Genital HSV-2 susceptible areas for men

[curious1990]

Hi Terri

I wanted to clarify where exactly men are susceptible to acquiring genital HSV (or HSV-2 specifically if the serotype matters). My understanding was that transmission requires viral contact with a mucous membrane or micro-breaks in the skin, and for men the primary (perhaps only) vector here is via the urethra and via the thin skin of the penis, especially when erect. Intact skin, even on the penis, should prevent transmission in my understanding.

However, I have seen questions talking about the use of e.g. tight-fitting boxers in addition to condoms, which seem to imply that men can also acquire genital HSV through I would guess breaks in the skin of the thighs? I’d really appreciate clarity on exactly where men can potentially acquire GSHV (e.g. penis, thighs, pubic area), to what extent men should be concerned about non-penis vectors (i.e. are boxers worth considering), and whether micro breaks (not noticeable) can and do form in these other genital areas in the same way as on the penis.

I guess that this may relate to the much smaller risk reduction that men seem to enjoy from the use of condoms (relative to women). I spoke to GPs who suggested that this was largely due to incorrect use, study design limitations etc., but if non-penis areas are susceptible in men (but do not shed) this could account for a significant part of the difference. I’d be really interested to hear what you understand the primary drivers of the difference in condom effectiveness between men and women to be.

Thanks so much!

[Terri Warren]

Men acquire HSV primarily on the shaft of the penis and anus, if there is anal contact. This can occur when there are symptoms present in a partner and when there are not. Acquisition through the urethra is less common. Men also shed virus primarily from the shaft of the penis, with or without symptoms, and condoms reduce transmission of HSV 2 from men to women by 96% with regular use. This is because the condom covers the shaft of the penis. Condoms reduce transmission of HSV 2 from women to men by 65% because genital secretions from women can come in contact with part of the penis not fully covered by a condom. Is that what you are asking?

Terri

[curious1990]

Thanks Terri, I appreciate the response. When you say primarily– I’m interested specifically in whether it’s possible and how roughly how likely it is for men to acquire HSV on say the thighs or pubic area (areas that could come into contact with genital secretions as well) if there is minor skin barrier compromisation. This may inform the question of whether there is any merit to discussions I’ve seen in other threads on this forum about wearing e.g. tight fitting boxer shorts during sex, or whether this is a completely negligible risk.

[Terri Warren]

Is it possible if a man has a break in the skin on the belly or thigh that is significant, could they possibly acquire HSV in that location? Well, anything is possible I guess but I would say the odds are just incredibly low.

Terri

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