[Question #1771] Herpes questions in discordant couple

44 months ago
Hi Terri,

We have spoken several times on the phone and you recently facilitated Western Blot testing for me and my partner.  As of late December 2016, my WB blot results were negative for both HSV 1 and 2 and my partner of 3 years is positive for both types. He takes 500 mg of Valtrex daily to reduce the possibility of transmission. We do not use condoms.

My questions are as follows:

1. My partner will be away for 3.5 weeks without me. Is there any reason he can't go off his meds while he's away and resume taking them 5 days prior to his return?

2. I very recently had a suspicious bump on my inner labia. My doctor did a PCR swab test by forcefully rubbing a q-tip over the bump several times without popping it open. The test came back negative for herpes. How confident can I be in those results?

3. I’ve seen you say that transmission typically happens in the first 3 months of a new relationship. For discordant couples where the uninfected partner remains so for many years, is that simply a matter of luck — in other words, there was no contact during times of asymptomatic shedding? Or is it that the immune system of the uninfected partner has been exposed many times and is somehow able to fight it off over and over again? My partner has both HSV1 and HSV2. I’ve read that HSV1 is shed 25% of days. It’s hard to imagine I’ve managed not to kiss him during periods of asymptomatic shedding — how have I not at least gotten HSV1? Have you seen discordant couples remain so for decades and then suddenly transmission occurs? Is there a certain number of years after which one is "safe"?

Thanks so much for your insight and expertise!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Hi,
Of course I remember you. He can be off the medication during this time if he wishes, yes, resuming 5 days before returning to you.
You can be very confident in the results of the PCR swab test
The reasons transmission does not occur vary greatly - the infected person may not be shedding enough virus to infect someone else, the infected person may be avoiding sex during periods when they have subtle symptoms, also the uninfected person may develop an immune response over time that helps to keep them from becoming infected. 
Yes, the newest study from Dr. Ann Wald suggests that HSV 1 orally sheds on about 25% of days.  And yes, I have seen couples who are discordant for 30 years not transmit or transmit after all of that time.  The immunology of this is not well characterized.  I would not say that there is a time after which you are safe, for sure, no.

A recent study showed a 96% reduction in transmission from infected male to uninfected females with regular and consistent condom use.  I'm puzzled, given your very significant fear of getting herpes, why you two aren't using condoms. 

Terri
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44 months ago
Hi Terri,

Thank you so much for your reply.

Do I understand correctly that it's possible for someone to no longer shed enough virus to be infectious? My partner has had herpes for about 25 years -- might he no longer capable of transmitting the virus?

Your question about condom usage is a good one. And one I'm grappling with. For the first 3 years, we didn't use condoms because I didn't know he had herpes. Since finding out, he has been on daily antivirals. I was hoping that would be enough for me. For obvious reasons, condom usage isn't ideal in terms of spontaneity and intimacy. Given the nature of our relationship (committed and monogamous), neither of us want to use them every time there is any genital contact. And I'm not sure how I can ever protect myself against his HSV1 given that I don't want to stop kissing him! But your point about my fear is a very good one. I have OCD and herpes is simply my latest obsession. Because of that, I am quite sure that even with condoms, my obsession would persist as logic doesn't seem to matter when it comes to OCD. I realize that my preoccupation with herpes, and what I fear it means about me given the social stigma, is a psychological issue and not a physical one. I hope I can get to a point where I can put it in its proper place and move on!

Thanks again!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
We did a study looking at shedding rates in people with long standing herpes infection (greater than 10 years).  Some people didn't shed at all during the two months of daily home swabbing but one woman shed on 94% of the days she swabbed so you can see that it varies greatly.  People who have fewer or no outbreaks shed less than people who do have recognized outbreaks so that speaks in his favor.  Unfortunately, there is really no way to know how often he is shedding except for daily home swabbing which is expensive though some people do do it to determine their shedding rates, some do it while taking medication to see how well it is working. 

I hope you are getting help with your OCD or I fear it could impact your relationship negatively not to mention your own mental health.  So here is the bottom line:  would you rather be with him and potentially get herpes or be without him and date someone new who does not have herpes? 

Terri
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44 months ago
Thank you for your thoughtful reply.

Yes, I am  getting help with my OCD. I am in therapy and recently started taking Prozac. Your bottom line question is a good one. I do not want to end my relationship because of a benign, albeit inconvenient, skin condition. There is no guarantee that the next person I meet won't also have herpes and it seems craziness to screen out all potential partners because of HSV! I don't want to live my life ruled by my anxiety. If only herpes didn't have such incredible social stigma -- I had chicken pox and have no shame about that! I truly think for many of us with health related anxiety, the fear of the disease is far worse than the disease itself. I have to remind myself that if I do end up getting it, I will manage it and be the same person I have always been.  There are far worse viruses out there!

Thanks for all that you do, Terri! I will surely be in touch in the future to arrange another WB. In the meantime, hopefully I can get a handle of my OCD and stop worrying so much!


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
You are thinking very clearly and honestly and in a healthy way about your relationship and your feelings about herpes - good for you!  Now the trick is LIVING what you say, and I know that you can do it.  Trust me please on this topic - herpes in a relationship of high quality and great love takes a backseat to the rest of it all.    You can chose to ignore the social stigma - if you get it, no one even needs to know except you two, if you want to keep it that way.  Or you can shout it to the world and say the hell with all of you who stigmatize this!  I know this is a minor health condition! 

I hope your medicine and therapy help.  The best therapy (research says) is CBT, cognitive behavior therapy, along with medicine.  If you fine the Prozac interfering with your sexual desire, ask your doctor to switch it up.  Not everyone does, but some do.  And I'm always here for you, even in the wilds of Maine on a snowy day, right?

Best
Terri
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