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Transmission: HSV2 area, non-penetration risk, best test after recent exposure


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Hello,
 
This is a great resource and I thank everyone for input and queries as reading the forums has already left me better informed and better equipped to dealing with Herpes. I have questions about my particular situation and also I would like to know references people have for transmission, although I did read some commentary which mentioned studies about transmission/ outbreaks and locations.
 
Ultimately I realise I'm asking for advice on these forums and there is no guarantee but as new to this diagnosis, any further information really helps to relieve the stress. 
 
I was diagnosed about 2 months ago, my OB was labial and then after the pain, it also spread to the rectum, now I bleed when there is an OB. When I had my first OB did not take the medication regularly, until the results came back and at which point I completed the 10 day treatment, I had continuous symptoms and another GP said perhaps it could have been because I did not complete the full 10 days, although from these last months, I realise my period has been a trigger for an OB. 
So prior to my last 2 outbreaks (as they seem to be monthly, milder compared to the initial outbreak) I've started taking one 500mg vaclovir a day, last month, I started to take it a week before my expected menstruation date, but missed 2 days because I didn't have my vaclovir handy. I had itchiness but honestly, my labial area feels raw all the time. 
On the second night (not taking the vaclovir), I had intimate relations, he touched my clitoral area and slightly touched my labial area. There were genital secretions.
I was quite wet as well but there wasn't any genital rubbing, maybe the thighs. My period started 3 days later and I had an outbreak on the rectum and I saw a painless white pus filled ulcer on the labia.
 
Since then I have been taking the vaclovir daily, and at the end of my period, about 7 days later, I got intimate again except I wore underwear and never rubbed my genitals on him but did get close.
 
My questions are about both incidents, from what I've read you're more contagious the first year, I'm trying to decipher the virus, it feels prodromal stage always, unlike the first OB which had clear itchiness like fleas, I now just feel raw and as if I have a yeast infection. It itches a bit before my menstruation, but I usually have vaginal discharge before my period. strangely I've noticed this vaginal discharge to be cloudier. Menstruation definitely irritates the vagina and seems to cause the OB, therefore I guess the prodromal stage is still when I'm contagious as well, but how contagious?
 
 
The first time (when he touched the clitoris) he didn't have cuts, microtears on the skin so could he have contracted HSV-2?
 
The second time, he did grab my buttocks with his bare hand, but the crack and rectum was covered with underwear, what area is possibly contagious?
 
From this forum people have written, a 1-2 inches radius from OB is where the virus could be present in the epithelial tissue, but could grabbing it with your hand lead to transmission, I didn't have an OB, but as described I was in the 5-10 day range of an OB.
We weren't rubbing but my thighs did grip his legs (albeit I don't feel it got close to my genitals and I wore underwear). What is the likelihood of transmission?
 
Just to clarify, we didn't have sex, we were kissing, hugging and I performed oral sex (I have hsv2 not hsv1).
 
The first time he touched me, I was more worried because I had an outbreak 3 days later and read 3 days before an outbreak is when you are very contagious. However I'm also worried about the second time because I read here that you should wait 10 days after an outbreak to have any sexual exchange.
 
My questions are: 
1-How/when is taking the vaclovir effective, how many days before it can effectively reduce the risk of transmission? (reduce the viral load)
2-If I had an outbreak but three days earlier I was intimate with someone (again no sex), what is the chance of them contracting the virus?
3-If I was on vaclovir for 7 days, had an outbreak 7 days earlier, was wearing underwear, no sex, but hands on buttocks, thighs but no genital to genital region rubbing/grinding what are the chances of transmission?
 
How to get tested?
He has no signs from the first encounter and it's been 12 days, therefore it would be another 12 days of no symptoms for increased possibility that he did not contract it. Although I know, it's quite likely to be exposed to the virus, contract it and never show symptoms.
What test should he do? I've read after 12 days you can do a test even if there are no active sores, so he will need to get swabbed?
I'm in Europe and would like to provide the person with enough information about which test he should get. From my reading an IgG antibodies test is the best option now.
Is that correct?
 
After I did my swab test, I did blood tests for all stds and it showed negative HSV 2, obviously since I had recently been exposed and my body had not produced antibodies. 
 
Thanks in advance, the testing is the most important but I'm also very worried about transmission but must know the % of risk in all circumstances to be prepared and properly informed.
 
 
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Hi!
 
I hope you are well.
 
Please know that you are safe. You may feel scared and like your body is a danger to your partner, but your body is not a danger. Your body is safe. You are pure. You are good. You are beautiful. H cannot change these truths!
 
Thank you for sharing your story with us. I'm sure so many folks can relate to your feelings of worry about transmission, as well as the symptoms you are experiencing. 
 
