[Question #1878] HSV-2 Sacral Transmission

43 months ago
A few years ago I was diagnosed with HSV-2 and have only ever had outbreaks (just a 2-3 sores at most) on my upper left buttock. I am on daily suppressive meds, Acyclovir. My question is in regards to transmission. Since herpes is spread via skin-to-skin contact, am I less likely to transmit the virus to my partner since I do not get sores on my genitals? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Good morning, Heidi
Yes, if you take daily antiviral medicine, at their FDA approved dose, they will reduce the risk of transmission to a partner.  The study done to prove this used valacyclovir (Valtrex) as the drug of choice.  The dose was 500 mg once daily and this demonstrated a 48% reduction in transmission to an uninfected partner.  Now some things to think about here:  first, the study was done with couples who had been together for a while, which is significant because most new herpes is transmitted in the first three months of a relationship.  Now it's possible that the medicine would work that well in new couples but we don't know that for certain.  Second, as you can see, it doesn't totally prevent transmission - it just reduces it greatly.  That means that it is still necessary to disclose the herpes diagnosis to future sexual partners.  If your partner uses condoms, the risk is reduced even more. 
The second part of your question relates to the location of your outbreaks and it's meaning in terms of transmissibility.  Even though your outbreaks are on the buttocks, you still shed virus genitally. 

The other ways to reduce transmission are developing awareness of prodromal symptoms (sensations before an outbreak) and avoiding sex during outbreaks, even if they are on the buttocks. 

Let me ask if I may - were you diagnosed with HSV 2 by typed swab test?

Terri
---
42 months ago
I believe they took a swab from a sore I had at the time.  Is Valtrex better than Acyclovir?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
No, we believe all antiviral medicines work equally well when taken as directed.  Acyclovir is to be taken twice per day and Valtrex only once, so if you are a poor pill taker Valtrex would be better but acyclovir is cheaper. 

Terri
---