optimist

Where the sore is located is a factor during outbreaks, but asymptomatic shedding occurs from much larger areas. So someone with a lesion on their thigh can shed virus from their penis, labia, anus, etc., and someone with a lesion in their nose can shed virus from their mouths. So while direct contact with lesions carries greater risk, other areas (mouth, genital tract, base of penis, etc., depending on whether the infection is oral or genital) can still be intermittently contagious.

About 80% of adults have HSV of one type or another and are therefore capable of transmitting HSV to an uninfected partner's genitals through oral sex and/or genital-genital contact. Most don't know they are infected due to a combination of current testing practices, mild or absent symptoms, or lack of understanding of how herpes presents and is transmitted. Likewise, most sexually active people contract one or more strains of HPV but don't know they're infected. Because both of these viruses are transmitted through skin-to-skin contact, condoms only reduce risk. Parts that are not covered by the condom are still vulnerable to transmitting or contracting the virus.

@lostandconfused99 Condoms reduce but do not eliminate risk. Without condoms, male-to-female transmission risk is considerably higher than female-to-male transmission risk. However, condoms do a better job of reducing male-to-female risk than female-to-male risk. HSV is transmitted through skin-to-skin contact and condoms do not fully prevent skin-to-skin contact. HPV works the same way.

@Akin How I approach it with a prospective partner is in a very matter-of-fact way in the course of discussing safe sex expectations and overall STI status. I don't attach a shameful narrative, nor do I try to convince them they should not care, I just state the facts of my situation. How I approach people talking about it negatively...you mean when I've disclosed? Depends on the reaction. Nobody has ever been mean, but I had one experience of someone majorly melting down with anxiety because he had not previously realized condoms did not fully protect against herpes and was suddenly alarmed by his own sexual history. Fortunately, we had not had sex, so I dealt with this by reassuring him he had not encountered any risk with me and advising that we should not have sex. In another case, someone reacted by stating that whoever gave it to me should be ashamed of themselves and I took that opportunity to educate them on herpes and also make it clear that I'm not ashamed and would not go back and live life differently to avoid it, even if I could. Another thing that helped was just experience. Having sex with people who were accepting and truly did not care. After that, people who reacted negatively just seemed like incompatible partners to me. What made me feel okay about having it was educating myself about it and talking through the feelings. Reminding myself that we're essentially talking about a virus that has the potential to cause cold sores in one location or another and that cold sores should not dictate my life choices. It sometimes helps me to replace the word herpes with "cold sores" when I hear someone say something really dramatic about herpes. That always helps me tease out how much of the issue is stigma. It is almost always about stigma, not reality. I also made a choice to go on daily antivirals. That helped with my own anxiety about potential transmission.

IMHO, both points are valid, but tone and timing play a role. Most people are distressed when they learn they have HSV. That's totally normal. Even if they have no physical symptoms, they have likely been exposed to the stigma for years before diagnosis and now find themselves on the other side of that stigma. It takes time to sort of deprogram ourselves and separate reality from stigma. And if the person is experiencing a noticeable primary outbreak, I would imagine that is at the top of their mind, making other aspects of processing less of a priority and not particularly welcome. OTOH, it is true that most humans have HSV, so asking "why me" can sound strange to those who are aware of how very common it is. In the U.S., roughly 90% contract HSV1 at some point and about 40% of people contract HSV2. So what is not deserved is actually the stigma, not the getting it part.

Given the testing history and timing you've described, even if the other person comes back positive (which is very possible because HSV2 is common), it will not mean they gave it to you or that you gave it to them. If they come back negative, it will mean you may have exposed them to HSV2, but odds of infection are low in an individual encounter, even when it's unprotected (condoms reduce but do not eliminate risk), unless you had symptoms at the time that you did not recognize as related to HSV2. It's normal to be emotionally upset by a diagnosis. Most people feel this way, either due to primary outbreak symptoms, stigma or both. In your case, it's more complicated due to infidelity, though if your only extramarital contact, protected or unprotected, was one week before testing positive at a value of 5 by IgG, I don't think that incident has anything to do with your diagnosis.

From your post: "The only thing I can think is either the test is wrong or that the person ive been in a relationship for a long time with could have given it to me" I think those are the two most likely scenarios. I have seen Terri Warren answer a similar question before and she did not believe such a result would be possible one week after infection. My understanding is that false positives are very rare above a result of 4, but not impossible. A more sensitive test for confirmation would be the Western Blot. And as Hiking Girl mentioned, it can be transmitted through genital-genital region contact that does not include penetration but rather skin to skin friction. So maybe that's a possibility to consider, as well.

