Timing of transmission

[transmissionquestion]

I was diagnosed with HSV-2 on January 14, 2014, after a culture test and physical exam on January 9, 2014, and have a question regarding timing and source of transmission.

I am a woman and have had sex with three men in the last 10-plus years. My most recent sexual partner and I began having sex on December 7, 2014. Right before Christmas 2014, I started having my first-ever symptoms of HSV-2: itching/burning on my labia; strong, strange flu-like aches, pains and chills but no congestion as I’ve had with other flus; unusual discharge; groin soreness; and then two small bumps on my labia. I had never experienced these symptoms before, or any other symptoms of HSV-2. It is my understanding that they signaled I had recently been infected with HSV-2 and this was my first outbreak. I asked two different health-care providers at Planned Parenthood if these symptoms indicated both my first infection and first outbreak, but they said they could not confirm the former, only the latter. (I did not have a good experience at PP and am not confident in their advice — the nurse practitioner who examined me said if I was positive for herpes it was HSV-1 because the visible symptoms were so mild. This turned out to be incorrect.)

My most recent partner got a blood test (“six separate vials of blood were drawn,” according to him; I don’t have more specific information) for all STIs on January 19, 2015, and he says it was negative for everything. I’m having a hard time believing this. The last time he had sex with his previous partner was in early or mid-October 2014. Because of the timing of my first outbreak, I assumed he was a carrier and had infected me. He says he has never had symptoms of HSV-2.

I had stopped having sex with my penultimate partner on November 11, 2014. Before that time, I was married for nine years and both my husband and I were monogamous (there’s no question about this). The last time I had sex with my husband was in 2013.

So, to recap, I started having my first-ever symptoms of HSV-2 on December 24/25, 2014; here’s a list of my last three sexual partners, in order of recency:
#1: Sexually active from December 7, 2014, until diagnosis
#2: Sexually active from September 2014 until November 11, 2014
#3: Sexually active from 2004 until 2013

Can you provide any insight or thoughts about this? I would like to be armed with more information before I initiate a discussion with my most recent partner about the veracity of his test results. Also, he says he is planning to be retested; can you recommend a time frame and specific type of test for him to take if he does decide to do so? Unfortunately, he and I are not on good terms now, and I have no control over if/when he gets retested or whether he will share that information with me.

Because of privacy and other concerns, I’m very reluctant to contact my penultimate partner or my husband to ask them to be tested unless it’s possible based on the timing outlined above that either could have infected me.

I welcome any information, thoughts or advice you can provide. Thank you.

[transmissionquestion]

I do have additional questions that I should have included in my original post. They are:

1. After my diagnosis (during my primary outbreak), I did one course of 400mg three times/day of acyclovir for 10 days, as prescribed. I hadn’t planned on continuing to take acyclovir suppressively, because my primary outbreak was very mild according to the health-care provider who diagnosed me, and because I’m not planning to be sexually active for some time. I also don’t like the idea of taking any medication indefinitely, however safe and side-effect-free it is.

A few days after I finished my first course of acyclovir (around the time that I started menstruating, which may be a trigger for me), I started to have tingling and a little itching/burning on my labia and panicked, so I refilled the prescription and did your recommended five-day course of 400mg three times/day for a non-primary outbreak. I have just finished this second course and am wondering if I should continue taking it suppressively. Being diagnosed with HSV-2 has been extremely stressful and anxiety-provoking, and the prospect of having additional outbreaks in the near future is increasing my stress. But at some point, should I go off of this medication to allow my body to build up antibodies so that I can eventually safely have sex with another HSV-2-positive person, and also not worry about cross-infecting myself? Do you have a recommendation here? What would you do if you were me?

2. Before my body has built up resistance to HSV-2, how is it possible to auto-infect other parts of my body? What precautions should I take?

3. Does my diagnosis mean that an HSV-2-negative person cannot ever safely give me unprotected oral sex? How high is the risk of transmission during this type of sex if I am on suppressive medication?

• This reply was modified 8 years, 10 months ago by transmissionquestion.

[transmissionquestion]

Oops — regarding my first post, I incorrectly wrote “2014” for both January dates (test/exam and diagnosis); they should read “2015.” I was tested and diagnosed earlier THIS year, not last year.

