one in Turkey that offer the western blot for HSV-2. That would be connected with expenses for flights and acommodation and of course for the test itself.
Should I take the western blot there just to be sure or am I exaggerating right now and my risk for transmission is in no relation to this effort in taking the western blot?

Greetings

[Terri Warren]

Oral HSV 2 is rare indeed. We know that at least 95% of HSV 2 infections are genital.
There is a lab in the UK that does the western blot? And one in Turkey? If you could forward me that information, I would appreciate it.
It doesn’t feel like you would need to take the western blot unless you just can’t stop worrying about this.

Terri

[westbrook]

I forwarded you the information through the “contact us” function of your website.

I have 3 remaining questions:

If I decide to run a blot, I’d have to fly to London and get it done by your contact there.
The procedure would be to book a consultation with you and then book the flight etc to London. This means getting the blood drawn would happen a few months after the consultation.
1. Is this okay or is there a timeframe between our consultation and the blot getting done that has to be taken into consideration?

I understand that the risk for acquiring HSV2 in my situation was really really low and you think I do not need the blot. Also my GP and uroglogist both told that I am most likely not infected.
I believe I can move on and not worry about this (0CD therpy helps me a lot here). But just for reassurance:

2. In your over 30 years of practice, has there been any case where someone contracted HSV2 solely from receiving oral sex?

3. If I take the blot, how much money would you bet that my results are negative? 🙂

Question 2 & 3 are for my peace of mind 🙂

Thanks and greetings

[Terri Warren]

2. In your over 30 years of practice, has there been any case where someone contracted HSV2 solely from receiving oral sex?
Not in my practice, never

3. If I take the blot, how much money would you bet that my results are negative? 🙂
1 million?

Terri

[westbrook]

Hi Terry, it’s me again.

I tried not to worry about HSV2 but I failed. I had a lot of sleepless nights because of this and I even failed exams at university. Every time I feel the slightest discomfort in my private area I start to freak out and am unable to function for the day. OCD really sucks. I know this is a broader issues but I think getting this topic out of my desk would help dealing with my remaining OCD issues.

I am strongly in favor of getting the blot through you and put this behind me. But before we do the evisit meeting I want to ask you some question to see if it is possible for me to get the Blot (it would be more convenient for me to get things done from Germany instead of traveling to London)

1) Have you ever heard about a false positive on the blot?

2) Have you ever had the blot done from Germany? If no, is it possible to get it done from here (given that it will be send with adequate packageing and will arrive in Seattle withing 2 or 3 days)?
(Asking because I read somewhere on the forum that the Blot is not possible from Asia).

If yes, my next question is about timing. As you know shipping from Europe is quite expensive, so I want to avoid taking the test twice (in case of an indeterminate).
My encounters were in November and January. I believe I read on this forum somewhere that a blot taken one year after encounter, if indeterminate is considered negative.

3) Therefore, should I wait till January to take the Blot? Or can take it now? Is a indeterminate even likely after almost 10 months after encounter? I’d prefer to get it done asap but if its better to wait till January to save myself from the second test I would.

I found a lab which is going to draw and spin my blood in a serum separator tube and also found adequate packaging and calculated the shipping (FedEx said it would take two days).

This is really giving me tons of anxiety and my mental health really took a toll the last months. Your helping hand is highly appreciated!

[Terri Warren]

1) Have you ever heard about a false positive on the blot?
That isn’t possible because four antibody proteins must be present to call it positive, not just one like the IgG test.

2) Have you ever had the blot done from Germany? If no, is it possible to get it done from here (given that it will be send with adequate packageing and will arrive in Seattle withing 2 or 3 days)?
(Asking because I read somewhere on the forum that the Blot is not possible from Asia).
Yes, I have had people do it from Germany successfully

If yes, my next question is about timing. As you know shipping from Europe is quite expensive, so I want to avoid taking the test twice (in case of an indeterminate).
My encounters were in November and January. I believe I read on this forum somewhere that a blot taken one year after encounter, if indeterminate is considered negative.
Correct

3) Therefore, should I wait till January to take the Blot? Or can take it now? Is a indeterminate even likely after almost 10 months after encounter? I’d prefer to get it done asap but if its better to wait till January to save myself from the second test I would.
If an indeterminate is a worry, and it can happen, I would suggest that you wait until a full year after a concerning encounter.

Terri

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