Diagnosed today

[anenomy85]

Hi everyone

So I was diagnosed with herpes today, not sure which yet because in my shock I kinda hung up on the health advisor. But over the past week I've been reading up on it and the transmission rates from female to male and they seem really low providing you don't have sex when you're on an outbreak, you're on suppression therapy, and you use condoms. Had anyone else seen that and is it really true?

Also I want to start suppression therapy as soon as possible but I don't know how to go about it in the UK. Any ideas anyone? 

Thank you for your help, was feeling ok at first but starting to feel really down about it x

[WilsoInAus]

Quite a bit does depend on type and location. How were you diagnosed? This will give some clues in this regard.

[anenomy85]

Hi, thank you for getting in touch with me. This is all new to me so I'm not sure how much to share without it being too much! Basically, I had some blisters 'down there' and had swabs done. They checked me for other stuff too and it came back clear. 

This outbreak has been horrible and I'm terrified of passing it on to someone else. I'm in an open marriage, so I'm still 'active' as it were, but I've always used protection. The guys I'm seeing have told me they're clean but I've since found out herpes isn't tested for in a standard UK GU screening. Is that true too? 

Thanks for your help 

[WilsoInAus]

That's right, the NHS does not have herpes blood testing as a regular part of STD/STI testing. It needs to be obtained privately mostly.

It is worth finding out whether this HSV-1 or HSV-2 (I assume the swab was cultured and they told you it was herpes with no type tested for?).

HSV-1 is somewhat hard to transmit and most people have an oral infection which means no real risk to them.

[anenomy85]

Hi again, 

I'll be honest with you, I was so shocked I didn't think to ask what type it was. I'm going to call the clinic today and find out. 

So if it's HSV1, and they have cold sores, I don't have to worry about passing it to them as they already have it, is that right? 

[WilsoInAus]

That’s right, males are afforded really strong immunity from a subsequent genital HSV-1 infection if they have it orally already.

[anenomy85]

That's good to know. Obviously I'm going to tell my partners but it helps that I can put it into some kind of perspective for them. 

Sorry to keep asking questions! But when a herpes test is carried out, how accurate are they if you haven't had an outbreak? 

[WilsoInAus]

For HSV- 1. They are pretty accurate for recent infections. There are issues with HSV-1 testing which does miss infections particularly for long term infections.  On average the miss rate is about 10%.

Note that a primary infection with HSV-1 will almost always cause an outbreak. Many people have no living memory of an outbreak though if infected young. 

[anenomy85]

Thank you for all your help. I'm hoping like mad it's HSV1 and not the other! 

[WilsoInAus]

Did you receive oral sex in the week before the sores appeared?

[anenomy85]

Hi, sorry for the delay. Yes I did. I've since found out it is HSV2 

[anenomy85]

I've heard you can get hsv2 orally but that it's rare, is that true? 

[WilsoInAus]

HSV-2 orally is pretty rare for sure. A coinfection genitally and orally tends to occur more from oral HSV-1 infections.

I would check that the swab was typed properly. I’m not sure the NHS does type swabs?!?

[Confusedmw]

On 5/24/2018 at 3:20 AM, WilsoInAus said:

For HSV- 1. They are pretty accurate for recent infections. There are issues with HSV-1 testing which does miss infections particularly for long term infections.  On average the miss rate is about 10%.

Note that a primary infection with HSV-1 will almost always cause an outbreak. Many people have no living memory of an outbreak though if infected young. 

WhT do you mean by they are accurate for recent infections? Just wondering, I have a longstanding oral infection with hsv1 but I tested positive for hsv1. I had an oral outbreak about 7 weeks before testing. 

[WilsoInAus]

This deals with the issue of sero-reversion of IgG antibodies. It has been observed that a proportion of people no longer test positive for IgG antibodies after having the virus for quite a long time. From memory of research, it becomes noticeable from around 20 years post infection onwards. This is more observable for HSV-1 as the average duration of infection for HSV-1 is around 25 years longer than for HSV-2. 

Sero-reversion is one of the factors that leads to a miss rate for HSV-1 infections using IgG blood testing, but there are probably others related to the varying nature of strains for HSV-1 as well as subtle differences in immune response from individuals. Studies indicate blood testing in the months post infection has a very high hit rate for both HSV-1 and HSV-2.

[Confusedmw]

14 minutes ago, WilsoInAus said:

This deals with the issue of sero-reversion of IgG antibodies. It has been observed that a proportion of people no longer test positive for IgG antibodies after having the virus for quite a long time. From memory of research, it becomes noticeable from around 20 years post infection onwards. This is more observable for HSV-1 as the average duration of infection for HSV-1 is around 25 years longer than for HSV-2. 

Sero-reversion is one of the factors that leads to a miss rate for HSV-1 infections using IgG blood testing, but there are probably others related to the varying nature of strains for HSV-1 as well as subtle differences in immune response from individuals. Studies indicate blood testing in the months post infection has a very high hit rate for both HSV-1 and HSV-2.

So it’s possible to have a new strain of hsv1? I tested positive when I have had hsv1 for about 15 years. You’re saying most people test negative when they’ve had it for a long time? 

[WilsoInAus]

Yes some people test negative after they have had the virus for a very long time.

It is not really feasible at all to obtain a further strain of HSV once you have an established infection. Even if it happens (and that seems to be for a fraction of a percent of healthy people at worst) it doesn't mean they get worse symptoms for example.