Transmission of HSV-2 on Valtrex but Unprotected

[MrX]

I was diagnosed with HSV-2 by a blood test roughly 15 years ago. After treating it episodically for a few years, I switched to daily suppressive therapy. I’ve taken 500mg Valtrex daily for the last 12 years. I have not had an outbreak or even a prodrome in over a decade. My wife also has HSV-2 and treats it episodically.

My marriage turned sexless last year, and I started seeing other girls for sex. I almost always use condoms, but like most guys, I hate them.

Maybe once a month I will go bareback with my mistress. I also did this once with another girl. I have pretty rough sex, maybe for 15-20 minutes a time.

I have not informed the girls and I feel terrible guilt. I have rationalized by saying that the virus has likely weakened over time, and I am on Valtrex therapy, don’t have breakouts, and I am going bareback rarely.

Can you tell me roughly what are the odds of transferring HSV-2 in each unprotected event? And if I do transfer it, will it be a lesser version of HSV-2 because of the factors listed above?

Thanks!

[Terri Warren]

So what we know about transmission from males to females is this: If a couple has sex twice a week for a year, using no condoms but taking antiviral therapy, 5 women out of 100 in the same situation will acquire herpes from their partner. You can calculate the odds of transmission for one intercourse or more.

If you do transmit the virus, it will not be a lesser version but will be the regular version that you acquired. Medicine does not change the virus, only it’s activity.

I don’t need to tell you that you should inform these women about your herpes status, you already know that. But if you are not going to inform them, you should most certainly use condoms with every encounter, even if you don’t like it. You don’t like telling them and you don’t like condom use – but you are having sex WITH these women, they are part of this experience – you, in my opinion, owe them at least the greatest protection you can offer them if you are not also offering them the truth. Do you agree?

Terri

[MrX]

Yes I agree on the moral question which is why I feel guilty already, but to be honest Terri, I can get the same advice from a priest. From you, I want science.

You seem to be saying that if I had unprotected sex 100 times a year (50 weeks x 2 sex acts), there is a 5% chance of transmission. So a single sex act would be 1/100 of 5% which is .05% which is 1 in 2000? That seems improbably low to me. Is my math correct?

You also didn’t address the question of whether the odds of transmission are affected by the length of time I have had the virus.

Thanks.

[Terri Warren]

Those are the statistics, yes. And your math is correct. However, there are some things about the studies that reveal this science that I think may be relevant here. The couples that enter the studies have already been having sex for a while. Transmission is more common in the first months of a relationship than after that for a variety of reasons. The couples in the studies knew that one person had herpes and the other did not, but both knew the status of things. In your situation, only you know but that may be enough to help reduce the risk of transmission. If you did not know, then symptoms that might be herpes would be ignored, therefore increasing the likelihood of transmission.

While many people shed less virus over time, that is not true of everyone. We completely a study of people who had been infected for 10 years or more and one person shed virus on 94% of days. However, we also found in the study that there were more people who did not shed at all during the 60 days swabbing period than in studies that have looked at people infected for less time.

Terri

[MrX]

Thank you Terri.

[Terri Warren]

You’re welcome.

Terri

[MrX]

Terri,

After we exchanged emails, I decided to get tested at Quest and it came back as negative for HSV-2, does this mean that the daily Valtrex made the test unreliable?

HSV 1/2 IGG,TYPE SPECIFIC CB
AB HERPESELECT
HSV 1 IGG TYPE SPECIFIC
AB 2.00 H
HSV 2 IGG TYPE SPECIFIC
AB <0.90
Value Interpretation
—– ————–
<0.90 Negative
0.90-1.10 Equivocal
>1.10 Positive

[Terri Warren]

I’m not sure what to make of that test result. The testing we had 15 years ago wasn’t as good as it is now but not bad. Perhaps you had a low positive and no one knew to confirm it? But you are telling me that you have outbreaks, yes, and so does your wife? Have you ever had any of these outbreak swab tested to confirm they are HSV 2? Has she?

I doubt that the Valtrex is impacting the antibody test to be negative as it sounds like you had time in the beginning when you were not on suppression, correct?

This is your final question on this subscription (I let the “thank you” post slide through). If you have more questions, please renew our subscription.

Terri

[MrX]

HI Terri.

Actually I assumed that I got it from a GF who had herpes back in 1999 and didn’t tell me for a year. She didn’t say what type it was.

From 1999 to 2002, I did nothing. I knew nothing.

I did not have any outbreak till 2002, ditto for my wife. I was diagnosed by blood test and she was diagnosed by swab. Back then no one talked about type 1 and type 2, they just said you have genital herpes.

For a couple years I took Valtrex episodically a couple days a month and the most I ever saw was a little redness. The anxiety ate at me, so in 2004 I went on daily suppressive. I have not had an actual outbreak (sores) in 12 years or so. My wife has not had an actual outbreak since 2002 either, but she is not on suppressives, she just takes Valtrex for a couple days every few months when she feels something coming on.

Questions:
1–If the Valtrex affected the test, why would it give me a false negative on the type 2 but allow a positive on the type 1?
2–Does the Igg mean anything in terms of likelihood of transmission (i.e., does a lesser number translate into lower odds of transmission)?

All this guilt and confusion for two unprotected sex acts. Why can’t I sit quietly in my room?

[Terri Warren]

If I had to guess, I would guess that you have HSV 1 genitally, but that’s just an educated guess. I don’t think the HSV 2 is a false negative, but there is a small possibility of that, yes. But as you say, the HSV 1 antibody came through.

The index value of the IgG has nothing at all to do with transmissibility.

If you were my patient, I would order the herpes western blot for you to be absolutely clear what is going on here.

If either of your sex partners has ever had a cold sore and you really do have HSV 1 genitally, then they are NOT at risk of acquiring HSV 1 genitally from you. Maybe you don’t need to feel so guilty after all?

Few of us can successfully sit quietly in our rooms.

Terri

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