Questions about Overall Situation (Transmission/timing/tests)

[anonymous2009]

Long Post, but hopefully quite detailed and informative to others.

First off, thank you for this service, I understand it is a business but all the answers and opinions I have seen are beyond courteous and professional. I have heard multiple “facts” and opinions from now 4 different sources (astra urgent care, urologist, girlfriends gyno, college health clinic), so I take any answer now with a grain of salt and please excuse my lack of trust in this matter, however this clinic seems to be a legit source for herpes and the staff is trusted by WebMD, which I take as a good sign.

First my situation, then a few to the point questions.

My sexual history consists of one year long unprotected relationship (she had a few partners unprotected/protected before me) (100+ times sex unprotected), 8 more one time occasions with condoms only, and two unprotected oral only encounters. The long term unprotected relationship ended 3.5 years ago. Currently in an unprotected relationship for the past 8 months (100+ times unprotected) as well as oral unprotected. No symptoms noticed ever.

Current girlfriend has had one long term unprotected relationship ending about 10 months ago (40ish times sex unprotected, partner had no symptoms she ever noticed), but she had 18 partners prior, estimated at 13 protected and 5 unprotected. Most were one time encounters, a few once or twice, no person more then 2 times. (Tested twice yearly but she never realized hsv tests were not included, myself as well).

This is only for a statistical purpose, please do not infer any prejudice, but neither had intercourse with anyone hispanic or african american (In my research I read that statistically those races have much higher rates then caucasians, e.g. AA women are at around 45% positive for hsv 2), so that may be info that would effect your conclusions.

Current Situation
Went on a tropical vacation end of December 2014, having constant unprotected sex throughout, and during so my girlfriend contracted a uti (attempted anal), and then a yeast infection from the antibiotics (uti confirmed as ecoli from urine culture, and symptoms went away after antibiotics taken, same with yeast treatment). I then had an uncommon “feeling” mostly when urinating, like there was still “some left in the tank” and a slight sensation, as well as redness at the tip of my penis, shortly after the trip so I went in to get tested hoping it was in my head and never thinking hsv once, my results were below:

To note, neither has had any symptoms or any reason to go in to get checked specifically for herpes, in fact it has never even been a thought in my head.

December 30th Test (negative for bacteria and all other stds)
IGM
HSV 1 – Negative
HSV 2 – Negative

IGG
HSV 1 – Negative
HSV 2 – 1.10 (.9 = neg .9-1.1=equiv 1.1+=positive scale)

January 28th second test (all negative again except)
IGM
HSV 1 – Negative
HSV 2 – Negative

IGG
HSV 1 – Negative
HSV 2 – 1.14

By this point I had made my girlfriend fully aware, and she went in to get checked herself. Her tests came back today, February 6, (all negative for other stds) and…
HSV 1 – Negative
HSV 2 – Negative

Doctor Visits
The astra urgent care told me “I had an encounter but im not infected because no symptoms” and didn’t think false positives were possible. No symptoms during physical exam.

My urologist seemed to take the tests casually, said if one of us has it by now we 100% both do, but with such low tests and no symptoms from either person, I can rest assure we are both fine. No symptoms during physical exam.

Her gyno told her that we are only contagious when there are symptoms, so if no symptoms then we are fine (phone call).

Her college health center told her that either could be contagious despite no symptoms, but took it lightly as well.

All of these responses shocked me, as according to my online research and this site, most of that is wrong (note to people reading don’t just take the opinions of a random doctor or even a specialist during an appointment. In my experience, 3 out of the medical professionals we saw were quite uninformed).

My thoughts currently are that 99% chance I got it from one of two past long term relationships (3.5 years ago or current), and much more likely this current one judging by her experiences before me. I have more hope that: with my tests so low, her being negative (assuming she has not had any unfaithful encounter in the last 2 months, just no igg yet), and the fact that we have had unprotected sex 100+ times so she would probably have contracted it from me by now, but shes neg.

However I am still not jumping to any good conclusions because: I still technically tested positive (which many other sources say is 95-99% accurate even at low levels), I did have flulike symptoms for a night and a day (shivering, bad nassau) a few weeks ago and I usually do not get sick, and maybe I just did not pass it to her yet.

Questions:

1.) I understand the igm test is short-term, often wrong anyway, and is not any standard that should be relied upon. However, does me having two negative results a month apart when I thought I may be experiencing current symptoms, conclude that I did not contract this recently and these possible symptoms are not hsv, or is the igm so unreliable that it means nothing?

2.) Add on to first question. Since I already have iggs (assuming its true), is it again safe to say (combined with two negative igms recently) that I did not contract this in the past 2 weeks? 1 Month? 3 Months? etc? What timeframe can we rule out with 99% certainty (we can never say 100%) that with a positive igg and negative igms, I did not get this from her recently?

