optimist

@Katidid It does happen but it is uncommon. It's especially likely to happen when someone has a new infection (infected within the previous few months) before they would be testing positive themselves. One reason transmission of HSV2 from a one nighter is uncommon is that it sheds an average of 14% of the time (much more during the first few months though). So the odds are 1 in 7 the person is potentially contagious at the time of the one nighter. And even on those 14% of days, unless symptoms are present, often there isn't enough virus present to facilitate transmission. But it does happen, just like it happens that some people manage to never get it at all. There are also times when people have the perception they were infected by a new partner because sex can trigger symptoms of an existing infection. So someone contracts it unknowingly, has sex with a new partner, gets an outbreak, assumes it's from the new partner. Most people never test for HSV unless a symptom pops up or a partner is unfaithful or a partner discloses HSV. At that point, they're testing for the first time and might assume a positive result reflects a new infection. Sometimes it is, sometimes it's not. I know that when I disclose to people, if ever they test positive at some point in their lives, they will likely think it was me who transmitted it because they don't understand it is likely 1/3 of the women they've partnered with have had HSV2.

@annalove I've seen studies on disclosure rates and they vary depending on circumstances. Of course, the biggest barrier to disclosure is that most people simply don't know they have it. In the case of HSV2, for every one person who knows they have it, there are seven people who unknowingly have it. More people with HSV1 are aware they have it, but expectation of disclosure falls mostly on those who have it genitally, even though it's more easily transmitted from an oral infection. Again, this is the stigma at work. Anyway, the studies are focused on disclosure of genital herpes (types 1 and 2) and a fair number (a majority) of people who know their status do disclose, but less often for casual encounters. Additionally, the studies indicate that most partners are accepting and that those who experience rejection are less likely to disclose in the future. But again, when we take the 80% who have HSV and the whittle it down to those who know they have it, and know they they have it genitally, it's only about 4%, so increasing disclosure from 3% to 4% does not address the remaining 76% who don't know their HSV status or don't feel they have a type/location combo that needs to be disclosed.

I think one thing to keep in mind is that about 80% of adults have HSV. Most don't know it and have never been tested for it as symptoms are often mild or absent and it is typically not included in standard STI panels. It sounds like you were unusual in that you were testing regularly for HSV1 and HSV2 and tested negative for both prior to entering a relationship with this woman. She was also unusual in that she was aware of her HSV+ status. If any of that is incorrect, please correct me. It may also help to understand that people who are diagnosed with HSV are not given standard instructions, and they are often given mixed messages about how to proceed. Some are told disclosure is not necessary, some are told the test results are unreliable and should be disregarded, some are told to simply avoid kissing/oral sex/intercourse (depending on location of infection) during outbreaks, some are told they are only contagious when symptoms are present, some are discouraged from taking antivirals, some are told just to use condoms, some are told nothing at all. As humans, we carry many lifelong viruses, typically including at least four herpes viruses, but genital herpes (of either type) seems to carry a unique stigma. This is evident when people react differently to oral HSV1 and genital HSV1 which is the exact same virus, just in different locations. I don't know who I contracted HSV from or when. I found out later through testing. So there was nobody for me to feel betrayed by, except the doctor who included HSV testing in my STI panel without better setting my expectations about potential outcomes. And I did feel angry at him because my anger had to go somewhere. I still feel angry about it sometimes. But when I really examine why I'm angry, it's because I'm angry at the stigma, not the doctor. This helps me put my anger in perspective. It also helped me to think about how much I would have missed out on had I made the choice to prioritize remaining HSV-free. I wouldn't go back in time and eliminate 80% of my partners who statistically had HSV, I wouldn't go back and use dental dams and condoms for oral sex, I wouldn't have waited three months and done partner testing with each new partner before kissing or having even protected sex, so I guess I valued a certain about of sexual and romantic freedom over keeping myself free of HSV. And I ended up HSV1-, HSV2+ as a result. I do understand why you are angry and why you feel betrayed. I don't mean to minimize what happened here. But you asked for thoughts and those are my thoughts. If you feel very strongly that people with herpes should be required to inform partners, it's a much larger issue than asking the minority who have been diagnosed to adhere to this. The majority of the population is infected already and would need to be educated about this. The medical community would need to shift gears, normalize and encourage HSV testing, and provide standard instructions upon diagnosis. JMHO.

