[Question #2398] hsv2 - longtime partner immunity

46 months ago

I have just learned my secondary male partner has HSV-2 and has had it for 25 years. He and I have been engaging in regular sexual encounters for about 2.5 years. Our relationship is kinky and our intercourse is extended and rough, and consists of vaginal, oral, and anal sex. We did, due to my ignorance of his HSV2 status, engage in condomless sex on many occasions during the last year, including once when he had (undisclosed to me at the time) prodromal symptoms.

We don’t usually spend time with each other outside of our sexual encounters and we don’t live together. My primary partner and I are both HSV2 negative (recent IGG testing 15 weeks after my last sexual encounter with my secondary partner) and would like to remain this way. I do have antibodies for HSV1 but, to my knowledge, have not had cold sores or other symptoms as an adult.

My secondary partner, since disclosing his status to me, has told me that he rarely gets outbreaks anymore and each outbreak is preceded by prodromal symptoms. He does get prodromal symptoms WITHOUT outbreaks.

A prior answer suggested that the non-infected partner may develop immunity after a time. How does this work? Where can I learn more about this as this is not something I have seen in any of the medical literature I have scoured for information? Is this immunity only from close and extended contact? Or just from frequent sexual encounters? Should I read into anything from the fact that I have managed to stay HSV2 negative for this long?

Terri Warren, RN, Nurse Practitioner

45 months ago

I would say that we don't know exactly how the limited acquired immunity thing works, we just see evidence of it in specialized immunologic cells. This is work done by Dr. Larry Corey at the University of Washington. It isn't perfect at protecting people, don't misunderstand, it likely just decreases the chance that someone will get herpes from their infected partner over time. And I think it is from repeated sexual encounters, yes. But then on the other hand, he's been infected for a long time and people do shed less and recur less over time, at least most people, so that could be another reason did you appear not to be infected.

Are you thinking of starting to have sex unprotected with him again? Please don't relay upon protection that we have discussed here as a solution. If you both don't want to use condoms, then I would at a minimum suggest that he take daily antiviral therapy to reduce the risk of infecting you. This is, of course, your call, but I am responding to your statement that you and your primary sex partner would like to stay negative for HSV 2.

Terri
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45 months ago

Thank you, that's very helpful. We will not be going back to unprotected intercourse! I'm not sure if we will go back to having any intercourse because even with protection there is a risk and I do not want to get HSV2, and most especially do not want possibly unsightly and painful sores as I understand that newer infections tend to have worse symptoms during outbreaks than older infections.

Do my antibodies for HSV1 provide any resistance against HSV2 infection or decrease the severity of infection if I get it?

He has said that he is willing to go on antivirals. He has taken acyclovir in the past for outbreaks but doesn't anymore because they are so mild and rare. Since we plan our meetings ahead of time and they are usually at least a week apart, he wonders if he has to take the pills every day or if it would work just as well to take them for a day or two before we meet. Is anything know about how long it takes for the suppression to be effective?

Also, is there a treatment regimen for suppression that can be taken once a day instead of twice a day?

Terri Warren, RN, Nurse Practitioner

45 months ago

Sometimes a first infection can be painful, true, but you would know what it is and start medicine right away and that's usually the problem with people with new infections - they don't know what's going on, they have to wait for an appointment and in the meanwhile, their symptoms worsen. The good news is that having HSV 1 definitely decreases the severity of most new HSV 2 outbreaks, yes, though it likely does nothing to decrease the chances of getting infected, I am assuming you've been tested already to know that you are not know infected?
The medicine takes five days daily to reach peak effectiveness. Valacyclovir can be taken once daily - acyclovir twice daily, but way cheaper.

Terri
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45 months ago

Thanks for pointing out that the valacyclovir is more expensive, even though a once a day preventative treatment.

As I understand it, the primary mechanism of genital to genital transmission of HSV2 is from skin to skin. Specifically thin skin to thin skin (questions 1570, 383 and 2144 ). It sounded like the balls are not infectious but the penile shaft is. Where is the skin thin enough on a woman to allow virus transmission? A landing strip zone? The entire vulva? Any of the inner thighs? Parts of the buttocks? Is there a diagram that could help me get the lay of the land where transmission is most likely? I would like to know where penis shaft to my skin should not be in contact! Is cum or pre-cum infectious? We typically engage in some very rough sex. Would cuts or breaks in the skin around the thighs or buttocks provide a means for virus transmission? What about bruised skin or reddened skin? Would merely irritated skin provide for easier transmission through, for example, the buttocks?

Thanks for providing your expertise through this forum and for allowing these follow ups.

Terri Warren, RN, Nurse Practitioner

45 months ago

Landing strip? LOL? Yes, a landing strip. The buttocks and thighs are too thick for virus to enter. So I would say the labia, vagina and anus. Is that the landing strip concept? Ejaculate is NOT a good carrier of virus, no. Yes, breaks in the skin would allow virus to enter more easily, even if the breaks are microscopic. Bruised or reddened skin is not necessarily more easy to enter unless the skin is red because of enough irritation to break the skin.

This is your final post - if you have more questions, feel free to renew

Terri

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