Serodiscordant couple, controlling HSV2 transmission risk

[abbd2]

Hi Terri! First of all, thank you for providing this amazing resource and help & peace of mind to so many people.

I have been dating a wonderful man for several months. He has always been completely asymptomatic, but has the herpes 2 virus, and we have not been having sex. I am in love with him and am coming to feel like, as you’ve said in other posts, I would rather be with him in all ways and risk herpes than not be with him or continue to limit our relationship. Obviously, we’d both still like to keep my risk of contracting the virus as low as it can be, so I have a couple of questions about how to do that. (If you need to count this post as all 3 of the “questions” I’ve paid for + bill me extra in order to answer all of them that’s fine and sorry for misunderstanding.) Here they are:

1) It’s my understanding that if my boyfriend goes on daily Valtrex, we always correctly use condoms for vaginal sex, and we always abstain during an outbreak if he ever starts to have them, my risk of contracting herpes from vaginal sex will be about 2.5% in a year. Is that correct?

2) How long does he need to be on daily suppressive therapy for the reduction in transmission risk to go into effect?

3) I have read in a few different places that the female/internal condom provides better protection against herpes transmission than male condoms. Nobody is backing this up with statistics, I assume because it has not been studied yet. However, it seems to stand to reason that it could be true, because female condoms cover some of the surface of the vulva. In your opinion, do female condoms present any significant advantage over male condoms in minimizing risk?

4) I know that I can get HSV2 orally by performing oral sex on my boyfriend. Every source I’ve consulted says this risk is much lower than the risk of getting it genitally from vaginal sex, and many even imply that the risk is negligible, but again, I can’t find any statistics or actual estimates of the risk anywhere. I assume this is also because it hasn’t been studied enough, and that information isn’t available to anyone including professionals like you. But, to whatever extent you’re comfortable commenting on it, how would you describe the risk of genital-to-oral HSV2 transmission? How often do you see oral HSV2 as compared to genital?

5) I only recently learned that some people with herpes have their outbreaks on the buttocks, not genitals. Can this type of herpes be transmitted by skin-to-skin contact between an infected person’s genitals and INTACT skin on a non-infected person’s butt?

Thanks so much!

[Terri Warren]

1) Yes, I would agree, between 2 an 3 %. That’s an average.
2) Five days
3) Yes, I would agree that female condoms likely prevent a bit more transmission, though that has not been studied, but intuitively, that just makes sense. But they are more expensive and can make some noise 😉
4) We have no statistics on your question. I see the risk of acquiring HSV 2 orally as considerably less than acquiring it genitally, but if you did acquire it genitally, it would basically vaccinate you against genital infection. If you have ever had cold sores, this would look just like a cold sore.
5) No. Buttocks herpes is basically a reactivation of genital herpes, only on a different branch of the sacral ganglia

You have two more posts on this subscription. Great attitude, the way.

Terri

[abbd2]

Thanks for your fast response & the kind words! Some follow-up and additional questions:

1. Do you recommend that people with oral hsv2 disclose before kissing new partners, or only before oral sex?

2. One of my main concerns in considering a scenario where I do get herpes is the possible risk to future pregnancies/children. It looks to me from what I have read like if I had access to good prenatal care and followed doctor’s orders, the realistic worst-case scenario would be that I had to have a c section. Obviously other problems are not impossible, but can you comment on this & any other complications you think moms with herpes should be seriously prepared to face?

3. My boyfriend and I had sex with condoms a few times before he found out that he had herpes. I had UTI-like pain and flu-like symptoms about a week after the last time this happened, basically immediately after we found out. I went to my doctor and a urine culture showed no UTI, but she also didn’t find any lesions of any kind or anything visually out of the ordinary. I have not had any other symptoms since then (about 2 months). With condoms, his lack of symptoms, and the small number of times we had sex, I am thinking my risk is pretty low, the pain was probably psychosomatic, and the flu was a poorly timed coincidence. I am still planning to get the igG after 16 weeks have passed since the first time we had sex. We were not monogamous during that period and there is someone else I slept with after that first time. On the off chance I was infected in that first encounter, the other guy is at risk and I need to let him know. My question is this:

From a health perspective, is there any benefit to waiting until 16 weeks after the LAST time we had sex to get tested, instead? The only benefit I can currently think of, assuming we’re going to start sleeping together again, is that if we wait until after I get tested and I do end up with herpes either then or in the future, I will know for sure whether it happened before or after we knew that the risk existed. I can’t decide yet whether that would be worth anything to me emotionally, or even a positive thing. Do you have anything to say about this?

Thanks for listening!

[Terri Warren]

1. I have not had enough patients with oral HSV 2 (maybe 5?) to have to have given this advice. I would say before oral sex.
2. I would agree with your assessment. Since 1 in 4 women in the childbearing years have HSV 2 infection, this is a common and manageable problem. Babies born to mom’s with established herpes rarely get infected.
3. I would say that a baseline antibody test would be a good idea for you. Have you not had that done yet?

Terri

[abbd2]

Thanks for the answers!

I assume by a baseline antibody test, you mean a herpes blood test meant to gauge my level of antibody before I would have the chance to seroconvert after this exposure. Is that right?

I haven’t had that, and unfortunately at this point, I’m about 11 weeks out from the last time I was exposed, so it seems unlikely that I would still be at “baseline” if I was infected. My doctor didn’t say anything about it when I saw her right after I found out I had been exposed and just recommended that I come back at 12-16 weeks.

Is there any reason you recommend this test other than the peace of mind of knowing for sure where I got it, if it turns out I have herpes? I realize if I do have it I will never be able to know for sure whether I got it from my boyfriend or not.

Would it be worth it to get a “baseline” test at this point?

Out of curiosity, what if a couple in our (probable) situation (positive man, negative woman) made it to the point where they were going to have a child and the woman still hadn’t contracted the virus? I understand it is more dangerous if a woman contracts herpes while she is pregnant. Do people stop taking precautions to try to get the woman infected before they try for a child? If the woman ends up pregnant and still doesn’t have herpes, do people abstain during the pregnancy?

• This reply was modified 7 years, 9 months ago by abbd2.

[Terri Warren]

Yes, that is what I mean by a baseline test. The reason I always suggest this is because it is fully possible that you might have been infected prior to your relationship with him. This can be important from an emotional point of view, for both of you! If you are positive at 12-16 weeks, you will never know when you contracted this. And yes, 11 weeks is too late.

If it most dangerous of a female contracts genital infection during pregnancy, yes. People vary on what they decide to do about pregnancy. Some people just go for it, while the infected person is on suppression. Others use artificial insemination, which I think is a bit over the top but fit for some people. After achieving pregnancy, it’s best to go back to condom use and I think, in the 3rd trimester, abstaining from intercourse is the best option. Just my opinion.

This is the final post on your subscription. If you have more questions, please feel free to renew.

Terri

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