Please advise me regarding a clients case.

His girlfriend recently had a Herpes ECLIA test and was found to be HSV2 Reactive. IGG level 9-10. Brand not known.

She doesn’t recollect having any symptoms but her ex boyfriend who she was last intimate with 2 months ago was found to have cheated on her and she thinks she may have been infected by him - as they had unprotected sex - admittedly she has had a previous partner too.

Now they were together and felt the urge to have sex. First he put regular alcohol hand rub on the shaft of my penis and pubic areas. After a few minutes he put on a condom. He then put on my boxer shorts and put his penis through the slit in his boxer shorts. He then put on 1 further boxer short and a full length Pyjama and repeated the previous action through a small slit he had made.

During sex his method worked and there was no skin to skin contact. However after ejaculation he immediately went to bathroom and removed the condom first. His main concern is there may have been secretions on the condom that got on the underside of the inner layer as it was removed and possibly some secretions on the outside of the outer two layers from intercourse.

As he then rushed to remove the three layers - he is worried that secretions may have come in contact with his penis.

What are his risks of HSV2? When should we arrange a test?

Note- 

His girlfriend took 2g of Valtrex 20 hours earlier and 1g 6 hours earlier. He took 1g of Valtrex 15 hours earlier and 1g after the episode.

This situation presents no real risk of acquiring HSV 2.  I have to say I've never seen anyone go to such extensive lengths to prevent transmission.  

Was he even tested before deciding to do all of this?  he could test now, but a positive would almost certainly a prior infection to this encounter.

Terri

Lets say client = friend.

So what’s the risk and course of action you would advise. Anxiety levels are through the roof as it was a casual encounter with a non working girl and their is another long term partner he has.

Please allow one further f/u as my second msg was just a correction.

Thanks Terri 

And slight penile itching but no visible sore.

Please can you answer the last post and take into account the added information. Hoping for a speedy answer. 

Thanks 

An index value of 9 is likely to confirm as positive.

A test now would provide a baseline to the experience - what his status was prior to this encounter.

I would not advise any action in this situation at all.  I just don't see this as a risk

TErri

If he has concerns that there might be something near the anus that he cannot see, he should see a clinician in person to have someone objective visual that area.  

If the risks are as you describe them for your friend, then I really don't see this as a source of HSV genitally.

If your friend kissed someone else, they could get HSV 1 orally, yes

Terri

This will be my last post. I would appreciate if you could answer each point.

From your answers my understanding is:

1- an index case with a Hx of unprotected intercourse and an HSV2 IGG level of 9 is likely to be positive.

2- if this index case was to kiss another person on the cheek and neck three or four times - what are the chances of that person getting oral/nasal HSV2 assuming the index case has oral HSV2 (note there is no mouth to mouth kissing and both are HSV1 negative).

3- if this index case lays with another person, and has minor skin to skin contact of the thighs, protected vaginal sex without skin to skin contact, what are the chances of transmission assuming the index case has genital HSV2.

4 - finally, if the index case had oral HSV2, and gave a man protected oral sex but the condom then rest against the recipients thigh, what are the chances of the recipient acquiring genital HSV2.

Thank you in advance for your answer.

Right now the recipient who is baseline negative HSV1/2 is fearful that he has acquired both oral and genital HSV2 from a female index case with HSV2 - presumed oral site, because of symptoms of an intranasal sore, penile discomfort, and peri-anal itch.

1- an index case with a Hx of unprotected intercourse and an HSV2 IGG level of 9 is likely to be positive.

Be sure the index value is 9, not 0.9 (which is negative).  And yes, 9 is likely to be positive

2- if this index case was to kiss another person on the cheek and neck three or four times - what are the chances of that person getting oral/nasal HSV2 assuming the index case has oral HSV2 (note there is no mouth to mouth kissing and both are HSV1 negative).

First, oral HSV 2 is rare, and the kind of kisses you describe are not going to transmit HSV 2 is it is there.

3- if this index case lays with another person, and has minor skin to skin contact of the thighs, protected vaginal sex without skin to skin contact, what are the chances of transmission assuming the index case has genital HSV2.

The risk is low.  Condoms reduce transmission of HSV 2 from a woman to a male partner by 65%

4 - finally, if the index case had oral HSV2, and gave a man protected oral sex but the condom then rest against the recipients thigh, what are the chances of the recipient acquiring genital HSV2.

Again, HSV 2 is very unlikely to be oral so this question represents just about zero risk

Terri