I am male, and negative for both HSV1 and HSV2
My partner is female, and positive for HSV2 genital, and negative for HSV1. She has always been asymptomatic.
In terms of frequency, we have sexual intercourse on a once a week basis.
Our understanding is that asymptomatic shedding of active HSV2 virus occurs approximately 10% of the year.
It is also our understanding that use of condom prophylactics reduces the chance of transmission to males by 50%, while the use of antiviral suppressants like Valacyclovir also reduces the chance of transmission by 50%.

Given the above status, assumptions and frequency, our question is about the probability of transmission in several scenarios:

1. What is the approximate percentage chance of transmission without the use of condoms nor Valacyclovir? (Not our plan, but just as a point of comparison).

2. What is the approximate percentage chance of transmission with just regular, diligent use of condoms?

3. What is the approximate percentage chance of transmission with the use of both condoms and daily use of antiviral suppressants like Valacyclovir?

We’re just gauging the various possibilities and odds of transmission for consideration, so any perspective or info would help.

Let me start by asking - if she is asymptomatic completely, how does she know she has HSV 2 infection?  As you may know, the rates of false positives on the IgG HSV 2 antibody test are very high.  If she's never had any symptoms suggestive of HSV 2, try sending me the index value that she obtained on the test and I'll help decide if she should have a confirmatory test.  ---

Thanks for the info and statistics. One clarification: When you mention 4% transmission in the scenario you described - is that a 4% chance of transmission, or 4% of the population end up transmitting it?

Regarding your question about my partner’s status and numbers: She has never had any symptoms, ever (completely asymptomatic). The reason she believes she has an HSV2 infection is she was tested recently (September) and her IgG HSV2 came back positive (above high normal) with an index value of >23.60. As point of reference, the test result indicated Negative as <0.91, Equivocal as 0.91 - 1.09 and Positive as >1.09.  

The lab also advised her: “Due to the increased possibility of false positives on the test you ordered, we HIGHLY RECOMMEND you complete an HSV-2 Confirmation Test. This test is used to confirm or rule out an HSV-2 infection by using enhanced and more sensitive testing methodologies.”

An index number of >23.60 seems awfully high, considering the threshold for Negative is <0.91 and Positive is >1.09. Or maybe that’s normal for a positive result? Could there be something wrong with the number and another reason they want to do a confirmation test?

From what I’ve read, an IgG test that results in a number of 3.5 or lower stands an 80% chance of being a false positive and should be retested to confirm. However, according to the test, both threshold positive and negative numbers are well below this threshold (<0.91 and >1.09). Which seems odd.

Thanks for any help, info or perspective.

Yes, I would agree that with this number, she is almost certainly infected with HSV 2.  ---

Thanks Terri. Would you still recommend a confirmatory test?

I wouldn't, no.---