@Trixie8 I'm trying to imagine scenes that are more along the lines of what @annalove mentioned above. Maybe you have a woman who is disclosed to by a dude and she kind of freezes and imagines this ideal scenario where she is 90 years old and receiving a trophy for being HSV-free along with two other residents of the nursing home while 100 other residents are clapping for them, and there's a visual of her college alumni newsletter congratulating her for her lifetime HSV-free award, and she's feeling super proud and smiling, but then her eyes train on some residents in the audience who are making out with abandon and her imagination shifts to having sex with that hot guy who disclosed herpes and she decides to go for it.

80-90% of people don't notice upon contracting HSV2 because they have very mild symptoms or no symptoms and this is especially likely when someone already has HSV1 before contracting HSV2. A considerable percentage of people contract HSV1 first because they are exposed to it from infancy through adulthood while HSV2 exposure does not begin until people become sexually active. In a U.S. study of more than 8500 pregnant women, 66% tested positive for HSV1, 30% tested positive for HSV2, and 19% tested positive for both HSV1 and HSV2. Overall, 77% tested positive for at least one type of HSV while 19% tested positive for both types.

First of all, people with HSV are not contagious all the time but rather intermittently. Therefore, you may or may not have been exposed, let alone infected. If he has HSV2, because he is symptomatic, and if he does not take antivirals, it is likely he is shedding virus about 20% of the time, so 1 in 5 chance he was shedding virus that day. If he takes antivirals and has HSV2, this would decrease shedding to about 6% of days, so significantly less chance he would have been shedding virus that specific day you had sex. If he has HSV1 (which can cause genital herpes), average shedding without antivirals would be 5% of the time, so about the same as if he has HSV2 and takes antivirals. In other words, on average, he would be shedding virus 1 of every 20 days and not at all contagious the other 19 days. If you got unlucky and happened to have sex on a day when he was shedding virus, odds of transmission are still low outside of an outbreak, but there is a possibility of infection. Studies indicate that if 100 men with HSV2 who do not take antivirals have regular unprotected sex with HSV2- negative partners over the course of a year, 10 of their partners will become infected with HSV2 by the end of the year. This drops to 5 partners if condoms are used regularly and 2 or 3 partners if both condoms and antivirals are used. Transmission risk is assumed to be lower for genital HSV1 due to less frequently shedding. So while it's possible one day of sex could result in transmission, the odds are very low. In the future, you may want to keep in mind that the great majority of people with genital herpes don't know they have it and therefore can't disclose it to you, so if it's important to you to avoid it, you may want to make it part of your pre-sex talk to ask partners if they have recently (or ever) been tested for HSV.

My guess is he's angry at the stigma, not you, but you are the target of that anger. Or if he had a particularly painful primary outbreak, his current emotional state might be influenced by that. Consider that statistics indicate roughly 1/4-3/4 of the women he dates will have HSV2, depending on demographic. You alone could not protect him from HSV2, you could only share your known status. Actively avoiding HSV2 requires taking steps such as partner testing. He may not realize this. But like many of us, he probably grew up exposed to the stigma and has suddenly found himself on the other side of that which can be disorienting and jarring. If the physical component is also an issue, hopefully he will see marked improvement over time, as most people do. I'm sorry you're experiencing this. You did your part in disclosing. I would guess he would not have wanted you to push him away due to your HSV2 back at the beginning. The other side of that coin is that he was aware of the risk of HSV2 (which is more insight than most people have into their own status or their partners' status) and he chose to proceed. Having said all that, I would give him the space he has requested as you are likely not the person to best support him through this time, and it doesn't sound healthy for you either.