3.) I read all these stats and conclude that in a relationship having unprotected sex 2-3 times a week for a year, 4% of couples spread it to their partner if they do not have intercourse during symptoms (Maybe thats with condoms and I am misinformed?). But that seems to directly contradict other facts that say that even asymptomatic people are contagious 10% of days and 80% of transmission comes from people that don’t even know they have it. If even asymptomatic people are contagious (shedding) 10% of days, and a couple had sex 156 times in a year, how is is possible only 4% of them would pass it on even not having sex during symptoms, wouldn’t that rate be almost always 100%? I ask this because…

What are the chances that I was positive coming into this relationship, and just have not passed it on to my girlfriend after 100+ times of unprotected intercourse and not monitoring for symptoms? I see this as a positive sign that she is negative, because it helps my cause that my positives are false.

4.) I would classify what I am feeling (assuming some level of being a hypochondriac from stress) slight redness in a few mm size areas, seen in certain lights, and slight sensitivity around only the head/tip. The tip has been redish and slightly sensitive along with a slight form of dysuria for 6 weeks, and possibly more redness in the last few weeks in very small spots that may or may not go away, almost like irritation from intense sex that hasn’t left. This has never come close to an ulcer, open cut, or anything that a standard hsv symptom would look like, but I am still obviously concerned.

Would hsv 2 symptoms ever be this mild, but lasting this long? Such a rare chance but possibly yeast infection, parasite from tropical place, urologist is correct with prostatitus? (Im reaching here)

5.) I was negative for hsv1 all around, but am 85% sure I had a oral cold sore, a cut that scabbed over in the corner of my mouth and took a week to heal, (maybe even 2 although I used abreva right away) about 5 months ago. I do not specifically remember getting any cold sores frequently but I easily could have had them over the years. If it is true and have had them, why is my hsv 1 negative? Maybe I just had cuts?

Final Thoughts
To note my urologist, after stating my symptoms and checking me physically, concluded I have prostatitis. I also made sure to point out the minimal irritations and he said absolutely not hsv and said it was in my head. (Also please remember I was negative for all stds including trich twice, negative for bacteria in urine tests twice, and my girlfriend was negative for all once.)

Again, thank you for reading this and helping me out. I apologize for the length, I thought that giving you my exact situation would allow you to make an accurate conclusion. Also, I think sharing my entire plight could provide others something specific to gauge their situations on. Again, thank you very much.

I will be getting the Western Blot done through your clinic whenever you advise.

[Terri Warren]

1. The IgM should be ignored. I don’t have any faith whatsoever in this test.
2. I seriously seriously doubt that you have HSV 2. Your numbers are so low; statistically, there is about an 85% chance this is a false positive.
3. There are many factors that influence transmission, some people are more vulnerable than others, some people shed a lot more. I don’t think you can use the statistics about transmission in the way you are using them.
4. This could be herpes, yes, but I still don’t think you have HSV 2.
5. The ELISA screening test misses 1-2 of 10 infections, so you could certainly be infected with HSV 1 and the tests are missing is. The western blot, which I recommend for clarification of your HSV 2 status, is more sensitive for HSV 1 as well. You may well have HSV 1, given your description
I think your partner should definitely get tested to see what her status is. If she’s negative for HSV 2, then you need to figure out when you last had sex with someone else and get tested 16 weeks later.

I hope this is helpful but feel free to ask more questions as needed.

Terri

[anonymous2009]

Thanks again for all the information, i’ll keep my follow up short.

My partner was tested just a few days ago for igg hsv 2 and was negative. The only person I had unprotected sex with before that was another partner, 3.5 – 4.5 years ago. There were occasions of protected sex in between, but nothing more then once, and always condom use.

1.) So a follow up to question 3, is it possible that if I am actually positive, I just have not infected my partner yet after having sex 125+ times unprotected? That seems so unlikely from my limited knowledge on the topic, and my urologist, while seemingly uninformed, told me flat out “Whatever you have, by now your partner has as well, so if she is negative you can be rest assured you are too.”

2.) Also, I have read so many different time frames when hsv 2 igg antibodies show up, from 2 weeks to 6 months. What, in your opinion, is the earliest that they generally will be detected? Of course there are the extremes, but I am wondering what the standard earliest is?

3.) Last inquiry. Lets assume that I am positive for a second, and now it is confirmed that my current partner is negative igg. Could I have had this for 3.5+ years, and just now am having minimal symptoms? I know that sometimes people don’t see things right away, but again in my limited knowledge it seems unlikely that this would just start to occur 4 years later…

Again, I appreciate your input. How should I go about setting up the Western Blot through you? Easiest to call in?

[Terri Warren]

1) I disagree with your urologist. If you had gonorrhea or chlamydia, that would be true, but because herpes is not always active on the skin of an infected person. I have couples who have been together 25 years where one person is infected and the other still is not.

2) The earlier I have seen anyone seroconvert, from INFECTION, not symptoms, is 10 days. By 3 weeks from infection, 50% of those who will be positive, will be positive.

3) Yes, you could have been infected for many years and just now having symptoms, yes.

You can order your western blot test through our clinic. The cost is $250, which includes the office consultation and the test itself. Yes, you can just call the clinic and set it up with the front desk. It takes about 1-3 weeks to get results.

Terri

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