First, let's talk about your symptoms. Since it's only been two months since your first outbreak, it makes sense that your body is still adjusting to having H. Inner labia skin is basically one giant mucous membrane (where H typically enters the body), and it's very sensitive to change, pain, and skin irritations. People do report a change in discharge, or a larger production of discharge, when they have an outbreak. Furthermore, hormones are a large trigger for many people, especially those with periods. It is helpful that you have identified a trigger. Anal herpes can really be painful, because of bowel movements, and because internal sores are possible, too. What you can do is keep a symptoms log, to identify what specific times during your cycle you feel symptomatic. You can also see if diet, exercise, clothing, or activities trigger it or make it better. Collecting data is really helpful and empowering! 
 
These are the toughest months right now. But have faith! Trust your body. Your body is not your enemy. It's trying its hardest to heal and adapt. It will be okay ❤️
 
To answer your questions:
 
1-How/when is taking the vaclovir effective, how many days before it can effectively reduce the risk of transmission? (reduce the viral load)
This is a great question! I did some research, and according to a scientific study in Oxford's The Journal of Infectious Disease, called  "Valacyclovir and Acyclovir for Suppression of Shedding of Herpes Simplex Virus in the Genital Tract" https://academic.oup.com/jid/article/190/8/1374/878164, and the study concluded, "Viral suppression is not immediate and takes 5 days to achieve. After the cessation of therapy, the suppression effect lingers and returns to pretreatment levels in 5 days. This lag may reflect the inhibition of viral replication that occurs not only at the mucosal but also at the neuronal level." Furthermore, the study found that patients who used Valacyclovir "shed virus on a smaller percentage of days than when they received Acyclovir (although it was just by about 5%). The study also explains how some people experienced "occasional episodes of high copy numbers of HSV DNA shedding" even though they were taking daily suppressive medication. 
Basically, it depends on many factors, including factors we really have no control over (such as viral shedding). However, suppressive medication definitely can help. In general, it isn't magical. If you see a sore and you take an antiviral, it doesn't make the virus stop shedding 110% right away. Plus, it's best to wait until the sore has completely healed, even if you are taking suppressive therapy. Similarly, if you feel an outbreak coming on (prodrome symptoms), it is best to avoid intimacy, even when you take a tablet, since it takes days for the antivrials to cease the shedding of the virus.  
 
If I had an outbreak but three days earlier I was intimate with someone (again no sex), what is the chance of them contracting the virus?
Another great question. This depends on many factors, such as, were you shedding the virus. You may have been, but even if you were, it doesn't mean they contracted it. It all comes down to chance; the spot could have been touch, or it could have not been touched. Also, just because someone touches the virus, it doesn't mean it will break through their skin (hand skin is thicker than genital skin and lip skin, and the hands do not have mucous membranes). He could have hypothetically contracted it, but it's not too likely. If you or they are worried, monitor symptoms.
 
If I was on vaclovir for 7 days, had an outbreak 7 days earlier, was wearing underwear, no sex, but hands on buttocks, thighs but no genital to genital region rubbing/grinding what are the chances of transmission?
The risk here is very low. HSV doesn't spread through clothing. You can snuggle with someone even if they are having an outbreak, since clothing acts as a barrier! You can also share bedding with them and do laundry in the same load as them. HSV spreads from skin-to-skin contact, not clothing. Also, you were on the medicine for 7 days. Did you still have any sores/symptoms?
 
What test should he do? I've read after 12 days you can do a test even if there are no active sores, so he will need to get swabbed?
Your partner could get an IgM blood test, which shows IgM antibodies, the first antibody the body makes when you contract HSV. These antibodies spike in number at first, but then decrease as IgG antibodies build up. It takes about 12 weeks for IgG antibodies to build up into detectable numbers. However, it is not recommended you get an IgM test, because they cannot distinguish between HSV-1 and HSV-2, and IgM tests can be misleading as other herpesviruses can cause an increase in IgM antibodies, causing a false positive. Interestingly enough, according to the American Sexual health Association  "IgM antibodies can reappear in blood tests in up to a third of people during recurrences, while it will be negative in up to half of persons who recently acquired herpes but have culture-document first episodes. Therefore, IgM tests can lead to deceptive test results, as well as false assumptions about how and when a person actually acquired HSV." Source: https://www.ashasexualhealth.org/herpes-testing/
 
Overall, your partner should be fine ❤️ You are so kind to ask all these questions. You are a good person, and you were honest with him. You did your part; you took your antivirals and waited 7 days. No matter what happens, it's not your fault. ❤️ Be kind to yourself! We are here for you. Feel free to reach out with any questions! 🙂 
 
Blessings! 🙂 
 
grace
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