Herpes Transmission Multiple Partners

[nvalley2011]

Hi Terri,I frequently visit escorts for sex (unprotected oral/ protected vaginal or anal). Maybe 10-20/ year. i have been tested for HSV I’m pos for HSV1 and neg for HSV2. According to the stats often quoted, with couples it shows per episode the chance of getting HSV2 from a positive person is 1 in 1,000., and with a condom about 1 in 2,500. However on medhelp there seems to be some conflicting info. Dr. Handsfield will tell someone a one time exposure is very low risk almost nil, while he also says if you have multiple partners (one night stands)even protected your risk increases. To me this makes no sense stats wise. Wouldn’t it be 1 in 2500 per exposure no matter if you had a single exposure to a new partner or 100 single exposures to 100 new partners? I was always under the assumption that if I followed the usual precautions (100% correct condom use covered to base of the penis, looking for any obvious lesions, and if possible discussing std testing with partner) then my chances of getting HSV2 were extremely low like 99.9% safe. Please explain.

[Terri Warren]

I would not say your chances of not contracting HSV are quite that good, no. Condoms do reduce the risk of transmission, yes, but they do not eliminate it. The only statistics that we can accurately quote are from studies done between couples where one has herpes and the other does not. In this relationships, these people have been having sex for a while and we know that most transmission occurs within 3 months of starting a new relationship. These people also know each other’s antibody status and are working around it. They are also not having sex with outbreaks and they recognize what constitutes an outbreak. Commercial sex workers (CSW) are very often positive for HSV 2 as an occupational hazard and may not be on suppressive therapy and may not avoid sex during symptomatic periods because this is their work, their income. I’m guessing at that and could be wrong. But my point is that I don’t think we can apply the statistics that we derive from the studies that we do to different kinds of sexual encounters. Does that make sense?

Terri

[nvalley2011]

I think I understand what you are saying, that it’s an apples to oranges comparison. The stats from the valtrex study deals with monogamous couples who are not in the early stages of infection, know their status, and have the past experience of outbreaks to know when they are about to reoccur. With my situation these variable are pretty much unknown for any credible statistical analysis. So let me ask this in a more basic form. To be as safe as possible I always assume whomever I see is HSV2+ until proven otherwise. I always use protection. I also look for any obvious signs of outbreak( I am aware that asymptomatic shedding can occur 30% of the time.) With these precautions would you say my risk of contracting HSV2 is low, or as stated in some medhelp conversations “to low to worry about” and just a case of “bad luck” if infected? Or..with my current behavior no matter how many precautions I take it’s very real possibility I will eventually get HSV2. I understand that getting HSV2 isn’t “the end of the world” or a “death sentence” however with practicing “safer sex” the only STDs that are of concern are skin to skin contact (HSV & HPV). So I’m trying to figure out my overall risk level (low,moderate,high) of getting HSV2 to determine if it’s worth it to continue my current behavior.

[Terri Warren]

I think I would say that your chances are still low, but I would not say too low to worry about. Sort of just low. I would not describe it as medium or high. Does that help? I’m not at all clear how to quantify this. Keep using those condoms! I would not say that it is inevitable that you will acquire HSV 2, no.

Terri

[nvalley2011]

Thanks for the info. Just so I can be on the lookout for any symptoms in the future. I read on medhelp the primary outbreak is usually the most severe. That it almost always occurs in the genital region. Since a condom protects most of the penis I would expect an outbreak would usually appear on or around the area of the base where there is little protection. Would it be rare for a primary outbreak to take place in thicker skin areas like on the thigh or pubic area above the penis? Also are there any other obvious symptoms for a primary outbreak other than blisters or lesions? I have read the tingling feeling and flu like symptoms are usually associated with secondary outbreaks but not the initial outbreak.

[Terri Warren]

Yes, the primary outbreak is often the worst (not every time) and usually on the genitals. It would be rare to have the first outbreak on thick skin, yes. It is more common for flu like symptoms to occur with the first infection. Recurrences are often preceded by tingling. Most first infections that are going to be symptomatic occur with sores of some kind.

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Terri

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