[Question #1567] Risk of transmitting HSV2 (herpes type 2) to a partner by receiving a blow job

44 months ago
I recently tested positive for HSV2 via a blood test, IGG type specific. Twice as i wanted to confirm it. I'm negative for HSV1 oddly enough as type 1 is very common.  I have never had an outbreak. So I don't know where my site of infection is though I have read and been told its most likely my genitals as its type 2. I have read and been told about asymptomatic shedding. My question is what is the risk of transmitting HSV2 to a person who gives me a blow job without using a condom and when no symptoms are noticeable (given my infection site is my genitals)? I tested negative for both HSV1 and HSV2 in 2013. I engaged in risky behavior from then until now so I would guess I've had HSV2 for a few years though there is no way to know. Related and implicit in the question I asked is how often does asymptomatic shedding occur and is it as contagious as an open sore. Is there any probability of risk that can be assigned to the aforementioned act. And can HSV2 take up latency from an oral infection. Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Can you look at the test results and share the index values with me?  It is a number associated with the positive result.  I agree that if truly positive, it is a genital infection, with a large degree of certainty.  Yes, HSV 2 can be present due to an oral infection but it is almost always accompanied by genital infection as well.  We don't have any research to address your question about the risks for someone else giving you oral sex.  I would say the risk is low because HSV 2 doesn't like the mouth much but it is not zero.  Asymptomatic shedding occurs, on average, 13-14% of days sampled - so about 45 days our of a year, on average.  Some people shed a lot (more likely those with lesions) and some shed a lot less but there is just no way to know for certain, on days with no symptoms, if you are shedding or not.

Terri
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44 months ago
Thank you for your response.  Both times I got tested it was IGG type specific. Something like three months ago at City Clinic in San Francisco HSV2 index was 6.11 They told me that means I have had it for a long time as in years. Subsequently I read and was told the index value is NO indication of how long one has had it. Is that true? About two months ago I got tested at planned parenthood to confirm my results IGG type specific HSV2 index was 4.31. As far as being truly positive unfortunately these index numbers are truly positive correct? Is there a test that can determine how long I have had HSV2? As for risk to a person giving me oral sex can you quantify in any way what "low" is? My dermatologist said a positive blood test for HSV2 with no symptoms is not even worth talking about. Would you agree with that? I talked to an infectious disease specialist from Kaiser who told me HSV2 cannot take up latency from the mouth. She said yes I could infect someone if they give me oral sex and they could have one breakout and it could be a bad breakout but it could never reoccur as HSV2 cannot take up latency from the mouth. However one would always test positive even though the virus was not latent. It's probably not the case but could I have gotten HSV2 by performing oral sex and now I always test positive but I'm not in any way contagious? I will assume I have genital infection no matter. Just a curious question. I believe oral infection takes up latency somewhere in the neck and genital takes up latency somewhere in the base of the spine. To repeat is it true HSV2 cannont take up latency in the neck region (the only possible area to take up latency via oral sex)? I have read HSV1 can take up latency in either the neck (oral) or base of spine (gential). The point being if I was to infect someone by receiving oral sex they could worst case have one bad break out around the mouth but never again break out. And they would not be contagious other then perhaps that one and only one episode? Shedding 13-14% of days sampled is good to know. I have read various numbers. If shedding is occurring what are the chances of infection? In other words is shedding say way less contagious then a sore with active symptoms? And again I'm asking about oral sex. The risk of transmission is much greater when shedding if having insertive vaginal sex? I'm a male in case it matters. If one is shedding is the virus in seamen? I was told the virus is in seamen but when? Always? Only when shedding? If i was to ejaculate into someones mouth would the seamen have the HSV2 virus and be likely to infect the other person? Thank you for your time and effort!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
An index value can only tell someone how long they've had herpes if they go from a negative to a positive during a specific time period - seroconversion.  But with an index value of 6.11  and subsequent one of 4.31 there is absolutely no way to know if you've been infected for 6 weeks, 6 months, 20 years.  It's a solid positive and doesn't need confirmation and indicates that you are both infected and infectious to others.  I fear the dermatologist is unaware of the accuracies about herpes antibody testing and would suggest that they read the CDC guidelines about herpes testing.  HSV 2 can most certainly take up latency in the mouth.  I'm sorry the ID doc is unaware of this as it is well documented in the literature.  There are even studies about how frequently HSV 2 is shed from the mouth - not often, by the way.  I have no idea why this physician would say you can have one outbreak but not establish latency.  My guess is they heard that somewhere at some point and they just believe it no matter how irrational the concept.  We don't have research to tell us how much risk there is in giving someone with HSV 2 oral sex - how often that happens.  You would likely be less often contagious with sores than without.  The risk of transmission is higher with intercourse, correct, as HSV 2 has a site preference for the genital area.  Semen is not a good carrier at all of semen - the shaft of the penis is the most infectious area for men.

