[Question #1792] HSV-2 Transmission

42 months ago
I am a 35 yr old male. In October I contracted HSV-2.  Since the initial outbreak I have not had any more, however, since I am having regular sex with one female partner I've decided to take daily antiviral medication (500 mg Valacylovir).  All the literature I have read states that HSV-2 is spread by skin to skin contact.  So I would like to confirm the following.  Is this true that HSV-2 is not present in my semen?  Secondly, during my outbreak, no sores were present on my penis or scrotum (all above on my groin) and there was no irritation inside my urethra.  So, does the use of a condom actually help to reduce risk of transmission if I am taking daily antiviral and not sensing any irritation or itchiness?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
Good morning.  Can you clarify for me how your diagnosis of HSV 2 was made?  A swab test from a lesion?
Is the female partner you are having sex with a different person that the person from whom you acquired HSV 2?
A study done at UW of 400 semen samples from men with herpes did not find any virus in semen.  So it seems to the odds are good that semen is not a great carrier of virus but I can't say it is impossible that virus would be in semen, just very unlikely. 
The main site of viral shedding in men is the shaft of the penis, regardless of the location of your first infection.  So yes, condoms are a fundamental tool in reducing transmission to a female partner - in fact a recently published study found about a 95% reduction in transmission for men who used condoms regularly. 

Terri
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42 months ago
My initial diagnosis in October of HSV was by swab test.  At that time my blood test for HSV-2 came back negative, but in January came back positive.  Yes, the current partner is a different person than the one from whom I acquired HSV-2.  From what I have found online,  during non-outbreak times the rates of transmission (male to female) are 10%(no protection), 5% (condoms or meds), 2.5% (condoms & meds).  https://herpesopportunity.com/downloads/herpes-opportunity-disclosure-handout.pdf    I understand that asymptomatic shedding is a real thing, however,I would like to know your opinion on how much of that is actually shedding without symptoms and how much is people not listening to their bodies and recognizing the prodromes (slight tingling, itching of the area)?  Is there any link you could provide me to data of the UW study of HSV 2 in semen (or another study)?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
I would agree with these statistic.  Asymptomatic shedding is very real - we've done lots and lots of study and people are definitely able to swab virus from their genital skin when absolutely no symptoms are present.  This happens more frequently in people who have symptomatic  outbreaks than in those who do not.
So I looked for the article (albeit an old one and probably used culture instead of PCR, the most sensitive test available for detection of virus) on the semen study and couldn't readily find it - I did find other articles saying they were able to recover virus from semen, but not frequently and that most recovery was associated with a symptomatic recurrence.  So it's possible to shed herpes in semen but unlikely.  I did find a basic article on shedding for you, on which I am an author.  Hope this is helpful for you.  It is real, and actually accounts for many new infections .

Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.

Tronstein E, Johnston C, Huang ML, Selke S, Magaret A, Warren T, Corey L, Wald A.  JAMA. 2011 Apr 13;305(14):1441-9. doi: 10.1001/jama.2011.420.


Terri
 

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