[Question #307] Genital Herpes Transmission Clarification

36 months ago
I need clarification on exactly how (easily) Herpes (genital - HSV-2) can be transmitted.  I had a very confusing encounter this week.  BACKGROUND: I'm 66 and was Dx 25 years ago.  I have very few outbreaks and when I decided I wanted to become sexually active again in February 2015, I went on Acyclovir (800mg 1xday/Doc gave that dose due to my wt of almost 250#). Also, I always inform a potential sex partner and I carry my own condoms and dental dams if I think I will be needing them.STORY: I was with a potential partner and on our first meeting, we had a few (mouth) kisses and a little above the waste fondling....and determined there would be more later in the evening. The sexual 'plans' came as a surprise as he told me he had a very low libido, Low-T and felt there wouldn't be chemistry.....I didn't even take my condoms and dental dams...I wasn't expecting anything sexual to happen....just a nice date.  So, I almost forgot to tell him about the Herpes (no active lesions, I forget - it doesn't rule my life) - when I did, he freaked out....I suggested he look it up on the internet (like CDC, WebMD, NIH - some professional site).  He looked it up on some random site then said; "You can get it from Kissing and skin contact".....next he went to gargle and take a shower.   {I thought I would die - I had never realized how much shame I must have - I thought I'd gotten to be pretty brave and I have always told partners and never have transmitted to anyone... I've never had such a devastating reaction.  If I could have disappeared, I would have.  I tried to tell him what I thought I had learned - which is you have to have contact with a lesion or at least the vaginal area where they occur - unprotected.....but I'd never heard it could be transmitted JUST from touching arms, breasts, torso and gentle tongue kissing of the mouth and breasts only. QUESTION:  PLEASE EXPLAIN TRANSMISSION POSSIBILITIES for Genital Herpes, Precautions and Preventative measures.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
oh Nancy, I'm so sorry you had that bad experience, it sounds pretty awful to me. But he's way off base.  In order for him to get your genital herpes, there needs to be genital to genital contact.  He might be thinking of oral herpes which can be transmitted through kissing.  No one can get your genital herpes by touching arms, breasts, torso and tongue kissing.  It sounds to me like you are a very conscientious person about your herpes infection and you are doing all the right things.  This guy was misinformed completely.  You presented absolutely no risk to him, zero, zilch.  I would say he's a jerk (and he might be) but in this case, he just isn't correct about the facts. 
Please let me know what other questions you might have, Nancy.  I hope you don't let this terrible situation impact how you deal with potential partners in the future. 
Also, 800 mg once a day is not an adequate dose to reduce the risk of transmission.  When using acyclovir, you must take it twice a day to be effective as it has poor bioavailability.  The usual dose is 400 mg twice a day, 12 hours apart and I've not really heard that it needs to be adjusted based on weight.

Terri
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36 months ago
That's a relief........I thought I misunderstood and everyone I kissed would get it.  Sorry the following is mixed questions and comments - hope you can answer my questions......for all of us!
Anyway....When  having genital to genital contact.......or mouth to genital contact...I believe in and have generally used protection.  Is it enough to use condoms & dental dams?  I also wouldn't have contact when I have (a rare) outbreak...but sometimes the symptoms come on as a bit of a surprise.....what else do I need to know?  I will alter my Acyclovir (break in half and take 400 - 12 hrs apart) and discuss (show doc your letter when I see him in January).....do we know that is reduces transmission - how much?  Where can I find accurate information on transmission rates when on Acyclovir & using protection?  I'm so glad I've found your site - I trust this information more than any I've found.  P.S.  I'm tired of being ashamed and am using this to catapult me out of it.  We need good & accurate  information. Thank you for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
Condoms and dental dams reduce transmission, for sure, but condoms only reduce transmission about 50%, depending upon the study that you read.  It could be more or less, but that's kind of the average.  Good you have no contact with outbreaks, that's the one time you can be pretty certain you are shedding virus.  The studies on transmission have only been done on Valtrex, but we no  reason to believe that the acyclovir data would be different since both reduce shedding about the same amount, and we use shedding as a surrogate marker for transmission potential. 

Great that you are using this to catapult you out of your shame.  I can just see you flying through the air now!

Terri
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