Terri
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44 months ago
Thanks again for your answers. Just a couple last things and questions. Thank you.
To clarify my dermatologist did not question the accuracy of my tests in any way at all. His point was given I have HSV2 (no doubt there) 
and I'm asymptomatic the transmission is so unlikely it's not worth talking about. I'm looking for a second opinion on that. The question 
is given I have no symptoms is it important to tell a partner before any sexual activity that I have HSV2 because the risk of 
transmission even with no symptoms is indeed significant?

A related question, what is the likely hood of transmitting it when shedding asymptomatically vs having an active sore present?
In other words is one just as contagious when shedding with no symptoms as if one has an active sore? I'm only guessing the viral load 
of asymptomatic shedding is much less then an open sore and therefore much less contagious but this is only a guess on my part.

You wrote "You would likely be less often contagious with sores than without". I'm sorry I don't understand this. Again I have never had 
a breakout, I've never seen that I have any symptoms. I do have positive tests for HSV2. My main concerns are around asymptomatic shedding.
And wondering if asymptomatic shedding, when it occurs,  is less contagious then active sores?

A related question is if one is exposed to the virus via a mucous membrane, skin to skin contact, what are the chances they will become 
infected? 100%, 50%?

I don't know what to make of what the infectious disease specialist told me then about latency of oral HSV-2. Perhaps she was saying 
because its so rare for a reoccurrence that she said it cant take up latency. Though that is incorrect. 
I found the following  from reading this link http://www.herpesite.org/herpes-virus-infection-transmission-risk-shedding/
"And although HSV-2 can be transmitted to the mouth, because HSV-2 “prefers” the genitals, the recurrence rate of oral HSV-2 is statistically very low 
– about once every ten years."
So as you said "not often" here it says once every 10 years.

Can you point me in a direction where I can find any RESEARCH STUDIES done on asymptomatic shedding and risks of transmission?
Are there any promising clinical studies for a cure of HSV2? And if so can you point me to where I might join a clinical study?

Thank you once again!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I would completely disagree with your dermatologist.  Our research suggests that people with genital HSV 2 shed 13-14% of days sampled.  For people who have outbreaks that's closer to 20% of days and for people who simply test positive, it is about 10% of days.  So you can see the risk of transmission is not insignificant. 
Also, our research suggests that there may be as much virus in some episodes of viral shedding without symptoms as there can be in lesions, so that assumption is incorrect.
The next was a typo - you are more infectious WITH sores (more frequent shedding) than without.  Sorry about that.
We don't have statistics on exactly what percentage of time people who come in substantial contact with the virus actually get infected.  That is likely dependent upon  several immune factors as well as amount of virus, duration of sexual activity, all sorts of things
I don't know where the every 10 years comes from - I think that is likely low.  What is your reference?
You can look at PubMed for articles on viral shedding - just type in your topic and it will take you to articles that you seek. 
I don't think there are promising cures out there at this point that I am aware of - you can go to clinicaltrials.gov to find ongoing studies.

Terri


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