optimist

@LoveTheMountains I agree with you on not "selling" prospective partners, though I do find stats helpful for a couple reasons. First, it helps me put my own infection into context. Also, when I disclose, I always offer to answer questions and transmission risk is a common question I've been asked in response. I like to be prepared to answer that question when asked. I don't find it contradictory that HSV is very common yet transmission risk under certain circumstances is low. Many factors go into these seemingly conflicting statements. Though I do emphasize to prospective partners that risk exists, even when condoms are used. I've also opted out in cases where I felt the person had not had enough time to process the information, as well as a case where someone came back around after educating themselves but still had a lot of anxiety. I'm always aware in such cases that risk DOES exist, even if the risk is small, so I consider whether or not *I* am willing to take that risk with that particular person. Sometimes the answer is no.

I've only seen one study with actual data on this but the study size was very small. It says "However, among 48 source partners of people with documented newly acquired genital HSV‐1, HSV‐1 was isolated from the genital area in seven and from the oral area in three (unpublished data). This suggests that genital to genital HSV‐1 transmission is potentially not uncommon." Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564733/ My understanding is that research is underway to better pinpoint genital to genital risk. In the meantime, it might help to look at average shedding rates which indicate how often a partner would typically be exposed to the virus. The average rate for GSV2 is 3x higher than that of GHSV1 (14% vs. 5%). Additionally oral HSV1 sheds more often than either of the genital varieties at 25%, and more people have oral HSV1 than any other type/location combo, so many more exposures of oral HSV1 are occurring in general, often through oral sex. FWIW, my doctor gave me the same advice about HSV2 and risk outside of symptoms. I think this is how many people in the medical community view it based on a variety of factors including prevalence and general impact of contracting the virus.

This man having oral herpes does not make him unclean. Nor would genital herpes. Both are very common. Many people contract oral herpes as tiny children. Most people contract it during the course of a lifetime. As for telling you he had been tested, it was wrong of him if he lied about testing for STIs in general, but bear in mind that most STI panels do not include testing for HSV. If they did, a majority would come back positive, that's how common HSV is. So when people say they are "clean," even if they have been tested for STIs, it's likely there are some they have not been tested for, such as HPV and HSV. As for you daughter, if your infection is genital, you don't need to worry about transmitting it to her. If your infection is oral, refrain from kissing her during outbreaks.

No idea if you have genital herpes. Visual diagnosis can be inaccurate. If you do have genital herpes, you may have type 1, type 2, or both. Genital HSV2 most often goes unnoticed. 80-90% of people don't notice when they contract genital HSV2 and then either have no symptoms or symptoms so mild they mistake the symptoms for something else (ingrown hair, yeast infection, pimple, razorburn, etc.). Those who do notice symptoms may have the type of significant symptoms you described you saw on Google, but that is generally the very first outbreak. If they have recurring symptoms, they are usually much more limited (such as a single small ulcer). Genital HSV1 often results in a noticeable primary outbreak. However, those who have recurring symptoms typically have them less often than people who have recurrences caused by HSV2. Don't know if the bumps you saw on someone else were herpes related. If they looked like little ulcers, that could be a good guess. But other things cause "bumps" as well. It is not *necessary* to take antivirals. Those who take them generally take them either daily to reduce/eliminate outbreaks and/or reduce transmission risk to a partner, or they take them when they feel symptoms coming on to shorter the duration of symptoms.

@PresentMoment That was not my experience when someone disclosed to me when I was young. I chose to continue dating them and we broke up for others reasons later. It has also been my experience that most people I've disclosed to have been fine moving forward. Not all but most. I also don't feel I've made anyone out to be a "bad guy" but instead have pointed out that different people assess risk differently, whether they have very few partners or many partners or all kinds of other factors. That was the only point I was trying to make to @freya who speculated that those having more casual sex might be more likely to take the risk in stride.

