[Question #12770] Risk of getting HSV2 from a known partner

5 months ago

After about 5 very successful dates, my woman partner informed me she has genital HSV2. She was diagnosed about 18 months ago, but hasn't had an outbreak in 12 months. She takes the 500mg Valtrex prophylactically. We have only kissed and there has been no escalation in the sexual relationship. I was quite shocked by the news, but am struggling to find good information about what the transmission risk is. A commonly cited article: https://www.nejm.org/doi/full/10.1056/NEJMoa035144 states that "respective rates of acquisition ... among susceptible men, 0.23 and 0.35 per 1000 sexual contacts." when comparing couples where one partner is taking the prophylactic 500 mg Valtrex. However, the transmission rate was 1.2% in susceptible men in the Valtrex group. 0.23 in 1000 sexual contacts seems like the rate should be much lower than 1.2%. She seems like a 5 star person and I would have no concers about persuing a relationship with her otherwise, but I do feel very anxious about the idea of getting HSV2. I also work as an optometrist and am concerned about getting Herpes Whitlow on my hands as I touch people around their eyes all day. Would I need to always were gloves when coming in contact with her genitals? What is the risk of transmission if she uses 500 Valtrex, consistent condom use, etc?

Terri Warren, RN, Nurse Practitioner

5 months ago

Good morning. We have some averages about transmission of HSV 2 from women to men. Doing no interventions and having intercourse about twice a week, about 4 men out of 100 will acquire HSV 2 in a year. These are averages from studies that have looked at this issue. Some studies see significantly lower rates than others. Daily Valtrex 500 mg once a day cuts that number by 48%; condoms reduce it by 65%. So you can see with those two things, you can get the rate to a very low number. I would certainly not recommend gloves in contact with her genitals, no. If you have breaks in the skin of the hand, just wash your hands with soap and water after contact.

Terri

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5 months ago

Thanks Terri for the solid information.

I had a couple follow up questions:

1. Is contracting Herpes Whitlow not a realistic concern from fingering/heavy petting?

2. When considering the risk of contracting HSV2 from a partner, should I think of it as an inevitability over time? Or should it be considered extremely low risk if all precaustions are taken(valtrex prophylaxis, avoiding sexual contact during outbreak, safer sex methods)?

3. Would things like dry humping be considered a low or no risk sexual behavior? Are there other things considered no or low risk we could engage in until the relationship is more cemented?

For me, HSV2 is less of a concern when considering the possibility of a long term relationship/marriage, but in terms a short term relationship it feels like a hard no. I see tremedous potential with this partner for a happy life, so I'd hate to let an occasional skin rash get in the way. That being said, I'd like to hedge my risk until there is a greater level of commitment in the relationship.

Thanks again!

Terri Warren, RN, Nurse Practitioner

5 months ago

1. Is contracting Herpes Whitlow not a realistic concern from fingering/heavy petting?

Not if the skin of your hand/fingers is intact. The skin is too thick for virus to penetrate intact skin

No, not at all! People go lifetimes together and never transmit

3. Would things like dry humping be considered a low or no risk sexual behavior? Are there other things considered no or low risk we could engage in until the relationship is more cemented?

Dry humping is not a risk. And I like your attitude! We all bring negatives to relationships - I'm sure you have yours, this happens to be hers.

Terri

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5 months ago

1. I'm a little confused about the touching the genitals aspect of things. You said you don't recommend wearing gloves and just washing the hands if there are breaks in the skin, but what constitutes a break in the skin? Paper cuts? Hang nails? It would be easy to be unaware of this. Would wearing gloves be wrong for added protection?

2. Would touching her genital area or dry humping present any risk if she was very sexually aroused and the clothing became wet with vaginal secretions? Would touching her genital area over clothing present any risk? I'm trying to asses what we could do in the mean time that would present no risk. I assume kissing(given no oral breakouts previously), sleeping in the same bed, cuddling, etc, would pose no risk. If we were both naked, would cuddling pose a risk?

3. Do you recommend that I get tested for HSV2 if we do get to a point where there is a sexual relationship?

4. My thought so far is to abstain from sexual activities that would pose a transmission risk to me, until we each feel confident that we see a future with each other. I feel really overwhelmed trying to navigate this, but does this seem like a reasonable point of view? Are there any counseling resources you recommend regarding this tricky situation?

Terri Warren, RN, Nurse Practitioner

5 months ago

Yes, hang nails, yes, paper cuts. How hard would it be just to look at your hands before touching her. I can tell you that i I had genital herpes and someone decided to wear gloves when touching my genitals, that would not be acceptable to me.

No, the virus does not migrate through wet clothing. sleeping in the samea abed, cuddling pose no risk, even if naked

3. Do you recommend that I get tested for HSV2 if we do get to a point where there is a sexual relationship?

That would depend upon how many partners you've had in the past and if you've ever had any symptoms.

I'm not aware of any counseling services regarding this, but the fear that you apparently have about contracting HSV may be transmitted to her and do damage to her self esteem Be careful.

Terri

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