@Alli9966, I'm sorry to hear that. I can understand why you feel betrayed.

Are you certain he knew his status? Only 1 of 8 people with HSV2 are aware they have it. Or he may have been told long ago that is was only contagious if/when he had symptoms. Some doctors still inform their patients this is the case, though it is inaccurate. I'm sorry you're feeling embarrassed and betrayed. If it helps at all, please know that is it exceptionally common in our age group. When I tested positive at 47, I was surprised to learn that more than half of divorced women my age have HSV2. Most are just unaware for exactly the reason you mentioned, it can be mild enough to not realize there's an issue. In many cases, there are no symptoms at all.

Because you have a history of cold sores, I think it's fair to assume your HSV1 infection is oral. Yes, it can be transmitted to a partner's mouth or genitals if they don't yet have it. It's very possible your boyfriend already has HSV1, considering how common it is. Even without a history of cold sores, he may have it. Many people are asymptomatic. It has been my experience that most people do not disclose oral herpes. Until I tested positive for HSV2 and began disclosing to people, I had never once had someone disclose HSV1 to me, though statistics indicate at least 2/3 of my partners have had HSV1. IMHO, it seems the stigma is more tied to location and therefore the societal expectation of disclosure differs between oral and genital herpes, regardless of HSV type. However, the possibility of transmission does exist, so if transmission occurs, the person who contracts it may be more upset as a result of non-disclosure of *known* HSV status. I do have a friend who contracted genital HSV1 through oral sex from a partner who knew their status but was unaware herpes could be spread that way. My friend has never stopped being angry about that (the lack of disclosure), even though she knows how common it is and does not consider HSV to be a big deal. So that's something to consider. As for your boyfriend, he may be having a hard time dealing with his current HPV diagnosis. It may not be the best time for him to be able to put HSV in perspective. I would focus on dealing with the HPV diagnosis for now.

Wow, yes, that was cruel. I'm sorry it took six months for you to learn this about him.

So sorry to hear that. If you're already taking the the full suppressive dose rather than the dose to reduce transmission, I wonder if it might help to try a different formulation. Some people have better luck with one antiviral over another. If that fails, it may be a matter of waiting it out. It's my understanding that the most viral activity typically occurs during the first several months, then typically there's a drop-off after a year, and then another drop-off after two years. I hope that's the case for you. If the white dots are always there, it's doubtful those are related to HSV. Is it possible you have another infection? I've seen women post about getting secondary infections after a primary HSV outbreak and they had trouble distinguishing one issue from the other until they got the right treatment and cleared up the secondary infection. Random thoughts: I've seen people post about being triggered by stress, lack of sleep, alcohol, eating nut products, shaving, rough sex. If any of those might be possible triggers for you, maybe you can keep a journal to get a sense of whether modifying any of those things could help (such as avoiding nut products, trimming instead of shaving, using more lube for sex, practicing meditation for stress, etc.)

Have you tried daily antivirals?

@tiny30 If you only received a visual diagnosis, I would suggest following up with actual testing to confirm. A visual diagnosis can be inaccurate. Having said that, what you described (many painful lesions followed by only one insignificant legion) sounds to me like a primary outbreak and a recurrence. Recurrences are generally much different from primary outbreaks and also last a much shorter time (a few days rather than a few weeks). A single bump would be typical of a recurrence.

After 12 weeks, the rate of false negatives for HSV1 with an IgG test is 30%, and the rate of false negatives for HSV2 is 5%. Visual diagnosis is incorrect about 20% of the time, so you are right to want actual testing. In my opinion, if the doctor didn't swab you during that first visit, one option is to wait until the 12 week mark to test again, or get swabbed if you ever have symptoms again. If you get another negative result at 12 weeks and don't get symptoms again, you can either assume you are negative or follow-up with a more sensitive Western Blot if you feel a need to know with greater certainty.