There is very, very little document research on this. I've only seen one very small study that looked at people with brand new GHSV1 infections and then assessed where their source partners were shedding from and it revealed that some of the new cases were a result of genital-genital contact. However, this was a very small study, like maybe fewer than 50 people, IIRC. If you're interested, I'll find it for you. I do recall Terri Warren (well regarded clinician with HSV expertise) mentioned a while back that GHSV1 transmission research is underway and that in the absence of data, she would point to shedding rates as possibly giving insight. Oral HSV1 sheds an average of 25% of the time. Genital HSV1 sheds an average of 5% of the time. Genital HSV2 sheds an average of 14% of this time. An educated guess might be to divide documented average transmission rates for GHSV2 by 1/3 since GHSV2 sheds about 1/3 as often as GHSV1. And also may be helpful to bear in mind that genital HSV1 sheds on average 5x less often than genital HSV1. As for the lesion on your chin, you'd need it swabbed to know if it's HSV related, I think.

@PresentMoment I hope I didn't come across as judging someone with a history of 100 partners. I was trying to illustrate that even someone who is comfortable unknowingly taking that risk, assuming at least 25 of his past partners had HSV2 based on statistics, may still have anxiety about one partner with known risk. He had never been disclosed to before and reacted with anxiety to the known risk. I was addressing @freya's speculation that people who are already taking this risk with random sex partners of unknown status might be more open to having sex with someone who knows they are HSV2+. It's my opinion that risk assessment is often more complex than that.

@freya This has not been my experience. I've experienced both outcomes with people who were very emotionally invested, and I've experienced both outcomes with people who were extremely active participants in hookup culture. That is not to say that there aren't some cases where people who hookup more randomly factor that into their decision making and people who are more relationship oriented do the same, but just to say that risk assessment is a very complex thing. I encountered a guy with a history of 100 partners who had extreme anxiety when I disclosed. It's a complex situation due to the stigma.

@50andsad If it helps at all, please be aware that having HSV2 at your age is to be expected. A majority of single/divorced/widowed women in the U.S. contract it by your age. Your partner may not be aware of how very common this is due to the stigma and how it is typically not included in STI panels.

The situation you describe presents no risk.

No, HSV2 is not transmitted this way. Additionally, in the U.S., 30% of moms of newborns have HSV2, most don't know they have it, and no additional precautions are required. Even moms who have oral HSV1 which is more common are not advised to take precautions outside of abstaining from direct skin-skin contact with the infected region during an outbreak.

80-90% of people don't notice upon contracting HSV2 and most of those people never notice. The same is true for 70% of people with HSV1. In these cases, occasionally people will notice symptoms later on or put it together that something like repeated jock itch or yeast infection or ingrown hairs was actually HSV. Very common. So if he has tested positive for herpes, yes, it's possible he had it before you, or that he contracted it from you after a few years.

It's unfortunate they didn't swab you. Also unfortunate they did not test you for both types when you tested for HSV2 in the past as you would have then had a baseline. Current possibilities include: - You have oral HSV1 (70% of people with HSV1 have no symptoms or mild symptoms they don't recognize) and the ingrown hair symptom is not at all related to HSV - You have genital HSV1 - You have both HSV1 and HSV2 but tested too soon after having a vaginal symptom of HSV2. It takes at least a few weeks and up to 12 weeks from time of infection for antibodies to build to a sufficient level to trigger a positive test result on an IgG blood test. The IgG blood test will pick up 70% of HSV1 infections and 95% of HSV2 infections at/after 12 weeks following infection. (They can also return false positives, usually in ranges under 3.5, so even with the HSV1 result, you may want to ask for that data.)

@Adam I agree with you that it's good to be educated enough to answer questions accurately. Personally, I tend to just keep it to the facts of my situation when I disclose and then provide more information based on their questions. I've provided the annual risk stats for people who asked about risk, and it's funny how different people can see the same numbers very differently.

