Sacral HSV recurrence & transmission

[Tse]

I tested positive for HSV-2 three years ago after I had a small lesion on my lower back / upper buttock. I have had two recurrences since then—-about once a year and always in the same location. I’ve gotten so many differing answers to my questions and am hoping you can help me!

Will I always get recurrences in this same location? (So far, that has been the case, but I’ve also been told that outbreaks can happen anywhere below the waist including the genital area. I’ve also heard that outbreaks only happen within the same “dermatome”. Does sacral HSV-2 live in a separate dermatome from the genitals? Is it possible I was only infected in one location and I won’t get it anywhere else?)

Can I transmit HSV-2 via asymptomatic shedding to another person from my genitalia, or just from that area on my lower back? If the answer is only from the lower back, is it somehow harder to transmit because it’s skin and not mucous membrane?

I understand there is a 1-3% chance of genital HSV-2 shedding asymptomatically. I take Valtrex which is supposed to reduce transmission by 50%. Does that mean a potential partner would have a 1.5% chance of getting it? (Is the risk lower with sacral HSV-2 or is it the same as a genital infection?)

Thank you!

[Terri Warren]

You may get outbreaks only there or your outbreaks could move to other areas innervated by the sacral ganglia – that’s an area sort of waist to mid thigh. The sacral dermatone does include the genitalia, for sure.

Even though your outbreaks are in the gluteal cleft, you will also periodically shed virus from the genital area as well and could transmit virus from there during sex.

I don’t know your gender, but regardless of that, valacyclovir does reduce transmission about half, that is correct.

Terri

[Tse]

Thank you so much for answering my question!!! It’s relieving to just know the answer. I forgot to mention I’m female… and I take valacyclovir. When I share information with a new partner, what percentage risk do I let him know he might have? You said the antiviral reduces risk by 50%. Is it correct that without the antiviral, asymptomatic shedding occurs 1-3% of the time? I know females are at more risk than males for transmission, but I’m not sure what that means as far as a “data point” I can tell a partner. (Again, thank you so much for offering this service.)

[Terri Warren]

Males are more likely to transmit to partners than females are, due to females being receptive with intercourse. For the couples we’ve studied about transmission rates, the average is about 4% in year, having sex about twice a week, no condoms, no antivirals. Add antiviral and condoms and you’re down around 1-2 % a year, more sex, more risk. This is a statistic from longer term couples so it may not apply fully to new couples.

Terri

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