Hi, @Aries_Girl! There is no one right way to do this, but I first want to share with you that in the time I've been disclosing, I've encountered many people who were fine with it, then a few who were not, then another few who were. I think if I'd experienced those few "not fine with it" guys at the beginning, I would've felt kind of hopeless and discouraged. Fortunately I've done it enough times now to know that lots of people are fine with it. I hope you can remain optimistic. When I disclose, I try to keep it brief and stick to the facts. I explain that I tested positive for HSV2, one of the viruses that causes herpes. I explain that I take antivirals daily to reduce a small risk of transmission to a smaller risk. I also get into my expectations around condom use. I always invite the person to ask questions and I've educated myself well enough to answer pretty much anything. Most often, they ask questions about outbreaks (whether and when I have them) and transmission (how likely, which sex acts pose risk, etc.). Sometimes they ask how long I've had it or what it's been like for me. I just answer honestly and trust that it's sort of a compatibility exercise. I try to keep in mind that the greatest fear many people have about contracting herpes is having to disclose to others in the future. With this in mind, I disclose in a way that is matter of fact and not shame based. There is no narrative with villains and victims, just the facts. I also try to keep in mind that people I disclose to may have it themselves, or they may be familiar with it from a previous partner disclosing, or they may have friends or relatives who have shared their status with them. Or they may just be the type to not dwell on these types of risks. With all of that in mind, after stating the facts, I allow them to drive the conversation based on their own concerns (if any) and existing level of knowledge. If they say they aren't comfortable with the risk, I tell them I appreciate their honesty and move on. If they say something grossly inaccurate, I may educate them on that specific point, but I don't argue about it. Some people disclose while texting, some in person. Some right away, some after multiple dates. You may need to experiment a bit to find what feels most natural for you.

It's very complicated for the following reasons: - A very small percentage of HSV2 cases *are* indeed oral. In these cases, if there is an initial outbreak, that's usually the only outbreak that ever occurs and it looks just like oral HSV1. Oral HSV2 tends not to recur and sheds virus very rarely, much less often than oral HSV1. So if you have recurring oral symptoms, much less likely to be HSV2. If you ever have symptoms again, perhaps you can request a swab test to confirm, if that matters to you. The good news is that oral HSV2 largely protects against contracting oral HSV1 and genital HSV1 and genital HSV2. - While IgG tests are good at identifying HSV2 (95% of people test positive after 12 weeks), they are not so great at picking up cases of HSV1. 70% of infections are picked up while 30% return a false positive. - Most people with HSV2 do not have recognizable symptoms. A minority (10-20%) have obvious symptoms and the rest are asymptomatic or have symptoms so mild they don't notice them or mistake them for something else. This is even more likely if someone has contracted HSV1 before contracting HSV2. The body tends to react more strongly to the first HSV infection contracted which is more often HSV1. The photos on the Internet are misleading in that a minority of people experience that type of outbreak, and those who do have severe primary outbreaks typically only experience that type of outbreak once and then may or may not have recurrences, almost always less severe than a primary outbreak. Think in terms of how you have seen cold sores present and it's the same thing. Maybe you know one or two people who get lots of cold sores at once or frequent sores, but most people get a tiny sore once in a while, or maybe they haven't had one in years. Same deal with genital herpes. And many people with HSV1 and HSV2 get no sores at all. The doc may be acting in a dismissive way because about 80% of women your age have HSV, including about a 1/3 with HSV2, yet it's usually only a medical concern for the minority who have significant symptoms. Some people also struggle with the stigma but doctors are sometimes not attuned to this aspect and maybe even less so if a patient is already partnered. So maybe you have oral HSV2, or maybe you have asymptomatic genital HSV2 which would be more common. And maybe you even have oral HSV1 but are among the 30% who test false negative. If you feel a need to know, you might want to look into a Western Blot test which is more sensitive. But you might want to first talk to your husband about what these various test results will mean for you both. Maybe they won't mean anything and you will continue the same as before. If so, maybe it's unnecessary to escalate to swabbing and Western Blots. I don't know, just something to think about.

Some do come back positive early, but I was referring specifically to the antibody level of 5+ which would take more than 2 weeks to reach, according to Teri Warren. I thought you were trying to determine whether the encounter you mentioned that was 2 weeks prior to testing was when you became infected. But yes, it could absolutely fit within the timeline of your current 6 month relationship.

I've seen someone ask Terri Warren (a clinician who specializes in herpes) if it's possible to build to an antibody level of 5+ within two weeks. She said no, that would indicate an older infection. How much older, I don't know, but older than two weeks. I think it's more likely your immune system was low from an unrelated condition and that prompted your body to express symptoms. A negative test result in 11/15 would suggest you were negative through at least 7/15, so I'd guess you contracted this sometime between 8/15 and maybe 6/17? This is just a guess based on your testing history and most recent antibody levels. I'm not a medical professional. In the end, it's important to note that HSV2 is very common. Most people who have it are unaware and therefore unable to give partners a heads-up, so it's difficult to avoid.

That's awesome! Best of luck to you with the new guy!