@Adam Sorry, forgot to answer your other question. Whether it's misleading would be based on a few factors. How much does the other person know about how all this works? Is this being pitched to someone who is making a choice to have sex one time only or is this a long-term partner? When potential partners, including casual partners, ask me about risk, I share with them that the available statistics are based on couples who have sex a couple times a week over the course of a year. I state it this way even though I know we likely won't be having sex that mirrors how those couple have sex. But I feel it could be misleading to them to divide risk by 100 acts or 150 acts or 365 days or whatever because too many variables influence risk on any given day. Just my opinion.

@Adam The 6% was my estimate based on my scenario of having *daily* sex which is 3x more frequent than the frequency of sex in the study that states 2% per year female to male with antivirals but no condoms. It is not a perfect calculation but my goal was to provide an estimate based on a person being exposed to virus 3x more often than accounted for in the study. I wanted to explain that the actual risk is based on those 9 shedding days, not divided by 365 days or 100-150 acts or whatever.

@Username You mentioned this attitude of "Oral herpes, no big deal, not transmitted sexually." I'd say more like "Oral herpes, no big deal, not *acquired* sexually." Because oral herpes is a sexually transmittable infection, but most cases are not *acquired* sexually.

I still think it's misleading to describe risk per sex act. I'll provide a different example to explain what I mean, again using the stats I quoted earlier that apply to an asymptomatic woman with HSV2 who takes daily antivirals. On average, someone with this profile is shedding virus 2.5% of the time. Sometimes it's enough to potentially infect someone if multiple factors come together, sometimes the level of shedding is too low to infect someone or other factors come into play that increase or reduce risk on the partner's side. So let's say I'm this woman and I have sex (with a condom) with a different partner every day of the year. 365 partners and none of them have HSV2. I met them at all a HSV-free pride convention. Because I'm shedding virus 2.5% of the time, 9 of the partners were potentially exposed to the virus, 356 were not exposed. You asked about condoms and the reason I say 9 were still exposed is because shedding occurs from the genital tract and these partners are likely coming into skin-skin contact with my vulva and perineal area if we're having vaginal sex. Condoms are believed to reduce female to male risk by roughly 50%. They're more effective in reducing male to female risk (I believe closer to 90% though I don't know the exact number) because more of the shedding area is covered by the condom. In other words, transmission risk is significantly higher male to female when no condoms are used but condoms provide greater benefit in reducing male to female transmission. But back to my example, you can see the risk was not .0000something for each of these sex partners. The risk was zero for 356 of them, but then the risk fluctuated for the other 9 of them based on a variety of factors. In the studies of partners having sex for a year, these people were not having continuous sex with others who had a steady stream of risk. The average frequency of sex was something like 2x per week which means they were likely not even making contact on a majority of the days the partner was shedding virus.

> Would you agree that this is correct, or have I missed something? Not really, no. I don't think it's possible to pinpoint a "per act" risk because too many variables exist. I'll use my own case as an example... Asymptomatic female with long established HSV2 infection who takes daily antivirals. Average shedding rate for someone like me without antivirals is 10% (37/365 days), but with antivirals is 2.5% (9/365 days). So let's imagine I have sex every single day of the year (which is 3x more often than the risk studies account for). I pose 0% risk during 356 of 365 sex acts. Roughly speaking, if I have sex all 9 days I'm shedding, that represents perhaps a maximum collective risk of 3% (condoms) or 6% (no condoms). That's not precisely how it works when having sex 3x as often, but close enough. And even if you then say the risk is less than 1% per each of those 9 acts, that's still not entirely accurate because risk varies on each of those days. I suppose I could say in my individual circumstances that risk is zero percent 97.5% of the time and up to 3% (condoms) or 6% (no condoms) 2.5% of the time and I just don't know when those 2.5% of times are occurring.

