HSV1, HSV2 discordant couple

[lightsail]

Hi Terri,

Thank you for the work that you do.

I have oral HSV1. My partner has genital HSV2. We had been together for several months before she was tested (she didn’t realize HSV wasn’t part of an STI screening). Her HSV2 IgG test result was about a 10 (HSV1 was negative). She says she never had an outbreak (at least not that she noticed).

I was tested 3 weeks since our last sexual encounter with a 0.10. From what I’ve read it’s 50/50 that it would detect if I were positive. I’m not sure how my HSV1 status affects the IgG test.

Also, about 10 days ago she had an outbreak on her labia that appeared one day and went away the next. Neither of us uses antivirals but we do use condoms. I would like to how long after an outbreak is she still more contagious.

What’s the most likely transmission risk? That I would get HSV2 genitally, that she would get HSV1 orally, or that she would get HSV1 genitally? I’m assuming me getting HSV2 orally is the lowest. We only use protection for PIV sex.

What is the likelihood that I would have a visible outbreak given that I’ve had HSV1 for over 5 years? Sometimes I feel itchy but I haven’t had any redness or raised bumps like I would with a cold sore outbreak. My cold sore outbreaks happen about 1 every 1.5-2 years.

One thing that concerns me is that she is unlikely to take antivirals. She was trying to treat hers through natural supplements but then she had the outbreak. It seems like she is more contagious now than before but I don’t know if that’s just because she’s now aware that she has it or if something she takes caused the outbreak.

I really like her but she’s made it clear this is a short-term relationship so I’m just trying to figure out what the risks are. I can’t ignore that the stigma for oral herpes is less than the stigma for genital herpes even though oral herpes can be passed genitally. I had asked my doctor to go on antivirals for my oral herpes (he said no) prior to her test because she didn’t want to get genital herpes so all these thoughts are running through my head. Unfortunately, if she wanted a long-term relationship I probably wouldn’t worry about this but since I know that I will have to move on it just seems like I’m unnecessarily putting myself at risk (it seems a little hypocritical given I have HSV1, though I suppose risk of stigma, not necessarily medical risk, is different). I know my friends would say to just move on so I don’t ask them but I really like her.

Thank you for your help with my questions.

[marky]

my friend, getting genital herpes from a person who doesnt want to be with you seriously is TERRIBLE! Why would you cause yourself potentially future struggles in other relationships for this temporary one??

Sorry, I probably have no business commenting here, but as a stranger who has no reason to be biased, maybe it will help you to hear it. So not worth it at all!

[Terri Warren]

You know, I don’t feel as strongly as Marky does, but I am leaning slightly in that direction. She won’t get your HSV 1 – people who have HSV 2 don’t get HSV 1 subsequently. But you could certainly get her HSV 2.

I would feel differently about this if she was at least willing to take daily antiviral medicine- that reduces transmission by half. But she won’t take daily antiviral medicine AND she’s telling you the relationship is short term? You must like her quite a bit to be considering this sexual relationship I think. It is one thing to really care about someone and they tell you they have herpes and they will do everything they can do reduce the risk of transmission to you and there may be a future there for something longer term, but you have none of that here.

I think you have more at stake here than herpes. I think you’re about to get your heart broken. Please think about this very carefully.

Having said all of that, the statistical odds, if you are having sex twice per week with no outbreak, no prodrome, no medicine and no regular condom use, there is about a 4% chance in a year that you will get her HSV 2. And you might have very minimal or no symptoms when you acquire it. Up the intercourse frequency and you up the risk accordingly.

Terri

[lightsail]

Thank you for your response. I didn’t mean to make is sound like “doesnt want to be with me” because she does however she definitely has no illusions that any relationship is forever. Even though our long term goals are different, the same risks still apply to someone in any dating scenario – more than likely that person isn’t going to be with them for the rest of their life. Even still I do really like her, she’s pretty awesome.

Since I still have a couple questions left I wanted to ask a few follow-ups about my situation and a few other questions based on things I’ve read.

1) Is there anything we could do to lessen the transmission risk. I’ve read things like washing after sex, not shaving, putting coconut oil around the genitals, honey, Prunella vulgaris and Rozites caperata might also help.
http://www.wikihow.com/Treat-Herpes
http://www.webmd.com/genital-herpes/guide/herbs-supplements-gential-herpes
http://www.rodalenews.com/natural-herpes-treatments

2) Are there any studies on the transmission rate of genital HSV2 to a partner’s mouth (both with and without HSV1)?

3) Does the value of the IgG score reflect anything about the length of time a partner has it? A few years after I tested positive mine was around 2.5 (it had been higher), but now it’s back up to 40-50 and I don’t know whether that means I’ve just had it longer or if I’m shedding or if it doesn’t really mean anything.

4) Do you know of any studies that show the viral shedding rate of different type/location combinations? I’ve seen this brochure but I don’t know where their numbers come from:
http://herpesopportunity.com/downloads/herpes-opportunity-disclosure-handout.pdf

5) You said in another post that it takes people with HSV1 longer to seroconvert. Does that mean they should wait 5 months to get tested or is 4 still sufficient? (I’m always a little concerned I’ve transmitted it to a past partner and like to feel somewhat assured that that I didn’t.)

6) With regard to inanimate objects, I think I’ve seen you state that the only things you worry about are lipstick, chapstick, etc. I’ve heard people say that the virus can only live outside the body for 10 seconds but I haven’t seen anything to back that up. I did find this article that said HSV can live up to 8 weeks. Do you know of any other studies? What about saliva on a glass or straw used right after someone with HSV (but no outbreak)? I think you’ve also said that towels and toilets are transmission risks either.
http://www.nrcresearchpress.com/doi/abs/10.1139/m75-121

Thank you again for your time with this!

[Terri Warren]

1. We know nothing, scientifically, about the benefits of any of the things that you list here, including washing after sex. I have to only recommend things that have been proven to reduce the risk of transmission, like antiviral medicine.
2. Not specifically. We do know that about 15% of people with primary HSV 2 infection also display oral symptoms.
3. It sounds to me like you were tested with different test brands that have different index values. Also, there is no significance to the level of the index value, once it is over 3.5, only that infection has been well established.
4. These are the correct statistics about shedding and transmission.
5. I think generally 4 months is adequate, yes. I doubt that adding a month would be a benefit, unless antiviral therapy has been taken.
6. That article is 40 years old and I don’t believe that any other publication has found this long a survival rate. I think 10 minutes is probably too short and 8 weeks is far too long. So the issue is not only how long can the virus live(and I’m not sure what that means exactly) but the question more accurately is how long can virus live on an inanimate surface and still be transmissible. That time would be much shorter.

Terri

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