[Terri Warren]

the only way to know if this was a new infection or an old infection just showing symptoms is to have had an IgG antibody test at the same time you had the swab test done of the lesions. If the antibody test was negative for HSV 2 and the swab test was positive, then you would know for certain that this was your true first infection – there was virus present on the skin but not enough time had gone by for antibody to have been developed. I would guess that if you took the antibody test now it would be positive, but you could get it anyway and see what it says. By three weeks from infection, 50% of those who are going to make antibody will have done so. If you are negative now, it would mean that this is your first infection. If it is positive, you can’t know if this was your first infection or not.

I am a little confused about the dates that you listed. You said you started developing symptoms in late December that you were diagnosed with HSV-2 via a swab test in mid January 2015. Did you have symptoms the whole time in between? can clarify that for me?

In terms of your most recent partners blood tests: The fact that he had six tubes of blood drawn doesn’t really mean anything in terms of what testing was done. My recommendation for you would be to ask to see his test results and try to determine if HSV 2 type specific antibody testing was done. In many situations, herpes testing is not included in a full STD screen. You’ll want to know this for certain. If he tests negative for HSV-2, then I would wonder when his last sexual partner was other than you and try to sort out whether he may have brand-new infection and infected you or if he has truly not infected. You asked about the timing of his testing and my response is that it would be best for him to wait 12 to 16 weeks after his most recent partner prior to you to be tested for greatest accuracy.

I don’t think you need to take daily medicine unless you are bothered by frequent recurrences or you are having sex with someone who is HSV 2 negative. If you are taking daily therapy, I wouldn’t really worry about infecting yourself in other locations. Autoinnoculation is not common and the medicine is working to keep the virus under control until you mount an immune response. However, as I said, if you aren’t having sex with anyone right now, you could just not take daily therapy for now and allow antibody to develop. However, if you take the antibody test and already have antibody, it really doesn’t matter because you already have built an immune response of your own.

And yes, if someone is the giver of oral sex to you who is negative for HSV 2 there is a small risk that they could acquire this orally.

You asked a lot of questions – I may have missed something so please ask me more questions if you have them.

Terri

[transmissionquestion]

Thanks, Terri.

>>Terri wrote: “I am a little confused about the dates that you listed. You said you started developing symptoms in late December that you were diagnosed with HSV-2 via a swab test in mid January 2015. Did you have symptoms the whole time in between? can clarify that for me?”

Yes, I had continuous symptoms for that two-week-or-so period. It’s possible, though, that my first “symptoms” were just irritation from sex. I started having symptoms (itching/burning on labia, general irritation of vagina) on/around Christmas 2014, then had the strong flulike symptoms, etc., and still had one of two small bumps present when I went in for my exam on January 9, 2015, that was used for the culture test to diagnose HSV-2.

What did the flulike symptoms and groin swelling/pain represent? What was going on with my body; was that my immune system responding? From what I have read online, I thought that the symptoms I described could be signs of a first infection. Is that incorrect?

>>Terri wrote: “By three weeks from infection, 50% of those who are going to make antibody will have done so. If you are negative now, it would mean that this is your first infection.”

I am not three weeks from infection. I am six weeks from my first symptoms at this point. So probably no point in taking an antibody test, correct?

>>Terri wrote: “If he tests negative for HSV-2, then I would wonder when his last sexual partner was other than you and try to sort out whether he may have brand-new infection and infected you or if he has truly not infected. You asked about the timing of his testing and my response is that it would be best for him to wait 12 to 16 weeks after his most recent partner prior to you to be tested for greatest accuracy.”

As I said in my original post, his last sexual partner was in early or mid-October 2014. He says the blood was tested for herpes. What type of test should he ask for if/when he gets retested, keeping in mind that he may have been HSV-2-negative when we started having sex but contracted it from me, if I was already infected?

So it’s a possibility that I could have acquired this from my husband and it lay dormant for that period of time? How likely is this?

• This reply was modified 8 years, 10 months ago by transmissionquestion.

[Terri Warren]

It’s always hard to say what’s going on with flu like symptoms, especially in flu season. Yes, it could have been from first infection.

He needs an IgG antibody test and yes, I think he waited long enough from his last contact.
I would encourage him to get a copy of his herpes testing so you can see what was actually done and what kind of herpes test was used.
He wants an IgG type specific antibody test.
If his previous test was actually an IgG antibody test and was negative and is now positive, he could have acquired this from you. What was the date of his last testing?
It is possible that you acquired it from your husband or another partner. Did you have sex with anyone prior to your husband?
I’m afraid if your last partner tests negative you will not be able to know when you actually got infected. And if he is positive, I’m afraid you won’t be able to know with certainty who infected whom.

Terri

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