No, genital herpes would not cause a full body rash. Most often, genital herpes has no symptoms or has symptoms mild enough to go unnoticed. In cases where people have symptoms, they appear in the area that would be covered by boxer shorts, not all over a person's body. Many other things can cause a body rash (syphilis is one example, but many other non-STI causes, as well). As for HSV testing, bear in mind that 80% of adults will test positive for one or both types of herpes simplex (type 1, type 2, or both) and blood tests will not pinpoint whether the infection is oral or genital. Only a swab test of a lesion can do that. HSV2 is generally assumed to be genital in the absence of symptoms elsewhere, and HSV1 is assumed to be oral if the person has not yet had oral sex or intercourse. Once someone begins having sex, if they don't already have HSV1 orally, they are vulnerable to contracting it genitally. In the U.S., most people contract HSV1 over the course of a lifetime, either orally or genitally, and about 40% of people contract HSV2. Both are very common and incidence increases with age (with HSV1 rates increasing after birth and HSV2 rates increasing after people become sexually active). The CDC recommends testing for people who have symptoms in order to confirm a suspected diagnosis. However, most people do not have obvious symptoms that prompt diagnosis and treatment. Some people do choose to get tested specifically for HSV before having sex with new partners. In those cases, it's important for both people to wait three months after last having sex before testing to allow for most accurate testing. After 3 months, IgG tests will accurately identify 70% of HSV1 infections and 95% of HSV2 infections. But as you have experienced, some doctors are reluctant to offer this testing in the absence of obvious symptoms. They will often site the fact that the tests are not super reliable. They are mostly referring to the fact that false *positives* can occur, though those are easy to identify because they almost always fall in a specific range (less than 3.5), and then there are also false negative (30% for HSV1, 5% for HSV2). And most doctors are aware that HSV is very common yet highly stigmatized and are most focused on treating those who have symptoms rather than identifying carriers.

Herpes testing is not part of the standard STI testing for pregnant women. At least not in the U.S. Those at greatest risk (by far) are those who contract it in late pregnancy and don't yet have the antibodies to test positive before labor. Therefore, these people can't be identified through blood testing, only swab testing, if they happen to have a noticeable primary outbreak which happens in 10-20% of cases. So in the absence of obvious symptoms of a primary outbreak in the months preceding labor, the only way to capture these people who are at greatest risk would be to blood test pregnant women *and* their partners at the beginning of pregnancy, then focus effort on the women who test *negative* and have partners who test positive and pose a risk of infection during pregnancy. You can imagine that would be difficult. For now, doctors typically rely on women who are aware of their infection (about 1/8 of women who have genital herpes; the other 7/8 are unaware they are infected) to inform them of their existing infection so they can take the extra step of taking antivirals in late pregnancy and checking for any signs of an outbreak at the time of labor. Risk is extremely low among women with established infections (meaning infections old enough to test positive through blood testing; more than a few months old) and extremely high among those who contract it in late pregnancy and do not yet have sufficient antibodies to test positive through blood testing.

I don't know how unusual it is for a doctor to routinely carry Valtrex around. I do know that a large U.S. study indicated 30% of pregnant women have HSV2 (presumed genital infections) and 66% have HSV1 (some oral, some genital). Given 30% of neonatal herpes cases (which are rare and almost always due to an infection contracted during the final few months of pregnancy) are caused by HSV1, it may be fair to assume close to half of pregnant women have genital herpes, but that's just a guess since location of HSV1 infections can't be determined through blood tests alone. Most of these infected women don't know they have genital herpes, so it would make sense for doctors to not make assumptions one way or another, especially since HSV is not routinely tested for in pregnant women or their partners, but I can't comment on why the doctor might have Valtrex with her. I have no idea.

@dlacinda I most often disclose via text during an active text conversation, but I don't think there's just one right way. You'll figure out what's comfortable for you. The only situation I avoid is disclosing when clothes are coming off because I feel like that would put someone on the spot. However, that's my own concern and I don't judge others who approach disclosure in that way. People with a history of cold sores generally do not agonize about when is the best time to reveal that, so it could be that I am being too sensitive to the stigma of "genital herpes" in feeling like there are appropriate/inappropriate times to disclose. Therefore, I don't judge others who have a different thought process. I just do what feels right for me.

@lenticular I have never seen anything to suggest HSV influences menopause. However, hormonal fluctuations can be a trigger for HSV symptoms. Among women who experience recurring symptoms, many notice a pattern in relation to their cycles with symptoms more likely to occur when hormones fall just before menstruation. I would guess the types of hormonal swings that occur in perimenopause could be similarly tied to recurrences for women who get them, but I don't know for sure. If so, I would also expect symptoms triggered by hormone fluctuations to subside after menopause is reached and hormone levels stabilize.