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Risk of HERPES after unprotected sex. ACYCLOVIR.

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If there are too many question for one fee let me know and I will break it up.

I recently contact WebMd after my girl friend told me she was active with herpes after unprotected sex and I thought my penis looked different about 5 days later. I went to the emergency room as suggested and the good news is the ER doctor said he saw no signs of an outbreak (I may have overreacted) but prescribed acyclovir and ran blood work.

What I read online is blood work is best done weeks after exposure. Could blood work really show the presence of herpes less than a week after unprotected sex with an active partner? I know this was also suggested here.

She is on the herpes meds – what are the chances one encounter with a light outbreak would infect me? One web site (http://www.stdriskcalculator.com/) said 1/8.

How long after she has an outbreak AND the symptoms clear should we wait to have sex?

Going forward, I am older and wiser. I’ll have her check better.

I was surprised to read condoms only reduce the risk of herpes by 30% - is this accurate?

Can washing with rubbing alcohol and hydrogen peroxide after sex be used instead of a condom? To augment a condom? Or soap and water for a few minutes? If so, how much time would I have after sex before washing to be effective?

She also shaves completely. Is this a good idea – outbreaks would be more visible but on the other hand there is stubble left which could scratch me.

Thanks.

Richard Seibel


Category: Sexually Transmitted Diseases(STD)Specialist

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,
Thank You for your query at DoctorSpring.com Mr. Richard.
I am pleased to assist you.
To answer your queries one by one,
1) Regarding Herpes, the manifestations vary from individual to individual. A lot of people get genital herpes without even knowing they have it and never show any symptoms. Some studies claim by the age of 40, 70 % US population is infected with herpes. So herpes test is not even ordered unless there is an obvious rash or a cold sore ( HSV-1 ). For most of the people, to develop the HSV- IGM antibodies ( the first antibodies ) in the serum, it may take up to 2-3 weeks, depending on the person's immunity. Even if the partner is active, it can't be predicted when the other partner is going to develop antibodies for Herpes. But yes i will suggest if you really want to test wait for 2 weeks from the date of exposure. By then if you are not positive for HSV-IGM then it is negative.
But the good thing is she is on herpes meds, and that automatically reduces the chances of transmission by almost 80 %. Acyclovir especially reduces transmission chances really quickly.
Once her symptoms clear up, you should wait for at least a week, to ensure no further outbreaks or sores. Once that's ensured, you can be assured there is nothing to worry. Since having intercourse with protection is the best option in a partner with past Herpes Outbreaks. Because at times even without any active outbreaks, herpes can be transmitted.
No i won't agree with the 30 % protection part. It definitely does not ensure full protection because sores can be in places where there is no condom such as scrotum, and virus is extremely contagious. Still wearing condoms offers at least 70 % protection against herpes. Studies have various results and they can be biased.
Regarding rubbing with sopa and water or alcohol, it really won't lessen the chances because if during intrcourse the virus enters the skin, it starts multiplying almost immediately. So this is not going to provide any extra protection.
Shaving is a good idea, it keeps the pubic area more hygienic.
Regards.


Patient replied :

Thanks for the quick response.
Sorry for a few more. Not sure if your advice changes but you referred to HSV-1 I thinks she has HSV-2.
Would it make sex safer if before sex she washes the vaginal area to remove any sloughing prior to sex or use rubbing alcohol and/or hydrogen peroxide? she does shower thoroughly every morning.
Do you think the ER doctor ordered the blood test at the 5 day mark even after he said he saw no signs of herpes and after reexaming my penis and the list of symptoms there was no match because STD is not his area of speciality? You say wait at least 2 weeks, web sites that seem legit recommend waiting - there seems to be a disconnect. I can understand prescribing acyclovir.

Test just came back negative for HSV-2


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,
No i specifically mentioned about HSV-1 just to explain, but the advise remains the same.
HSV-1 is acquired mostly during childhood, while HSV-2 is more common in young adults.
Either ways, there can be Herpes present in the serum, without any symptoms.
I can't comment in washing the vagina before sex, and whether it provides any extra protection, because it is still not proved. The virus will be present in the lesion, if there are open sores, or lesions, and washing away or rubbing alcohol, won't really confer any extr protection.
If the test came back negative, then it is a good sign.
At the 5 day mark, the senstivity comes down of the test, so we advise to wait for a couple of weeks, because as i said, it depends on individual to individual. Some people's immunity is slightly weaker, and in such cases to form IgM antibodies, it may take even up to a month.
I won't asvise you any further tests until and unless you end up getting sores.
Regards.


Patient replied :

Thanks. Something that has been bothering me. I am circumcised. She gave me somewhat rough oral manual sex on Tuesday and at some point a few days later the ring around the base of the head of the penis was purple with no puffiness or swelling. Some of the veins on the shaft of the penis were a bit swollen and purplish. Could this have been from her being somewhat rough? ER doctor who saw the purple ring at the base of the head of the penis and the veins said it was not herpes but didn't discuss what could cause it. Could rough sex cause the purplish ring and the veins being purple and raised? If not, what else? Pretty much back to normal now but it took almost about a week to get to 80% and 9 days to get back to 95%. Richard PS - you must be doing this as a public service. You cannot be making that much money.


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello,
Yes sometimes due to rough sex or rough oral sex, the veins will appear a little prominent or inflamed. Even the penile skin may appear to be slightly inflamed.
It is definitely not due to herpes.
I am glad that you're getting back to normal.
I'm sorry i did not get what you were trying to convey in your last statement. Can you please elaborate?
Regards.


Patient replied :

Thanks for the incredibly quick response.

Can the purple ring around the base of the head of the penis also be caused by rough sex? Last couple of days I noticed the purple can come and go, but nowhere near as purple as it was on Friday.
WRT the last statement, the amount of time you are spending on this seems far more than you are being paid. And for people like me who want/need a discrete place to ask questions this is an invaluable service.


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

Hello,
Yes the purple color just indicates slight oedema in the areas exposed to rough sex/ rough oral sex. Both can be equally contributory definitely.
Thanks a lot for such valuable feedback. Please do write your feedback in the feedback column. Our main aim is to make great quality healthcare accessible for people like you. And such feedback from patients like you, give us the motivation to keep working hard and make this a success.
Thanks once again, and wish you great health!!
Regards.


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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