A physicists' thoughts on "one-night-stand" or getting herpes per-exposure probabilities

[hippyherpy]

Wow that is intense. I wish you the best of luck dealing with that situation Jane. You are probably right about the reasons for this place being a smallish community.

[MMissouri]

In regards to our members, you have to remember that most people don't even know they have it. If H were included in the STD panel, I'm sure our numbers would increase in accordance.

 

@aep001 I don't think that people took this post as a way to get out of disclosure. And if they did, odds are they weren't going to disclose to begin with. I'm sorry your date didn't end as you hoped. Hang in there!

[WCSDancer2010]

I'm curious about the stats on thus forum membership. Shouldn't a place like this have many more members if herpes was such a common and debilitating virus? Wouldn't there be many more Ella Dawsons jumping in the herpes as identity politics bandwagon?

 

Or do we represent the worst of the worst with regards to symptoms? I haven't had bad symptoms yet, but some people on here give horror stories.

 

1) 80% of people with H don't know they have it...so why would they be here.

 

2) Out of the 20% who know they have H, there is a HUGE difference in experiences. Some got diagnosed and have never had an OB. While some have ongoing and unrelenting symptoms.

 

3) Whether they have no symptoms or "bad" symptoms, HOW they experience things is a very individual thing. So someone with no symptoms may be totally freaked out while someone with "bad" symptoms may just look up "How do I deal with Herpes", get lots of info, and go on a self-led journey.

 

4) And to be honest, many get some kind of info from their Dr, go home, just accept their fate (in a positive OR negative way) and never look for outside help often because of the misconception that they are alone in this, or they deserved it, or whatever.

 

5) Last time I talked to @Adrial about this, which was last year I think, we were getting over 50 THOUSAND hits here EVERY MONTH. So we DO reach a LOT of people. The vast majority never post and just lurk. I expect that number is larger now but that's the last number *I* have.

 

6) We are not the only resource/forum out there. Our style isn't for everyone. So people will go where they find the information and support that works for them.

 

This is the problem with "statistics" ... if you only know one part of the equation, it's easy to make assumptions. We will never know how far our reach is because people may print out the handouts and give them to a friend who just got diagnosed, or to a potential partner and they may never come here. What I DO know is that this site has one of the largest impacts of any info/support group out there.

 

As for more "Ella Dawsons"? Well, there ARE a number of us out there. Most of us are not *quite* as public as she is and she is only that public because she was kinda forced there by a single article that she wrote and that she didn't realize would make such a huge impact on her as well as the H community. It certainly wasn't her intention to go screaming into the limelight that fast :)

[WCSDancer2010]

@aep001

 

Here's how I look at your "unsuccessful" disclosure.

 

I think it was a HUGE success. First - you did it. Like most things in life, the first time is the hardest. So - pat yourself on the back. You did it. You stayed in your integrity. It just didn't end the way you wanted it to.

 

Second... I tell women this, but it generally applies to men too: Odds are she was more interested in getting INTO you than getting into YOU.

 

And at 3 dates, disclosure can go either way...the other person isn't invested in you or the relationship. Their hormones are raging but their head may not be in the equation until you disclose at which time if they are not into YOU... if they don't realize what an AMAZING, WONDERFUL potential partner you are, they may well ditch. I'm slowly learning that if I want a "longer term" relationship (ie, not a one night stand) that having sex early is a double edged sword. My desires may be dealt with at the moment, but I have often had sex *knowing* in the back of my mind that odds are this person isn't right for me, or the tables are reversed and *they* suddenly realize they don't see a LTR with me. And then it gets messy and someone gets hurt.

 

Now, I know you are looking to "rebound". I beg you - don't. It's really not fair to do that to a woman when you are still raw and likely going to get in it, then realize you are not ready, and then bolt. Take it from someone who has been the "rebound chick" ... twice. IT SUCKS. They both went from crazy about me to disappearing when their reality kicked their ass and they found themselves still not complete about the past relationship.

 

Fucking someone won't get you over your ex. Promise. You need to work on letting go of how you believe things "should" be. She's moved on... and it's up to you to move on as well. Read the Success Stories on here ... not just HH, but the ones who were like you, who were picking the wrong partners, and who will say they realize now that THEY were PICKING the wrong person before and H has helped them to make better choices so that they find love like they never knew was possible .... I think you need to see the perspectives of people who have found success finding RELATIONSHIPS with H as well... and not just one night stands.

 

(((HUGS)))

[hippyherpy]

^Those are good points. I think it's interesting that now we live in a time when there is a lot of emphasis placed on the importance of the experience of hanging out with someone (the "getting into") instead of the "you" part (like what you describe).

