Hi. Can you help improve my understanding of HSV-2, which I have had for many decade?  I am very forthright about the condition  and always use a condom.  I have seen data indicating that condom usage can reduce risk of transmission to a woman to what seems like a minimal degree.  I also see data indicating that there is only a 5 to 10% chance of passing it per year for couples not using a condom -- which actually seems very low given the number of encounters likely over that amount of time and descriptions of HSV2 as highly transmissible..  I also have learned that condom usage is not always reliable (perhaps because this prophylactic does not always cover the top of the shaft?).  Because it is a condition I want to manage as wisely as possible, I would appreciate your insight, with any clear data, on whether my condom usage is as highly effective as I have thought.  Thanks.

Condoms reduce transmission from males to females by 96% when used with every intercourse, from start to finish.  Taking daily antiviral medication reduces transmission by 48%.  Together, the risk of transmission can be very low.  Transmission from males to females varies - in couples who have been together for an average of 2 years, doing nothing, having sex twice a week on average with no sex during HSV symptoms or outbreaks, can be around 10% per year.  But what is important to remember with this statistic is that these are couples in our studies who have been together for a while without transmitting.  Lots of transmission happens in the first few months of having a sexual relationship.  But these statistics are about as good as we have right now.  What do you think?---

Thank you very much.  The numbers seem very compelling regarding the risk factor.  When I asked the question, it was an effort to make sure I was on relatively safe ground following protected two instances of insertive vaginal sex with the same person.  Two days later, I noticed 2 or three tiny red bumps on the bottom backside of my scrotum (needed a magnifying class to confirm their presence versus just some irritation from binding trousers).  I assume they are visible signs of shedding.  I also assume this alters the calculus of risk both because of the red bumps and the fact that condoms can leave small coverage gaps at the stem of the penis.  Based upon these developments and exposure time of 20-30 minutes what percentage chance do you think there is of transmission in this jnstance?  Thanks.

Hi.  I received an email indicating you replied to my second question.  But I do not see the reply or any indication of its transmission.  Can you please resend?  Thanks.

That's weird!  I did not.  Something on the scrotum that needs a magnifying glass may have nothing to do with HSV. That is an uncommon place for shedding to occur.  If it was HSV, its hard to know how much direct contact there was between your scrotum and the person with whom you were having sex.  I can't give you a percentage risk but just an educated guess would be quite a small risk.---

Hi again and thanks.  The three tiny spots on the scrotum have pretty much vanished from sight, although I can get a tiny itch if I squeeze the area (which is difficult to locate).  Maybe it was some folliculitis that was caused by sitting on an 11 hour flight in uncomfortable clothes?  Having said that, it looks like I may be in the early stage of a break out on the buttocks (which I have experienced before).  In any event, my last sexual encounter was four days ago (which I understand to be the most common time for symptoms to begin occurring and an uncommon site for transmission.  I obviously am foregoing sex in the meantime.  From all this drama, including condom usage, would you still rate me in the low risk category for transmitting?  I appreciate the time and attention you have given this matter.

If you always use a condom, the risk of transmission was really low.  ---