[Question #3276] What are my risks?

39 months ago
I am considering sex with a 67 year old HSV2 positive female. She has had it for 8 years and has had two outbreaks.  She is on daily valacyclovir.  I am a 72 year old monocular male with rheumatoid arthritis and am taking methotrexate. We would have sex during non-outbreak periods for a few days each month. Does my RA and medication make me more likely to get the virus and would the symptoms be worse and harder to treat? If she is not having an outbreak but is shedding can I get the virus through kissing?, cunnilingus?, fellatio?, vaginal touching? Could I spread the virus to my eye by touching with a finger that has virus on it?  How risky would unprotected intercourse be in the conditions that I described?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I'm so sorry for the delay in answering your question - normally I get an email notice that I have a question waiting but not this time.

I don't think your medication would make you more vulnerable to acquiring HSV 2 but if you did acquire the infection, you might have slightly more frequent recurrences due to your medication but that could be managed with daily antiviral medicine for you. 

If she has genital infection only, you would not acquire this through kissing of her giving you oral sex  or vaginal touching.  there is a quite small risk that you could acquire this orally by giving her oral sex but HSV 2 doesn't like the mouth so rarely shows up there.  If you have ever in your life had a cold sore oral HSV 2 would look just like that and you would not know the difference by it's clinical presentation. 

So unprotected intercourse - if you were having sex with her twice per week while she is on daily valacyclovir, and you didn't use a condom and you didn't have sex when she had an outbreak, there is about a 2% risk of you acquiring herpes from her in a one year period, under those circumstances (and a 98% chance you would NOT acquire it).  I think these odds are very good and personally, if it were me and I really cared for someone with herpes, I would take the risk.  Life is short and compatible partners are not easy to find.  I don't know how you feel about her but these are the statistics and you'll have to decide how much risk is too much risk or is acceptable risk.

Terri
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39 months ago
I still worry about oral transmission to me genitally or through kissing.  Is it possible she could have acquired it orally without any evidence of infection in the mouth either initially or during an outbreak?  Also, you mentioned my risk through intercourse of 2% was based on frequency of twice per week during a year.  Is the risk percentage based on whether she is shedding during the days we have intercourse, or the number of times we have intercourse during a given day?  Finally, I need a little additional reassurance re: vaginal touching if she is not having an outbreak.  Am I still OK if I touch her with a finger that may have a minor skin abrasion?  Thanks so much for your service.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
You are fine to touch her but if you have a break in the skin,you might want to cover it with a band aid. 
If she has never had an outbreak orally, you cannot know if she has it orally but most people have it in one location.  Let's say that she had it orally - HSV 2 orally rarely gives off virus so even then, it's extremely low risk.  We know that people with HSV 2 shed virus - everyone does - so the statistic is based on the assumption that everyone sheds and we cannot know when that is happening. 
The more intercourse, the more risk - you are just potentially exposed more often, that's all.

Terri
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38 months ago
Thanks Teri:  My last follow up question is as follows:   Does the person with HSV2 always know when they are having an outbreak?  Is the risk higher right before an outbreak and for how long after after the signs of an outbreak are gone  should contact be avoided? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
I'm going to rephrase your question for you - does the person with HSV 2 always know when they are giving off virus from their body (with or without symptoms).  the answer is no.  You cannot know all the times that you are shedding virus from hour body. About half of asymptomatic viral shedding happens right around an outbreak (before or after) and half randomly.  I would wait a week or so after an outbreak to have unprotected intercourse, but know that there is risk there eve if no outbreak and even after a week - that's the randomness we were talking about.

Terri
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