Several Q's

[Teachers]

My girlfriend has genital HSV-1 and is asymptomatic.

I am negative for HSV-1 & 2.

Here are our questions.

1. Is showering and cleaning my genital area with soap after sex worthwhile? Clearly there are no studies that I have found that show washing with soap reduces the risk of transmission but it couldn’t hurt right?

2. I have read that condoms only appear to reduce transmission by 30% and possibly less than that for Female to Male. If condoms mean that sex lasts longer and is rougher, are we lowering that 30% even further?

3. I have psoriasis, mostly psoriasis gluttate. It does appear on the head of my penis sometimes and I almost always have at least some spots (sometimes a dozen or more) on my “boxer short” region. They ranging in size from pencil tip to about dime size. Two questions related to this.

a. Do these psoriasis spots constitute broken skin and therefore make me more susceptible to infection? I don’t scratch them and they are usually too small for flakes to start forming. I know some people scratch their psoriasis to the point of bleeding but I don’t (if that matters.)

b. Psoriasis is an auto-immune disease; does that mean I have a compromised immune system? In other words, in the event that I do contract HSV-1, can I expect to have more frequent/severe outbreaks than the average person?

4. She hasn’t had an outbreak in 2 years and that is the only outbreak she has had since her first one 9 years ago so she is basically asymptomatic. Should she be taking acyclovair? An RN told her she should only be on it if she has an outbreak. I think that her being on it is okay because it reduces the likelyhood that I’ll get herpes. She’s been on it for about 2 months and no side affects so that’s not a problem but she views it as an inconvenience. We are using condoms as well.

Thank you for your time.

[Terri Warren]

1. Is showering and cleaning my genital area with soap after sex worthwhile? Clearly there are no studies that I have found that show washing with soap reduces the risk of transmission but it couldn’t hurt right?

I would agree that it couldn’t hurt. I would be gentle with this so as not to cause any microscopic breaks in the skin.

2. I have read that condoms only appear to reduce transmission by 30% and possibly less than that for Female to Male. If condoms mean that sex lasts longer and is rougher, are we lowering that 30% even further?

No, I don’t think so really. Some studies even show better protection than 30%, so I think regardless of the type and duration of sex with that you have, 30% is still a conservative number.

3. I have psoriasis, mostly psoriasis gluttate. It does appear on the head of my penis sometimes and I almost always have at least some spots (sometimes a dozen or more) on my “boxer short” region. They ranging in size from pencil tip to about dime size. Two questions related to this.

a. Do these psoriasis spots constitute broken skin and therefore make me more susceptible to infection? I don’t scratch them and they are usually too small for flakes to start forming. I know some people scratch their psoriasis to the point of bleeding but I don’t (if that matters.)

Yes, they do represent broken skin, but depending upon their location, they may or may not represent a risk for increased transmission. Certainly, on the head of the penis without a condom, it would represent an increased risk. but if it’s on your leg, for example, no.

b. Psoriasis is an auto-immune disease; does that mean I have a compromised immune system? In other words, in the event that I do contract HSV-1, can I expect to have more frequent/severe outbreaks than the average person?

No, we have no evidence that something like psoriasis causes a person with herpes to get more outbreaks. Advanced HIV, yes, psoriasis, no evidence for that. I have lots of patients with various more minor immune issues like this and I don’t see their experience with herpes being any different than those without.

4. She hasn’t had an outbreak in 2 years and that is the only outbreak she has had since her first one 9 years ago so she is basically asymptomatic. Should she be taking acyclovair? An RN told her she should only be on it if she has an outbreak. I think that her being on it is okay because it reduces the likelihood that I’ll get herpes. She’s been on it for about 2 months and no side affects so that’s not a problem but she views it as an inconvenience. We are using condoms as well.

If you both want to do everything you can to reduce transmission then yes, she could. She is likely shedding virus infrequently, for sure, but if you both want to do everything you can to reduce transmission, then yes.

I think it is important for you to know that the screening test for HSV 1 is not great at all – it misses a lot of herpes. The western blot is better.

Terri

[Teachers]

Thanks Terri,

I’m guessing you can’t give a definitive answer to this question, but what are my odds of getting the virus if we have sex everyday? (with condoms and anti-virals)

[Terri Warren]

A wild guess but using math to calculate would be about 5% risk per year. So four times the amount of sex, right? About? Remember these are AVERAGES.

Terri

[Author]

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