@WhatNow17 Some of these viruses do occasionally cause major issues, just like HSV sometimes does (encephalitis, meningitis). EBV and HPV can cause cancer, shingles can be devastating to elderly people. IMHO, HSV2 is closest in impact to HSV1, each of which tend only to get negative attention when the infection is genital rather than oral. This makes sense in certain cultures like the U.S. that have puritanical roots, and marketing probably played a role, as well. I think the nickname "cold sores" has also influenced how people see oral herpes and genital herpes so differently. And there is a case to be made for more concern about genital herpes in demographics with high HIV rates because genital HSV can increase risk of contracting HIV. Looking at another aspect of HIV, you may recall that for many years those who contracted it through sex and IV drug use were shamed, while those who contracted it through blood transfusions were not. There's a puritanical influence in how the infections are perceived based on how the infections were contracted. Likewise, you will see people argue that oral HSV1 is not a STI while genital HSV1 is an STI. The emphasis is on the fact that oral HSV1 is most often not contracted through sexual means, though it is often transmitted from mouth to genitals via oral sex. So there's a distinction being made between how it was contracted rather than how it can be transmitted. However, in the case of HIV, regardless of how it is acquired, it is considered a STI because it is transmittable. Cold sores have been normalized over a long period of time. And I think that's GOOD because oral herpes is very normal. It's unfortunate that normalization does not extend to genital herpes. The inconsistencies are really interesting to me, but I hope things change some day. I am somewhat hopeful in that I'm old enough to remember when HPV and HIV where both much more stigmatized.

@WhatNow17 There are 8 or 9 herpes viruses but only two types of HSV. There are many more types of HPV than are covered by the current vaccine which addresses 9 types (two that can cause warts, 7 that can cause cancer). The vaccine is recommended for people in the pre-teen to mid-20s range as this was the age range used in studies and the age range believed to benefit most from the vaccine due to how quickly people begin contracting various types of HPV after becoming sexual. Yes, EBV (which can cause mono, usually if contracted after early childhood) is most infectious right after it is contracted, just like HSV. It then reactivates and is contagious from time to time without symptoms, again like HSV. How it differs is that it is passed through body fluids such as saliva and semen rather than skin-skin contact. A majority of people contract it by adulthood, again like HSV, though most people don't realize it unless they developed mono. Infection rates continue to increase in adulthood until almost everyone has it, just like HSV. Edit to add: Other common herpes viruses that are lifelong and reactivate are chickenpox (which reactivates as shingles) and roseola.

@beakind Is he already taking the suppressive dose of antivirals daily? Or is he taking half that dose daily to reduce transmission? If he's taking the half dose that is meant to reduce transmission risk and still getting outbreaks, perhaps he might consider discussing increasing the dose with his doctor. I don't know which type he's taking but in the case of Valtrex, this is a difference of taking 1000mg per day vs. 500mg per day.

@Whatnow17 I'll add that the existence of the HPV vaccine seems to have made less difference in terms of stigma than the knowledge that HPV is so common (which became known as a result of marketing the vaccine). What I mean by this is that many people beyond the recommended age for the vaccine opt not to ask to be vaccinated and assume they have already been exposed and/or that HPV is just a normal risk that goes along with sex. The HPV vaccine addresses 9 different strains of HPV, but the marketing was done in such a way that many people see themselves as having been exposed to HPV or not exposed to HPV. They tend not to think "I might have been exposed orally but not genitally, and I might have already been exposed to type 16 but not type 18" as people seem to do with HSV types and locations. Edit to add: I actually did go ahead and request the HPV vaccine as an adult in my 40s because I thought I might not have been exposed to all the 9 types it covers, so why not take advantage of the existing vaccine, but I think I am in the minority in that regard.

@Whatnow17 Have to disagree with the idea that permanence is the issue. Most adults carry 4 or 5 herpes viruses that are permanent and reactivate at times but do not carry stigma. Cold sores are permanent. EBV/mono is permanent and spread even more easily than HSV and can cause cancer in rare cases. The stigma related to genital herpes seems related to the fact that it is strictly contracted through sexual means. With EBV and HSV1, sometimes they are contracted through sex, sometimes not.

@Trixie8 @WhatNow17 I've had the opposite experience with two doctors telling me they had no concerns about HSV but they were very concerned about HPV. IMHO, because there was a need to convince parents to vaccinate children for HPV when a vaccine became available, excellent marketing was developed that put all types and locations of HPV under the umbrella term "HPV" in order to emphasize prevalence of HPV and explain why it was critical to be vaccinated early. The same could potentially be done with HSV. It would require referring to all types and locations as "HSV" instead of having a sliding scale of stigma for different types and locations. By my age, 93-95% of people have at least one type of HSV. I can't imagine that's less pervasive than HPV.

@WhatNow17 @Trixie8 I believe Inside Amy Schumer addressed herpes, as well.

