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positive guide to herpes disclosure



Negative Blood Test - Positive Cultures...confused. Transmission to partner?

Just received a positive diagnosis on two different cultures. However, I tested negative for the antibodies.

Two weeks ago, I had what I thought was a cut near the head of my penis. My GF and I had unprotected sex that night, since I didn't think anything of it. I went to the doctor a few days later and they took blood and did a tissue culture. The blood came back first, and it was negative. I just got the results from the tissue cultures (one on Tuesday of last week, and another on Friday) both came back positive. The doctors thought it was mechanical damage the first time, and the second time they thought any bumps were from neosporin reaction (dermatitis?)

I'm confused, though. My doctor said that assuming my negative blood test was accurate, this was a recent infection. Neither of us have slept with anyone else though, so I don't know how it just showed up. Also, my GF was tested in March 2017 and specifically requested a Herpes. Her blood work came back negative and she hasn't had any symptoms. We have been dating and sleeping together since June of 2016. If I had it prior to now (assuming false negative) surely she would have acquired it after a year of unprotected sex?

I don't know what to do. We had protected sex twice when there was an open lesion, and once when the initial one occurred. She's going to the DR on Friday. If I was truly just infected, how long will it take before her blood would show the antibodies?


  • edited September 12
    Was the culture positive for HSV1 or HSV2? And was it an IgG blood test? The IgG recognizes 70% of HSV1 infections and 95% of HSV2 infections, assuming 12 weeks have passed from time of infection . This means the IgG misses 30% of HSV1 infections and 5% of HSV2 infections.

    If you've had HSV2 throughout the relationship and did not have symptoms until now, studies indicate the odds of transmitting it to her (during the time you did not have symptoms) would have been 10% annually, assuming intercourse a couple times per week. If genital HSV1, then the annual transmission risk (outside of outbreaks) is likely closer to 3%, though this is just speculation based on typical shedding rates which are 3x more frequent for HSV2 than HSV1. Studies on genital HSV1 transmission rates are underway but current data is specific to HSV2. Transmission risk is higher during outbreaks, however.
  • Thanks for the response. The DR told me that both culture tests were positive for HSV2. I am not sure what blood test they did.

    Part of the confusion is when the actual infection occurred. I've slept with two people since fall of 2015, both were LTR. Neither had symptoms or issues related to HSV. So, if it occurred before fall of 2015, I should have had the antibodies. But, my test last Tuesday didn't show antibodies. If the HSV2 test is 95% accurate, then I must have been infected recently? It doesn't make sense, since neither myself or my partner have slept with other people. For my GF's sake, I'm not sure what to consider the date of infection as. If it actually just happened, then her blood test wouldn't be accurate for another 11 weeks.
  • @mloops It's possible one of you tested falsely negative by IgG blood test since there is a 5% false negative rate. Also possible one or both of you had an IgM test instead of an IgG test which would not be reliable.

    As for your previous partners, HSV2 is very common, especially among women. For every woman who has been diagnosed with HSV2, there are 7 women who have it and don't know it because they don't have symptoms or their symptoms are mild and/or infrequent enough to be mistaken for something else. 80-90% of people don't notice upon becoming infected with HSV2.
  • Okay, thanks for information. I will try to find out what kind of test my DR used.

    I only recently realized that generalized STD tests did not check for Herpes, which completely baffles me. I usually get tested multiple times per year, specifically because of concerns about Herpes. I'm concerned about how long I've had this, and if I gave it to other partners at some point. Not sure how far back to go here.
  • edited September 13
    @mloops Yeah, the CDC does not recommend screening for herpes at a general population level. 80% of adults have at least one type of HSV, most tolerate it fine, and the stigma is problematic. HSV2 is not as common as HSV1 but autopsies indicate 40% of people (in the U.S.) contract it over the course of a lifetime, so still quite common. This is not to say it isn't a significant problem for some people. It can be. But for most people, the stigma is more troublesome than the physical aspect. From what I can tell, doctors tend to focus on treating those with symptoms (cold sores or genital sores) rather than screening those who aren't bothered by symptoms but might otherwise be bothered by stigma. There is minimal effort to reduce transmission, the greater focus is on treating symptoms in the minority who experience significant primary outbreaks or frequently recurring outbreaks. The CDC provides a more complete explanation here: https://www.cdc.gov/std/herpes/screening.htm
  • Understandable.

    Now that I have it, it's raising a lot of questions about the future of my relationship. If my GF doesn't have it, is the relationship strong enough to justify her potentially putting herself at risk of contracting it? I also feel weird putting her in a position where she is at risk because of decisions that I made in the past. Odd situation. Especially not great timing since I am moving out of the apartment to have more space for my personal items...