Separately, I'll answer some of the questions you've asked in your post: > If you are in an H+/H- relationship - how did you or your partner get comfortable as the H-? I’m assuming it’s normal for me to have some mixed feeling about this given where we are in the relationship? I've had partners who did not know their HSV status but assumed they were negative. They were comfortable with it pretty immediately but the reasons varied. Totally depended on their thought process and risk tolerance. Reasons included a belief that I pose less risk than others who don't know their status (I take daily antivirals), the generally low risk of transmission with condoms and antivirals, an overall acceptance that sex includes risk (HSV, HPV, etc.), already having oral herpes so understanding what HSV is and how it works, already having had a partner who knew they had it. Different thought processes for each person. > Anyone have a similar experience having the talk with your partner after a few dates? Successes? Most of these talks I've had have been successful (I might use a different word for it, but I think you are equating success with moving forward, so I'll use it that way). However, I had one talk with someone who felt really exactly as you do. It didn't work out. He could not get comfortable with the risk unless it was going to be a forever thing and it wasn't going to be a forever thing. Like you, he wished I had not tested and did not know his own status or the status of previous partners. He revisited the topic with me a few months later after doing some research and seeing the stats you mentioned (1-2% per year) and thought he might want to try but still wasn't totally sure and still was anxious. That was the key for me. He had educated himself and had taken time and still was anxious. I had to move on at that point. We remained friends. > Should I be tested now? Not that I would hope for this but there’s slim chance I already have it. I would never wish for that but that certainly makes all my questions moot There are pros and cons of testing. I'd think through the various scenarios, keeping in mind you have about a 1 in 5 chance of coming back positive for HSV2 and a greater than 50% chance of coming back positive for HSV1. > Is my approach/ handling of the situation appropriate? I’m trying to be considerate of how she feels especially because she was so open with me and I think I was the first new partner she’s told If you're being honest and respectful, I think that's appropriate. As I said in an earlier comment, I would not assume she is embarrassed or ashamed unless she said this to you specifically. Bigger picture, I'd say that if you still feel very anxious after a little time and education, it's more respectful to allow her to find a partner who is not as anxious about physical intimacy with her. > How has it effected your sex life? Still have regular oral and vaginal sex? Any precaution outside of condoms for vaginal sex? Do you always use condoms. Has your partner contracted? Have you had kids? ...I don’t want to feel like I need a scrub myself with a bristle pad every time we have sex (ouch) It's affected my sex life in that I feel a need to build in a disclosure conversation before intimacy and about 1/4 of those I disclose to are uncomfortable moving forward. The flip side is that I've had disclosure conversations that led to increased bonding because the other person then felt comfortable opening up to me. As for your other questions, I've never knowingly transmitted it, but it's hard to know for sure because most people don't recognize when they contract it. I do use condoms but was in a very long relationship and not using condoms (and had kids) before realizing I had it. No idea if he ever got it or had it from the beginning or what. We're no longer together so it's none of my business. I do have oral and vaginal sex, yes. Oral with no barriers, vaginal with barriers, though I'd be fine going without barriers in a monogamous relationship if my partner wanted that. >She’s never had symptoms. I do not know if she’s on an antiviral. Does that change anything (I realize with viral shedding she can still spread it)? Do people go through life never getting symptoms or will she eventually have an outbreak? Daily antivirals reduce transmission risk by about 50%. They reduce shedding rates by 70-80%. What this means in this girl's case is that if she has been infected for at least a little while now (say at least a year) and she is not taking antivirals and has not had outbreaks, she likely sheds virus about 10% of the time (it is 20% of the time for people with symptoms; these are averages). Taking antivirals would reduce this to 2-3% of the time. That's the amount of time she is potentially infectious, but even then, the risk is very low. To put this in context, people with oral HSV1 shed virus an average of 25% of the time. And yes, 80-90% of people with HSV2 don't know they have it with many never having symptoms and others not recognizing very mild symptoms. The same is true for 70% of people with HSV1.