@Trixie8 I'm glad my comment rang true for you. Also, in reference to your comment about keeping a list of shows that mention herpes, the show "Girls" mentioned oral herpes a couple times during the last season or two.

@Trixie8 I researched on my own time after testing positive. I did not get the info I needed from medical professionals so I turned to published research. All the seeming inconsistencies bothered me, so I often looked at the source data to understand why info appeared inconsistent. Working backwards like that helped me gain a better understanding. I typically disclose either before I meet someone (but not in my dating profile) or after I meet and we've established mutual chemistry and they reach out to schedule a second date. When I disclose before meeting it's because the topic of intimacy arises in some way and I take the opportunity to open a discussion about safe sex expectations. Because I'm in a casual dating stage of life, I prefer disclosing very early because I'm more comfortable with partners who are generally accepting of HSV rather than making an exception for me specifically with some sort of long-term expectation in mind.

One more...forgive me! :) I often see people refer to HSV2 as "more severe" than HSV1. This is incorrect. However, certain type/location combinations are more active than others in terms of shedding virus, and while the most common experience with all types/locations of HSV is very mild symptoms or no symptoms, for those who have symptoms, recurrences are more common with the more active type/location combos. For instance: - Oral HSV1 has greatest prevalence, sheds most on average (25% of days), and I believe about 1/3 of people have noticeable symptoms (cold sores). - Genital HSV2 has next greatest prevalence, sheds 14% of days on average, and 10-20% of people have noticeable symptoms. - Genital HSV1 sheds about 5% of days on average. It's more likely than genital HSV2 to cause a noticeable primary outbreak, likely because it is the first contracted HSV infection while HSV2 is often contracted by people who already have HSV1. However, most people with genital HSV1 then have no further outbreaks or very infrequent outbreaks (on average, much less frequent recurrences than people with symptomatic HSV2 experience). - Oral HSV2 sheds about 1% of days on average. Initial outbreak symptoms are not visually distinguishable from oral HSV1 but it is much less likely than oral HSV1 to cause recurrences. It is the least prevalent type/location combo of the four and presumably the least likely to be transmitted to a partner, considering the very infrequent viral shedding activity. I say "presumably" because studies have so far only addressed shedding rates and not transmission rates, but it is known that a majority of HSV transmission happens as a result of asymptomatic shedding.

Oh! Thought of one more... I often see a narrative about people with genital herpes finding someone someday who will love them enough to accept them. Conversely, I see people judge others who shy away from relationships with people with herpes as just not loving them enough to be willing to take the risk. My own experience has been that many factors go into how someone perceives HSV and their willingness to have sex or a relationship with someone who discloses positive HSV status. Sometimes depth of feeling is a factor, often it is not. I truly believe someone can want to be with someone yet have too much anxiety to have a healthy sex life, which sucks for both people, and I also have encountered people who don't factor in HSV at all, regardless of how much or how little they like or love someone. Highly variable.