  • @mloops Again, you want to bear in mind that 80% of adults have at least one form of HSV that can be transmitted to an uninfected partner's genitals through various forms of sex. Opting out of being with her is not protecting her from HSV in general, it is only protecting her from your HSV specifically, which may or may not be important to her. It *is* a deal breaker for some people, yes. However, my experience has been that most people are accepting. The one time I was disclosed to, decades prior to my own diagnosis, I was accepting. Of the many times I've disclosed to others, about 3/4 were fine with it.

    I would not frame this as a result of bad decision making. HSV is very common, most who have it don't know it, and it can be transmitted when condoms are used (though condoms do help minimize risk). Some people do prioritize remaining HSV-free. Doing so means testing for HSV with all new partners after abstaining for at least 12 weeks, then being willing to pass on all partners who test positive which is most partners. That's a tall order. I respect those who make that choice, but I wouldn't say those who don't have made bad decisions. Just my opinion.
  • This has to be asked: if your blood test was igg, is there any chance your girlfriend recently cheated on you? Negative blood test + positive swab is the one situation where that becomes the most plausible answer.

    Do not accuse her, however, it is the most likely answer with that combo
  • Optimist, I think it's fair to not consider it a 'bad decision' since ultimately so many people are unaware. I doubt any of the people I've slept with in the past knowingly infected me with it. From my end, I was tested 2-3 times a year and assumed it included Herpes. This was because I was fairly active sexually, and didn't want to put anyone at risk without disclosing. I feel like I failed since I was never actually tested for it :\

    Jeff, I am not sure what to think. I sincerely doubt she's cheated on me. She wasn't sexually active for a few years, and I was her first partner since that point. I've been with a lot more people than she has, so odds are that I was the one who had it. But...it doesn't make sense that my blood test two weeks ago was negative. Hers was also negative back in March. I really just don't understand how this is possible...
  • There is the extremely rare person who never tests positive. That's the other explanation. But if you seroconvert in a week or 2 and so does she, well, that's it
  • @mloops Do you know what kind of blood test your current gf used in March? A lot of doctors use the IgM test, which is notoriously inaccurate. As @JeffH suggested, it couldn't hurt to restest at 12-16 weeks after your outbreak to see if the IgG blood test shows anything then.

    I also second @optimist's comment about not viewing this as a bad decision on your part. Believe me, many of us here have taken that view, especially initially. God knows I did! I was so mad at myself for a long time for not being better informed. Sadly, the lack of routine testing and the confusion or ignorance about types of tests is the norm. HSV is a very common virus that doesn't give a rip about our decisions and is difficult to avoid. On a related note, if you've been the carrier and your gf is indeed negative, there's no reason to think your gf necessarily received the virus from you in the past year. I unknowingly had HSV (both types) throughout my 15 year marriage and when I was diagnosed following the divorce, my ex actually tested negative.
  • edited September 14
    @mloops As @hikinggirl mentioned, if it was an IgM test, it would be unreliable for these purposes. I will go farther and say that a negative IgM and positive swab is more likely to indicate an OLD infection, not a new one, while the reverse would be true for a negative IgG. But even the IgG misses 5% of HSV2 infections (after 12 weeks from time of infection) and the same people tend to test false negative each time for reasons unknown. The Western Blot is a more sensitive option for people who have lingering concerns after a low positive result, but that's not relevant to you because you've had a positive swab which is considered definitive.

    I would absolutely not beat yourself up about testing. It is not a standard test and many people believe they are tested for "everything" when asking to be testing for everything. Additionally, many doctors discourage testing in the absence of symptoms. My experience with medical professionals has been as follows:

    - Gynecologist allowed me to test for HSV with my full STI panel but when the results came back positive for HSV2, he and the nurse practitioner essentially advised me to ignore it because I have no symptoms. NP went even further to insist I did not actually have it and had only been "exposed." Both discouraged antivirals. I did my own research and went back and requested antivirals and the doctor agreed it was fine.

    - Primary Care Doctor with whom I shared my results at my next routine physical said the results are unreliable and I shouldn't have tested because the tests are unreliable. I explained why I thought the results were accurate (antibodies beyond a certain threshold) and he said fine, go ahead and take the antivirals if you want, they won't harm you.

    I share all this to emphasize to you that I don't feel you were somehow negligent in not asking to be tested specifically for HSV. Or not knowing to ask. Your experience is very common. I think a minority of people are aware that they need to specifically ask for HSV testing if that's important to them. As I mentioned earlier, only 12.5% of people with HSV2 have been tested/diagnosed, and I would assume most of them were tested as a result of having an obvious primary outbreak or recurrences, given standard testing practices and the CDC's recommendation. I think maybe there are pockets of people who do test for HSV more regularly, but I believe your own experience is much more common.
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