I am worried about an exposure to herpes either through oral sex with condom through a few encounters over the past few months with the most recent one about 3 weeks ago. 

I never had any obvious symptoms (per earlier exchange - but I know symptoms aren't always obvious - I have psoriasis on my penis sometimes which makes it impossible to tell for sure) but my girlfriend has had fevers, vaginal itching, flu like symptoms (but not flu), and now what she is describing as very bad hemorrhoid pain.   

The only sex with her have had has been with condom and also frottage to buttocks with thout having condom.   What is the risk of transmission in this case??

 

I am seeing conflicting information on this as a transmission possibility from those claiming to have gotten herpes this way.    She has some health issues  that would be complicated by any additional illness I'm afraid so I am more paranoid than normally.   

In heterosexual couples in which one person has genital HSV2, the average transmission risk is roughly once for every 1,000 episodes of unprotected vaginal sex, and of course it is much lower than that when condoms are used consistently. Your negative HSV2 blood test is conclusive for any exposures more than 3 months before the test, so you need only consider the more recent ones. And although some new genital HSV infections are asymptomatic, most cause symptoms -- especially in anxious persons on the lookout for symptoms, including mild ones. So your lack of symptoms to suggest herpes is additional reassurance. Finally, as Terri said, even for your recent exposures, the negative blood test still is reassuring.

What about HSV1? Probably even lower risks of transmission. There are fewer data available than for HSV2, but it's a fair bet that each episode of unprotected oral sex carries under 1 chance in 10,000 of getting genital HSV1. And here too, lack of symptoms is moderately reassuring, as is the negative IgG blood test (ignoring IgM for the reasons Terri described). So considering both HSV1 and 2, there is very little chance you are infected.

As for your partner, genital contact without penetration carries much lower chance of HSV transmission. And while I suppose it is possible for herpes and hemorrhoids to cause similar symptoms, this is rare. If your wife had had hemorrhoids before and her symptoms are the same, there is no reason to doubt her self-diagnosis of the same problem.

For 100% reassurance, I would suggest ceasing outside sexual contacts for a few weeks and having another HSV blood test (IgG only) when you reach 3 months from the last outside exposure. Assuming those results remain negative, you can go forward with great confidence you don't have genital herpes and cannot infect your wife.

However, I think it's important for you to understand that if you current sexual lifestyle continues, you will always be at some risk of aquiring HSV or other STDs. Condoms are great at reducing risk, but they are not foolproof. You can assume you have acquired HPV, probably more than once, from your extramarital partners. Regular testing and being alert to symptoms will keep the risk on the low side of anything that might harm your wife. But not zero; that simply isn't possible (unless you can figure out a plan to not have sex with your wife for 2-3 months after each extramarital encounter). None of this should imply criticism of your choices:  humans are what we are and we do what we do. But you do need to keep your eyes open to the realities.

I hope these comments have been helpful. Let me know if anything isn't clear.

HHH, MD