[Question #4187] Help

31 months ago
Please help me assess the risk of the following situation: HSV 2 positive female, positive 10+ years, on valicyclovir 500 mg 2x a day for 5 days, on 6th day had unprotected vaginal sex with male one night, 3x in one night. No outbreak or symptoms at the time. How high is the risk here? Also, if female has been mostly asymptomatic over time, is it likely that if it was transmitted it would be asymptomatic to male partner?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
31 months ago
Well, I think the risk here is really low but it is not zero. The things you have going for you here our longer duration of infection, using antivirals twice a day which I like actually in some people better than once a day to keep drug levels higher more even, that you had drugs on board for five days which is at its most effective, and that you are asymptomatic. How are you originally diagnosed with herpes? Have you always been asymptomatic? If you were truly infected, sounds like you believe that you are, this does not mean that if you transmitted the virus that your partner would also be asymptomatic. It appears that a person's own immune system modulates whether symptoms will be present or not, not something about the virus itself. If your partner did indeed acquire herpes from you and was going to have symptoms Color They would normally show up within 2 to 10 days.

Terri
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31 months ago
Hi. Thank you for your help. I was at a routine gynecology appt in 2006 when coincidentally I had one small bump that I thought was from shaving. Doctor said it didn’t look like anything, but to be sure she swabbed it and the test came back positive. I never would have known otherwise. I have had since then maybe 5 or 6 similar bumps with slight tenderness but no other symptoms. Very mild symptoms, which is why I referred to it as “mostly” asymptomatic.  The strange thing is, back in 2006 I had unprotected sex with my boyfriend the night before that doctor appt with bump present, and I did not transmit the virus to him. As for the present incident in question, I hope that having no present symptoms, having been 5 days on valicyclovir twice a day, and the length of time since acquiring the infection are hopeful indications against the chances of having transmitted the virus. Final tonight: is it true that the majority of cases go unrecognized or unknown or without symptoms? Thanks for your help and your knowledge! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
31 months ago
Yes, 80% of those infected are unaware of their infection.

Terri
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31 months ago
Thank you. I have a follow up question: I continued on valicyclovir 500 mg once a day, rather than the 500 mg 2x a day, and may have missed a day or 2 within the 5 day period before having relations with partner. I was on period and we did not put a condom on but did not have penetrative sex, but did have genital contact. an hour later I felt a tenderness in area that symptoms arise but before contact felt nothing. Thinking it may be psychosomatic but still tender. Question is: 1) does missing dose or doses eliminate protection and 2) can symptom pop up that quickly and 3)can lack of penetration lower transmission risk?
31 months ago
Also, if there was the very beginning of an outbreak present, does that guarantee transmission? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
31 months ago
Missing a dose of once a day therapy does drop the drug levels in  your body and you MAY be somewhat more vulnerable to viral shedding but NO it does not eliminate protection completely by any means.  Yes,symptoms can pop up quickly and yes, lack of penetration definitely lowers the transmission risk

Terri
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