What is assumed about you, and what you assume about others. Or any other insights you have that you think are important for the general public to know. So many things, but off the top of my head... - I'll start with how it affects me personally. It's assumed I pose a unique risk of transmission among my peers. This is incorrect. As a white, divorced woman in my late 40s in the U.S., I'm in good company with 50% of my peers being positive for HSV2. In fact, most people with HSV2 don't know they're infected, so considering I utilize all available methods of risk reduction (disclosure, daily antivirals, condoms), the level of risk I present falls smack in the middle between those who don't have it and those who have it and don't know it. However, when I disclose my status (which I always do), I am often perceived to be uniquely high risk. - Most people have never been tested for HSV and assume they'd know if they or their partner have it. In the case of HSV2 specifically, 80-90% of those who have it don't notice upon contracting it and only roughly 12.5% have been diagnosed. This means that for every person out there who knows they have HSV2, there are seven others who have it and don't know it and therefore can't disclose or take precautions. I was one of those people before getting tested myself. - Many people with very limited sexual histories have HSV2. In the U.S., in the 14-49 age range, 19% of women with a lifetime history of 2-4 sex partners are infected with HSV2. I would consider that a conservative sexual history. I personally was more active, but I would imagine the promiscuity stereotype would be especially unsettling to those with a history of very few partners. - Some people who are very accepting of oral HSV1 (cold sores) are hesitant about partnering with people with genital HSV1. This is kind of illogical considering oral HSV1 asymptomatically sheds (on average) 5x more often than genital HSV1, but of course stigmas aren't logical. People who contract genital HSV1 were just lucky/unlucky enough to not catch it orally first, leaving them vulnerable to contracting it genitally. - Statistics for genital herpes typically only include HSV2 and exclude HSV1 because location of infection can't be assessed through blood testing. The most common stat I see is "1 in 6 people have genital herpes." What this actually means is that a large number of people between the ages of 14 and 49 were tested. A significant percentage of these people had not yet had sex, so were aren't talking about sexually active people but all people within that age range. Among non-virgins in that age range, it is roughly 1 in 4 that tested positive for HSV2. And even then, that is an average within that vast age range and does not address gender (almost twice as many women are infected as men). So this stat not only excludes everyone with genital HSV1 but also makes it difficult for people to truly understand prevalence in their own dating pool. Rates are extremely low at 14 and much higher at 49 with the average in that vast age range being 1 in 4 among people who have ever had sex. And if we're talking lifetime risk that goes beyond 49, in the U.S., about 70-90% of people will contract HSV1 at some point and 40% of people will contract HSV2. Both very common. - I see lots of posts from newly diagnosed women worried about future pregnancy. If you do the math on neonatal herpes, it is actually more likely to pass on neonatal herpes if you do not have genital HSV2 upon becoming pregnant. This is because the greatest risk (by far) of passing on neonatal herpes is when a pregnant women contracts either genital HSV1 or genital HSV2 near the end of pregnancy. By contrast, the risk is extremely low when a woman has an established infection upon becoming pregnant. Studies indicate roughly 30% of pregnant women in the U.S. have HSV2 (and an unknown additional number have genital HSV1). Roughly 2% of women contract genital herpes during pregnancy and a fraction of those women contract it in late pregnancy (these are the very high risk cases). Furthermore, if you are in the minority of people with genital herpes who know their status upon becoming pregnant, additional precautions can be taken such as antivirals in late pregnancy to reduce risk further. - I see people concerned that genital herpes means using condoms forever. If you've ever kissed someone who ever had a cold sore in their life, or you've given or received unprotected oral sex, you'll understand that it's all about risk tolerance and weighing maximizing risk reduction against other factors. Yes, using condoms maximizes risk reduction, but it is not a case of condoms = no risk while no condom = high risk. Many people, particularly long-term discordant couples, choose not to use condoms. In my particular case, as an asymptomatic woman who takes antivirals daily, condoms reduce risk of transmission from 2% per year to 1% per year. - I've seen people ask if it's necessary for those who have HSV to use HSV specific dating sites. I think it's important to recognize that roughly 80% of adults have at least one type of HSV that can potentially be transmitted to an uninfected partner's genitals, so all dating sites are HSV dating sites in my opinion. Additionally, in using a mainstream dating site and disclosing to prospective partners, my experience has been that most people simply don't know their HSV status and some are aware they already have HSV or have already been in relationships with people who disclosed HSV.

FWIW, I read a study that explored how best to approach the stigma and it concluded that humorous approaches reinforced the stigma rather than combating it. You may be able to find it online through PubMed. So far, I've only really heard one herpes joke that made me laugh. The joke: "Everyone has herpes" is both true and what someone tells you right before they give you herpes.

Hi, @HalfFull! You've already taken steps to make it safer simply by disclosing and opening that line of communication. Daily antivirals, condoms and abstaining during outbreaks also reduce risk. One thing to keep in mind is that viral shedding rates are significantly higher during the first few months after contracting HSV. You will be most contagious during those first few months.