I think you're correct that it is the *knowing* of her status that is creating anxiety here. A significant portion of women with her sex history (5 partners) have genital herpes. It's likely at least a couple of your previous partners had HSV2. While less common among men, statistically speaking, given your age and sexual history, there's roughly a 1 in 5 chance you already have it yourself. But IMHO, the issue for you isn't having it, it's knowing she has it, combined with being generally anxious. And as you said, you are less concerned abut contracting it than you are about how knowledge of contracting it could influence your sex life later. Also, heads-up that she may not feel embarrassed or ashamed. She might or might not. Maybe she expressed to you that she does feel that way. Otherwise, I would not assume that. I personally have HSV2 and do not feel embarrassed or ashamed. I just consider it a result of having been sexually active. It's a very common virus among people who've been sexually active. Nothing wrong with taking things slow in any new relationship, but I'd personally advise avoiding going into it with the intention of waiting several months to get physical due to HSV2. I think that timeline would both affect her self-esteem and put pressure on you if you ultimately feel too anxious to continue. Just my two cents. I'm sorry you've run into this problem. The stigma sucks and not just for those who have it but for those in your position as well.

The herpes simplex virus is not present in blood. Only antibodies are present. Also, a majority of adults have HSV, so a majority of blood donations will have HSV antibodies, but not the virus since that's not found in blood. Not sure what to tell you about the questionnaire but I'm certain HSV is not a disqualification for blood donation. Most adults carry at least 4 of the 8 herpes viruses that commonly infect humans.

It sounds like you contracted oral HSV1 as a child which is very common, then genital HSV2 after becoming sexually active which is also very common. Have you considered a hormonal link to your migraines? It's not uncommon for girls to begin getting migraines at puberty due to hormonal triggers. There is medication for cold sores and genital sores, yes. Antivirals can be taken daily or episodically. When taken daily, half of people who have symptoms no longer have any outbreaks at all. The remaining half see a 70-80% reduction in symptoms. A very small number (I think .3%) get no relief from antivirals. When taken episodically (only when cold sores or genital sores appear) antivirals are taken for a few days to shorten the length of the outbreak. Some people also take daily antivirals to reduce the risk of transmitting HSV to a partner. As for yeast infections, there are OTC topical preparations for vaginal infections, as well as oral medications such as diflucan. If the infection is oral, I would think the oral medication would be appropriate, but I'm not a medical professional, I'm only guessing.

@freya 80-90% of people with HSV2 don't know they have it, and it's very common in the population. So while your positive test did not reflect a 4 day old infection, it's possible you both had it when you met, or that he had it and gave it to you months ago, or that you had it and have given it to him since you started dating, or that you have it and he still does not have it. An oral infection is possible though uncommon. Asymptomatic HSV2 infections are generally assumed to be genital, though they are not always genital.

@PresentMoment For those people who experience a noticeable primary outbreak, it usually occurs within two weeks of infection. Because you do not have HSV1, it makes sense your body would've reacted more strongly when infected with HSV2. Your theory makes sense to me if you had sex with someone (and just that one person) within the two week time period before you experienced an extensive outbreak. Antibodies take time to build, but I believe it's possible to reach 2.34 six weeks in. Some people with longer established infections test in that range, and many people still test negative six weeks out, but the combination of a low positive, symptoms consistent with a primary outbreak and having had sex within two weeks of outbreak do seem most likely to point to a recent infection. Sure, you could test again to see if the antibody values have increased. Once the values get into the positive range, they can fluctuate within that range, so it isn't a case of values continuing to grow forever, but if the text was taken six weeks out, it makes sense you'd likely still be building antibodies. In general, those who test under 3.5 are encouraged to do confirmatory testing due to a greater chance of false positives. @Freya Not sure what you mean by "super high" but you are correct that you would NOT test positive by IgG a few days after infection. It would take at least a few weeks and up to three months to test positive (95% of infections are recognized by IgG after 12 weeks). If by super high you mean 5 or greater, I've seen that question asked by an expert in the field. Someone asked her if a value of 5 could reflect an infection that was acquired 3 weeks earlier and she said no, three weeks was too soon to test at that level. So I have to assume the same is true for a few days.