 

For many people, relationships are just a thrill ride of sorts, or a form of an entertainment, like watching a movie but being part of it. We live in a time when the things that used to hold relationships together are starting to slide or lose their meaning.

 

That said, it's more of a reason not to take rejections personally. It's not that they are rejecting "you" per se, but the experience that you might be offering them or that they are having. You are just the person who takes the admission ticket at the gate to the rollercoaster- the messenger.

 

If you want to get more riders, then you can change the roller coaster. Herpes is another part of that ride now. That's why I say it's good to maximize any other aspects of who you are, or to at least clean up any loose ends to your presentation that might have been neglected before. Give the other person the clearest picture possible of who you are. Make it as easy as possible for them to get your vibe.

 

[Bambina3]

Touching one life....is worth it, so the number participating on this site is not a factor to me.

 

[WCSDancer2010]

^Those are good points. I think it's interesting that now we live in a time when there is a lot of emphasis placed on the importance of the experience of hanging out with someone (the "getting into") instead of the "you" part (like what you describe).

 

For many people, relationships are just a thrill ride of sorts, or a form of an entertainment, like watching a movie but being part of it. We live in a time when the things that used to hold relationships together are starting to slide or lose their meaning.

 

That said, it's more of a reason not to take rejections personally. It's not that they are rejecting "you" per se, but the experience that you might be offering them or that they are having. You are just the person who takes the admission ticket at the gate to the rollercoaster- the messenger.

 

If you want to get more riders, then you can change the roller coaster. Herpes is another part of that ride now. That's why I say it's good to maximize any other aspects of who you are, or to at least clean up any loose ends to your presentation that might have been neglected before. Give the other person the clearest picture possible of who you are. Make it as easy as possible for them to get your vibe.

 

OMG - @hippyherpy ...

 

That was the BEST thing you have ever posted on here... Thank you for that.... it is SOOOO on point!

[Katidid]

@aep001 I enjoy your math! So interesting....those numbers would likely be less the longer the person has H as well. Just to encourage you a bit. I've had H since age 23 and am now 58. I'm in a 20 year marriage and my husband is currently H-. We always use condoms (his choice) and I've only been on anti viral for aprox 7 weeks. So, according to the math, another 24 years together my husband will likely get this lol...he will be 80 and prob not give a crap lol. Thanks again!!!

[hippyherpy]

@aep001 I enjoy your math! So interesting....those numbers would likely be less the longer the person has H as well. Just to encourage you a bit. I've had H since age 23 and am now 58. I'm in a 20 year marriage and my husband is currently H-. We always use condoms (his choice) and I've only been on anti viral for aprox 7 weeks. So, according to the math, another 24 years together my husband will likely get this lol...he will be 80 and prob not give a crap lol. Thanks again!!!

 

Did you guys start using condoms originally because of H or to avoid pregnancy?

[Katidid]

@WCSDancer2010 this question really does not pertain to this post, but you are so knowledgeable when it come to the H. After 30 plus years, I just officially found out my type lol. Hvs 2 which I suspected. My value was .500 positive for hvs2. Are there values higher than this or is this standard value to show you do, indeed, have it? Hvs1 was .09 neg. Seems like I've seen other people's values as high as .11000. Thanks in advance!

[WCSDancer2010]

@Katidid

 

.500 ??? Usually we start at 1.9 as a positive - 3.5 for anyone who is asymptomatic. So if somehow your results are playing with a different decimal point (not sure why) a 5.0 is a standard/common value.

 

Going on the way I usually see values presented though, I've seen many that are WELL over 11.00

[Katidid]

Oh ok....the nurse read the results over the phone so I have not actually seen in in writing yet. It probably is 5.0 lol. Thank you very much for responding so quickly!!! I wonder if very high values indicate "recently aquired" vs a lower value as having had it a very long time.....interesting.

[hippyherpy]

Well over 11? That seems very high. I think mine was about 5 after a while.

 

 

Last July it came back as around 1.2 (I didn't find out until September though- the nurse had told me was all clear :( ).

 

Then about a week after my first breakout I got a test (September), and it came back as .9. My first breakout happened a day or two after I had sex with a girl who had herpes. She had told me before and I did it, but I was freaking out a little bit anyway. I thought ingot it from her but the doctor reviewed my chart and saw that I had 1.2 way back before July.

 

I don't know how it went down to . 9, but I got retested a few times and it was higher after that like 4 or 5.

 

I think I panicked after hooking up with that herpes girl and that might have triggered my first outbreak. Looking back at the summer before though, I think I was getting some kind of outbreaks by new blisters.