@Charmander23 I'm sorry you experienced this. Thank goodness you were alerted to the chlamydia which can cause major problems if it goes unrecognized. Hopefully your ex will get treated for that before transmitting it again. If you haven't done so, please take a look at your IgG test numbers to be certain your antibodies were not in a range that commonly causes false positive. In general, levels above 3.5 are believed to rarely be false positives while levels below 3.5 are more uncertain. I'm sorry he reacted the way he did. I've encountered this mindset before. Some people have a very difficult time with known risk and prefer to assume they and their other partners are HSV- unless specifically told otherwise. I disagree with @Vin3 that is suspicious behavior, though the scenario @Vin3 proposed is certainly possible. I just think it's more likely he falls into the great number of people who prefer to assume they and their partners are negative unless told otherwise. Regardless of why he behaved the way he did, he is clearly not the right partner for you. If he's lying, it makes that more obvious. But even if he's simply anxious about intimacy with you, you deserve a partner who is all in. Next time you experience that, you'll be relieved you aren't in a situation instead where your partner is focused on the risk of HSV. It also sounds like he was insensitive in how he expressed his anxiety to you, another red flag for a partner. Not that I need to sell you on this; your post indicates you get this already.

I'm very sorry you're dealing with this. I think there's a major disconnect between how health professionals and patients and general society perceive an HSV2 diagnosis. In the U.S., a large majority of adult black women have HSV2. By age 27, more than 60% of single and divorced black women are infected and this increases to nearly 80% by age 42. It is exceedingly common (among other races, as well). And most of these women are unaware they are infected. Those who are aware often aren't vocal about it. So I think doctors look at it like a very normal thing (it is) and put their energy into treating the more bothersome symptomatic cases. In those cases, they may prescribe antivirals. Antibiotics are not a treatment for herpes, but would have been prescribed for your bacterial infection which may or may not be related. I've heard of cases of people getting bacterial infections with initial outbreaks but rarely with recurrences, and bacterial infections occur in women without HSV, as well. I don't understand why the antibiotics were prescribed for your partner instead. That part doesn't make sense to me as normally the woman with BV is treated, not the man. Maybe sometimes both are treated, but just the man? I don't get it. In answer to your questions, I'm not a medical professional, but here's my opinion: 1. Yes, unless they are the only two sex partners you've had. If they are your only two lifetime sex partners, then you would have contracted it from one of them. 2. False positive almost always occur in results lower than 3.5. However, someone on this board recently had a false positive that was a little higher, so you never know. 3. Yes, you can have it for years and not pass it on. Also, in case it's relevant, bear in mind rates of HSV2 are extremely high among adult black men, as well. Greater than 50% by early 40s. But regardless of race, if one these two partners has HSV2, unless you were his only partner, he could easily have contracted it from someone else. Most people never know they have it, and those who know they have it often never know who they got it from, just like the virus for oral herpes (cold sores). 4. Yes. 80-90% of people with HSV2 have no idea they have it because they do not have symptoms or symptoms are so mild, they don't realize they are HSV related but rather assume they have an ingrown hair, jock itch, razorburn, a pimple, etc. I agree with you that doctors often don't do a good job of educating patients on this, and studies indicate they are more likely to be dismissive of women's concerns and I can only imagine this is particularly true for black women, given how our society operates. I'm so sorry you experienced this and hope you will take comfort in at least knowing you are far from alone in this.

Please, please bear in mind that 94% of people your age in the U.S. have at least one type of HSV (either HSV1 or HSV2), and some have both. What is uncommon at 49 is NOT to have it. If you are afraid of your ex's temper, that seems like a significantly bigger problem than HSV. If you are not comfortable discussing it with him due to his temper, especially considering your ER comment, I would advise not only *not* discussing it with him but also not considering reconciliation, regardless of HSV status. Please be safe and take care of yourself and your kids.

HSV1 is very common among children. In the U.S., by the age of 5, over 35% of black children and 18% of white children are infected by HSV-1. These rates continue to increase through childhood and adulthood. By the age of 40, both blacks and whites have a similar prevalence of antibodies, with 70 to 80% having HSV-1. As for whether you have HSV2, I don't know. Most people who contract HSV2 don't notice they have it, especially if they had HSV1 before contracting HSV2. It is less likely than genital HSV1 to cause a noticeable outbreak upon contracting it, though more likely than genital HSV1 to cause recurring outbreaks for those who do have symptoms. By my age (late 40s), 55% of single/divorced/widowed women have HSV2 yet most are unaware. The only way to know for sure is to get tested. The CDC does not recommend testing in the absence of symptoms, unless you are proactively partner testing to avoid HSV acquisition, but it's an option. Perhaps you could consult a doctor about your current symptoms since it sounds like you could benefit from treatment, regardless of the cause (yeast infection, etc.).