We have been helping herpes-positive patients for more than 17 years.
Once a herpes diagnosis is made, it’s typically followed by embarrassment, frustration, and even anger. This article will explain why a newly diagnosed person shouldn’t jump to the conclusion that infidelity by their current partner is to blame for their STD.
How herpes is transmitted from one person to another is complex.
People tend to scrutinize their life and especially their current relationship. They have a lot of questions.
- I was always careful; how could I get it?
- Is my partner cheating on me?
- Who gave it to me?
It’s outside the scope of this short article to discuss these questions in great detail, but we can explain the most common scenarios that we’ve seen in our practice.
(For the sake of confidentiality, we won’t disclose real names or specific life situations.)
Dr. Fuzayloff (his patients call him “Dr. F”) will briefly explain some possibilities.
Case #1. A person who didn’t know they had it passed it to their partner.
A 25-year-old woman named Julia came to the office with a genital skin rash that she had never had before. A herpes swab test came back positive for herpes (HSV-2).
She confronted her boyfriend, Tony, whom she’d been dating for nine months.
Tony is a young professional who denied having sex outside of his current relationship with Julia. He also said the following:
- He’s been fully tested for STDs after each relationship ended (and he’s had only three carefully selected long-term partners in his life).
- He hasn’t ever had herpes symptoms.
We gave Tony the HSV-2 test (IgG), and it came back positive for herpes.
Conclusion: Julia got herpes from Tony. Though he’d never had any symptoms, he shed the virus silently.
Dr. F’s Explanation
Julia contracted HSV-2 from James. I trusted Tony and I believe that he’s being honest with Julia.
- It’s very common for people to have herpes and not know about it. Only 20% of herpes-positive people have symptoms. Most people are asymptomatic for life.
- You don’t need to have a herpes outbreak to pass the infection. It can be passed through silent herpes shedding. This means that James could have passed it to Julia without having symptoms.
- When people get “fully tested” for STDs, the testing might not include a herpes test. The CDC doesn’t recommend routine herpes testing. And James’s past test results didn’t show that herpes testing was performed.
Case #2. I have a herpes outbreak and I blamed my partner, but he’s negative.
Twenty-year-old Anna came to the office with a painful genital outbreak. A swab test confirmed the diagnosis of herpes type 2 (HSV-2).
Anna had just come out of a long-term relationship when she began dating Thomas. She and Thomas have been together for more than six months. She suspected that she must have gotten it from Thomas.
We tested Thomas with blood work and his results came back negative for both herpes types. Thomas began to suspect Anna of cheating on him.
Anna explained the following to us:
- She has been in only two long-term relationships
- She has always gotten a full STD panel before beginning and after ending relationships
- She has never before had symptoms like this
We tested her previous long-term partner, who turned out to be positive but had never had symptoms
Conclusion: Anna got herpes from the previous partner but is just now having her first outbreak.
Dr. F’s Explanation
I trusted Anna and believed she was telling the truth.
- A “full STD panel” doesn’t always include a herpes test, but she didn’t know that
- She acquired a herpes infection from her previous long-term partner and it was kept suppressed by Anna’s strong, healthy immune system. Now something has gone wrong (perhaps she is feeling stressed about work), leading to an outbreak
Case #3. We’re both having our first herpes outbreak. Who is the culprit?
A 29-year-old woman, Alexis, came in with a genital rash that was tested for HSV-2 with a swab; the results came back positive.
This is her first outbreak and she’s very concerned.
A few days later, she came back to the office with her boyfriend, Eduardo, who has a penile rash. He tested positive for the same type of herpes.
They started arguing and accusing each other of cheating.
Here’s what both Eduardo and Alexis said:
- They’ve been tested after each partner
- The results of their “complete” STD testing have been negative in the past
- This is the first time they’ve had an outbreak like this
They want to know who gave it to whom.
We tested both Eduardo and Alexis with a herpes IgG blood test, and only Eduardo’s result was positive.
This complicated the issue even more since Alexis had visible symptoms first.
Conclusion: Eduardo got herpes from someone else and passed the infection to Alexis, even though Alexis showed symptoms first.