 

Either that or I actually did get herpes from and my initial test results from before the summer were off.

 

Anyway, I have herpes now so, and was probably going to get it sooner or later because of all the raw dogging I was doing with strangers.

[optimist]

@Katidid - Some test result formats set a high end at >5. Both my tests (I took a second test to confirm) came back as ">5" which just meant the result was greater than 5 and therefore could be presumed to be an unequivocal positive result. Maybe it was 5.1, maybe it was 40, who knows, but greater than 5 is outside of the range that is questionable.

[Katidid]

@optimist ok....thanks!!!

[MMissouri]

You have your type now, yay!! It must be a relief to know!

[Katidid]

@MMissouri it confirmed what I has suspected all along. I'm just happy that with hvs2 we have kept my hubby from getting it:). I assume I shed less due to having it so long

[aep001]

Hello everyone,

 

I've been off this site for months now - a good sign showing that I've just been living my life. But I just logged on for a bit an found this in my inbox:

 

I recently encountered your post on single-exposure HSV transmission probabilities, and while agree with your calculations that led you to the 1% number. Unfortunately, the paper "Knowledge of Partners’ Genital Herpes Protects against Herpes Simplex Virus Type 2 Acquisition", by Wald et al., empirically measures some of the quantities you compute, and they are substantially less optimistic. (For example, they measure the median sexual relationship length before transmission as 3.5 months, or ~40 exposures.)

 

I suspect the discrepancy between your calculated results and those of the paper are a result of sample bias: The transmission rates are between couples who have been together long enough to participate in a couples' study, yet for whom HSV transmission has not occurred. This is very different from transmission rates in a new relationship, as the cited paper demonstrates. (This casts doubt on the 'independently distributed' assumption.)

 

Indeed, this underscores the caveats I put in the preceding posts, but makes them even more stark. The independent assumption is certainly false, and we as a community should not be citing hard numbers during our disclosure talks. I'll try to dicsuss my updated disclosure talk to the Ladies Man Disclosure Success Thread by @hippyherpy in a bit.

 

As the emailer above stated, the problem with the numbers we have been using is that they use "serodiscordant" couples - that is, couples where one person has HSV-2 and the other does not. There likely is some sample bias in using those statistics, because those couples by definition have not transmitted, so there could be something different happening with them (the HSV+ person has unusually low shedding, the HSV- person as a particularly well adapted innate immune system, etc.).

 

But the Wald et. al. paper also has a bias! Their sample pool was "patients presenting to the University of Washington Virology Research Clinic or Sexually Transmitted Disease (STD) clinic in Seattle with a first episode of genital lesions consistent with herpes." That is, they had an outbreak! We know that the probability of transmission goes down with time, and is much lower when you do not have an outbreak or prodrome. Indeed, I wrote the preceeding before getting to the discussion section, in which they state:

 

Another corollary of our study design is that only persons with symptomatic genital herpes were enrolled, because we relied on clinical presentation for the initial diagnosis. A minority of newly acquired genital HSV-2 and HSV-1 infections result in a diagnosis at the time of acquisition, and the factors that distinguish between persons with symptomatic and asymptomatic HSV acquisition are poorly understood [23]. However, the enrollment of persons identified as seroconverting to HSV without clinical evidence of infection would necessitate prospective monitoring, obviating the possibility of this study design

 

So for the 80% of us who have not had symptoms (like me), I would say the risks are all much, much lower. But that is not a scientific statement. This paper states that the hazard ratio of having lesions vs. not having lesions is 2.01, though it has the same "serodiscordant couple" sample bias as the original emailer stated. Still, this indicates that you reduce the probability of transmission by about half if you abstain from sex when you have a lesion (this is a relative risk. The 10% number cited in the worksheet is an absolute risk).

 

Further, as the authors state in the discussion section, they only studied people who acquired herpes. So they have the opposite bias! As they state, they can only cite relative risks - hazard ratios, i.e. the amount a particular intervention changes the risk - and not absolute transmission rates. Note that hazard ratios measure instantaneous risk, so there's no need to discuss "per year" or "per act" probabilities.

 

A few notes from the Wald et. al. paper:

• "Condom use was infrequent, with 50% reporting condom use the first time they had sexual intercourse with the transmitting partner and 20% reporting condom use the last time they had sexual intercourse." Am I the only one that always uses condoms, unless I'm in a committed relationship where we have both been tested? As they state in the discussion section, "consistent condom use was unusual among our participants, which potentially suggests that those persons who use condoms regularly are protected against HSV-2 acquisition and, thus, could not become participants."

