[Question #2926] HSV transmission

39 months ago
Hello,
My questions are about HSV 1 and 2 transmission. I have HSV1 since I was a child, I got HSV2  15 years ago. I get 2 maximum 3 outbreaks a year from HSV2. I am in a long distance relationship with a man, we see each other once every 2 month, avarage 10 times a year. He says he doesn’t have HSV 1 or 2. My questions are: since I only see him every 2 month, is it enough to start daily suppressive therapy 7 days before we meet, and is Valacyclovir 500mg once a day enough? Should I take 1000mg instead, would this decrease the odds of transmission? We use a condom for vaginal sex but no protection for oral sex. (We never have sex if I have an outbreak). 
Can he get HSV2 if he performs oral sex on me and where on his body, mouth or genitals? 
Can he get HSV2 if I perform oral sex on him, can HSV2 shed from the mouth? 
Can he get HSV1 on his genitals if I perform oral sex on him if no outbreak is present? (I almost never get a cold sore, maybe once every 5 years) Of yes, what are the odds?
And the most important question about vaginal sex: if I’m on daily suppressive therapy, use of condom, no outbreaks, sex 1day/every two month, what are the odds of him getting HSV2? 
If his skin from the unprotected areas (pubic, scrotum) come in contact with my secretions, how big is the risk?
Since asymptomatic shedding is what scares most people when it comes to transmission, are there any developments/studies for an at home device to measure shedding? This would be so helpful and considerably reduce transmission. 
Thank you very much for your help! This is all very confusing for me. I hope you will bring some light to it! 
All the best! E.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
You can start suppression 5 days before you get together - the antiviral medicines are fully effective at 5 days.  Valacyclovir 500 mg is indeed enough.  The higher dose really doesn't show improvement over the lower dose in transmission study.  Sometimes if people are having more frequent outbreaks than you,I suggest  500 mg twice a day, but really never 1000 mg in a single dose once a day. 
He could get HSV 2 orally though that virus doesn't like the mouth much and doesn't often appear there.  His infection would be oral
Your HSV 2, if genital, sheds only from the genital area, not your mouth.
Yes, he could get HSV 1 genitally from you giving him oral sex.  But since your oral outbreaks are so infrequent and you are taking daily antiviral medicine, that is also unlikely but not impossible.  We don't have statistical odds of that transmission.
If you are on suppression, you are using condoms, no sex with outbreaks and sex one day every two months, the odds are well below 1% that you would transmit this to him.  Coming in contact with secretions poses little risk - the risk is skin to skin contact. 
There is no device to measure shedding - don't we all wish! 

Terri
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39 months ago
Hello Terri! Thank you so much for your answers. Just to summarize, he can get HSV 2 only from vaginal sex (not oral) and his skin around penis (not covered by condom)  coming in contact with my secretions doesn’t pose too much risk. If his skin not covered by condom comes in direct contact with the area where I usually get the outbreak, how risky is that?
Also, what part of the penis is most sensitive to receiving the virus? 
I didn’t ask anything about anal sex since we don’t do that, but just for my education, is this posing same risks as vaginal?
Thanks again! Sorry for all these questions but I want to make sure I do my best in protecting him.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
The shaft of the penis is the most vulnerable place in a male
Anal sex poses the same risk as vaginal sex, approximately, though we don't have good research about this - just making an assumption that they pose a similar risk.
I think he should actually be tested rather than making assumptions that he is not infected.  Has he done that or would he do it?
Vaginal sex close to the place where you get your outbreaks while you are on medicine is still low risk - perhaps a 2% chance of becoming infected - but that's having sex 52 times per year!  So your risk is clearly lower.

Terri
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39 months ago
Glad I asked, I would have thought the head of the penis would be most vulnerable.  He got tested couple of years ago and yes, he should get retested. How about if he wants foreplay with no condom? Or sex with no condom, on daily supressive therapy and no outbreak present? What is the risk in this case? 
About asymptomatic shedding, is it only happening before you get an outbreak or could happen at any time? Anything that could trigger it? 
I really hope someone could develop an asymptomatic shedding home test, it will help so many of us. Thank you again for all the info, very helpful! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Foreplay without a condom is OK, depending upon what you mean.  Any direct contact with your genital should be protected.  Sex with no condom is about a 2% risk - that's what I meant above. If using a condom, about 1%, again,having sex 52 times a year.  Shedding can happen at any time.  We don't know what triggers it.

Terri
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