Dr. F’s Explanation
- Herpes swab vs. blood test
- Both Alexis’s and Eduardo’s swab tests were positive but only Eduardo’s blood test was positive. The swab test confirms only that a visible lesion is a herpes lesion.
- A blood test tests the body’s reaction to the virus and can take from two weeks to three months to be positive.
- Alexis got an outbreak first because Eduardo was shedding the virus silently (while asymptomatic). Silent virus shedding is the most common way of passing a herpes infection. (It is outside the scope of this article to explain why, how common it is, and how it happens.)
- Eduardo most likely had an outbreak after the stress of an argument with Alexis caused his immune system to become weaker and the virus to surface. In the past, his immune system kept it in check.
Case #4. We’re both positive for herpes, but we have two different types.
Twenty-six-year-old Donald came to get a “full STD panel” and asked that it be as complete as possible. He’s been dating Denise for three months and wants to start having unprotected sex with her after the test.
The test came back positive for HSV-2. He became very frustrated and was suspicious that Denise was having an affair with her ex.
A few days later, Denise, also 26, got the testing done. Her test came back positive for herpes too, but for a different type, HSV-1.
The fact that two sexually active people tested positive for different types of herpes caused more confusion.
Conclusion: Donald and Denise got herpes independently, from other people. They haven’t had the opportunity to pass their infections to each other yet.
Dr. F’s Explanation
- Since Denise and Donald have different types of herpes, they got them from other people. One type cannot transform into the other type.
- Even though they’re having sex with each other, they haven’t passed their infections to each other. The chance of passing either infection is 10% without symptoms (silent shedding) and 20% with symptoms.
Case #5. She got genital herpes through oral sex.
A 23-year-old woman, Jill, came to the office with a genital rash. A swab test confirmed genital herpes. She immediately suspected her current partner, Joe, of giving it to her.
The next day they showed up together. Joe denied having been diagnosed with genital herpes.
After being asked a series of questions, Joe remembered having sores around his mouth as a kid. But he’s not getting them anymore. All his previous STD tests were negative for “everything.”
Joe was very hurt and swore that he wouldn’t hurt Jill because he loves her.
Joe’s blood test came back positive for HSV-2. This is the virus that Jill has genitally.
Conclusion: Jill got HSV-2 from Joe via oral sex.
Dr. F’s Explanation
- Jill got the infection from Joe. Joe most likely has the HSV-2 virus in his mouth and passed it to her by giving oral sex. It’s not common to have HSV-2 in the mouth, but we’ve been seeing it more often.
- Joe passed the infection to Jill via silent shedding (while asymptomatic).
- Most likely, Joe got HSV-2 in a nonsexual way from his parents or friends.
- Since Joe has had this issue since childhood, he thought of it as only minor fever blisters that he wasn’t having anymore. He didn’t realize it was an STD and didn’t hurt Jill intentionally.
Case #6. I was careful, but I still transmitted herpes.
Kate and James have been together for a year. Kate is positive for HSV-2 that she got from a past partner. She has had only a few outbreaks and for the last five years has not had any symptoms.
Being a very ethical person, Kate informed James that she was positive for herpes. They decided to follow common-sense precautions:
- The wouldn’t have sex when Kate has an outbreak
- They would have only protected sex
- Kate would take daily antiviral medication to reduce the risk of transmission
Despite these precautions, James recently had his first outbreak. Kate feels embarrassed and guilty about hurting James.
They’re both puzzled about why he got it when they followed so many precautions.
Conclusion: James got herpes from Kate despite the precautions they followed.
Dr. F’s Explanation
- Transmission is possible even when precautions are followed
- Precautions only reduce the chance of transmission; they don’t eliminate it
- 50% reduction from antiviral suppressive medication
- 50% reduction from using protection
Conclusion
All the cases we’ve described are real. They’re only a very small sample of what we see in our practice. These cases are very simple and straightforward, unlike some others.
We didn’t discuss complicated stories that make it impossible to know which person gave herpes to the other person. Most commonly, the doctor is not able to make this determination.
The take-home message is this: don’t be quick to judge, and don’t assume your partner has cheated on you. From being in practice for a long time, we can assure you that most people are ethical and good and do their best not to hurt others.