   

  This paper states an incredible 0.085 hazard ratio for transmission to a women when a man uses a condom 25% of the time vs. less than 25% of the time! It also seems there is no signficant difference between using an not using a condom for female-to-male transmission!

• "The median time to HSV-2 acquisition was greater in participants whose partners informed them that they had genital herpes than in those whose partners did not (270 vs. 60 days, respectively; P=.03, log-rank test)." This really brings home the point that disclosing is the right thing to do. If you disclose, you are increasing the average time of transmission from two months to nine. Even more rigorous is the discussion of the hazard ratio, which indicates that the risk of transmission for those who disclose is 48% of those who do not. If you tell before the first time you have sex with the partner, that number goes to a wonderful 34%.

 

Confused? So am I. The biases, limitations, and conflicting results of all these studies really muddy the waters here. I really wish I had participated in the discussion with Dr. Peter Leone through this site. He or some other academic with more expertise in this area than I should write a review article with a "plain English" section. And there should be attempts to reconcile, or disregard, some of the numbers.

 

What will I do? I don't know. I have moved on with my life, had more success sexually than ever, and can proudly say I've always disclosed before the initial sex act. Further, I'm not burdened by guilt, and I now have perspective and know that, even if I do transmit to someone, their life will not be significantly affected. As the nurse-practitioner in the STD clinic told me, while pointing at the list of tests they perform there "diabetes is worse than any one of these diseases." So that should give some perspective.

 

I have taken @hippyherpy's advice - my disclosures are simple: "I have herpes." Sometimes I get a look like "who gives a shit", at which point we just jump in the sack, and sometimes I have to go a bit further. I'll discuss more on his "Ladies Man Disclosure Success Thread." I think the only thing I'll change is, if we get into real numbers, instead of saying the probabilities are less than 1%, I'll cite the nine-month vs. two month statistic, and further state that that was without rigorous condom use and suppressive therapy. I usually suggest the person go home and do their own research, which almost never happens, but that's the best I can do.

 

I've spent way more on this than I intended to. It's a beautiful Sunday! Oh well. I look forward to the discussion.

[hippyherpy]

Like I've said before, the numbers discussion is a dead end during disclosure for multiple reasons.

 

Instead, learn how to communicate the risks in ways that most people will be able to understand.

 

 

 

[Katidid]

Ditto Hippyherpy!!

[dani]

@hippyherpy, how do you communicate the risks? do you use analogies? any examples? (you may have posted some before but I didn't see it)

[hippyherpy]

First of all, I ask them if they know anything about it. If they say no, then I ask if they ever had a coldsore. If they say yes, then I say that they already have herpes I just have it in a different spot. I keep it simple and tell them I don't have sex on outbreaks and take a pill that makes very hard for it to pass to them.

 

I think if it's a tiny risk like 1/100 or 2/100 that's extremely improbable that it will get passed on.

 

I only get into numbers if they want to know more info, and really, telling all the numbers had less to do with the actual numbers but more of just showing them that you know a lot about this thing. If they trust you, then they trust that you wouldn't be reckless.

 

 

Knowing the risks is more for me in that regard. I know when it's more risky- without condoms and without Valtrex or on an outbreak. For them, it's all about whether or not they trust you or have confidence in you.

[scared1011]

I know that this forum was so long ago, but I got diagnosed this year and got it from a one-time encounter. I don't believe that the odds are that low (I'd only slept with my ex-partner which was 6 months prior to this one time thing and my blood test was negative). I also know several other people who only have one-night stands and have contracted it. I have had 5 outbreaks within 4 months and the whole thing has impacted on both my physical and emotional health. Because I know that you can contract it from a one time thing and the impact it can have, I would now never not disclose - it may be more irrelevant to those who don't get symptoms, but for those that do, it's pretty horrendous. I didn't have the choice when it came to contracting this and I definitely don't want to put someone else in the same situation.

[Katidid]

Well, yes....you can get H from a one night stand. Obviously, this depends on if the one night stand is with/without protection, with/without outbreak/ prodrome symptoms, with/without knowledge of having H/ with/ without anti viral....list goes on. It's less likely from a one night stand provided the person with H knows their status, uses protection, is on anti viral or is without outbreak

[ggrryy]

@aep001 Have you seen this study on transmission with a condom. It might impact your calculations:

https://www.healio.com/infectious-disease/stds/news/in-the-journals/{31ed8b2f-7ebc-493d-861f-94056e5a294f}/risk-for-hsv-2-transmission-using-condoms-associated-with-gender