[Question #4366] How is herpes transmitted and what activity is safe?

28 months ago
I am a gay man. I took the HSV IgG antibody tests just last week and got 4.2 for type 2, and <0.01 for type 1. This was 3 weeks after a possible exposure. I don't have any symptoms that I am aware of.

Questions:  (if you feel this is too many you don't have to answer everything)

1. I would like to be as safe as possible with my current partner. That means understanding exactly how HSV2 can and cannot be transmitted.
  a. Is it possible to spread it on my hands, for example if I touch my genitals and then my partner? Is mutual masturbation safe?
  b. Can I spread it by kissing or by giving unprotected oral sex?
  c. Genital to genital contact is dangerous (penis on penis)? What about if my genitals touches any part of their body that is not their genitals, butt, or mouth area? Can the virus be on the skin around the shaft of my penis (groin area)?
  d. Should my partner avoid touching my butt cheeks? Or is it just the anus that can contain the virus? 

2. Are there different strains of HSV2? I don't seem to have symptoms now, but if I were to have unprotected sex with someone else who has HSV2, could I get a different strain that gives me symptoms? Also, can I still get HSV1?

3. Is a false positive a possibility, and should I get tested again? How likely is it that I got HSV2 by receiving unprotected oral sex?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
28 months ago
1. I would like to be as safe as possible with my current partner. That means understanding exactly how HSV2 can and cannot be transmitted.

I am assuming that your concern is that you acquired HSV 2 from an encounter with someone other than your current partner?
Has your current partner had an IgG antibody test?  I would certainly encourage that to sort out if your partner is actually at risk or may have infected you.

  a. Is it possible to spread it on my hands, for example if I touch my genitals and then my partner? Is mutual masturbation safe?
Yes
  b. Can I spread it by kissing or by giving unprotected oral sex?
No, if you are only infected genitally
  c. Genital to genital contact is dangerous (penis on penis)? What about if my genitals touches any part of their body that is not their genitals, butt, or mouth area? Can the virus be on the skin around the shaft of my penis (groin area)?

The virus can be around you anus or on the shaft of your penis due to viral shedding.   If someone gives you oral sex, they are at a quite small risk of transmitting to their mouth.
  d. Should my partner avoid touching my butt cheeks? Or is it just the anus that can contain the virus?
Your partner can definitely  touch your butt cheeks.  The skin on the butt checks is too thick for viral shedding to occur without a lesion.  The anus is the concern.

2. Are there different strains of HSV2? I don't seem to have symptoms now, but if I were to have unprotected sex with someone else who has HSV2, could I get a different strain that gives me symptoms? Also, can I still get HSV1?

there are different strains of HSV 2 yes, but it is really unlikely to get a second strain of the virus and if you did, it would likely not make a difference in your recurrence pattern (which is now not present).  HSV 2 appears to protect someone against HSV 1 if they do not have it already.  But remember that the IgG misses 30% of HSV 1 compared to the gold standard western blot.

3. Is a false positive a possibility, and should I get tested again? How likely is it that I got HSV2 by receiving unprotected oral sex?

I have seen false positives at this level, yes.  I think there is no point in retesting with the IgG but to rule out false positives, you should get the herpes western blot.
It is extremely unlikely to acquire HSV 2 from receiving oral sex.

Terri
---
28 months ago
Thank you for the valuable information.

I am assuming that your concern is that you acquired HSV 2 from an encounter with someone other than your current partner?
Yes that is correct. As far as I know my current partner does not have herpes. I am having him get the IgG test.

Just to be clear, you are answering that yes mutual masturbation is safe? I take that to also mean HSV2 cannot be spread on my hands.
I am also wondering if that means I cannot reinfect myself in another location just by touching the infected area and then another part of my body.

Also, I would just like to confirm that genital to genital contact (penis on penis) is likely to transmit HSV2.

No, if you are only infected genitally
If I have it on my mouth, kissing can spread it? But since you said the risk from him giving me oral is low, that leads me to conclude the risk is similarly low from kissing.

No, if you are only infected genitally
How can I determine where I am infected?

there are different strains of HSV 2 yes, but it is really unlikely to get a second strain of the virus and if you did, it would likely not make a difference in your recurrence pattern (which is now not present). 
Is it possible for my partner to have symptoms if I transmit HSV2 to them, even though I don't have symptoms?

I have seen false positives at this level, yes.  I think there is no point in retesting with the IgG but to rule out false positives, you should get the herpes western blot.
It is extremely unlikely to acquire HSV 2 from receiving oral sex.
Thank you for this info. It's very helpful.
If the person who gave me oral has HSV2 in their mouth, does that increase the likely hood that they gave it to me? 
I think I would like to get the Western Blot. How do I go about doing that?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
28 months ago
Yes, mutual masturbation is safe.
penis to penis contact is not likely to transmit virus, but it surely can be transmitted in that way.  It is more likely to transmit if you are having unprotected anal sex, for example, where you have penis to mucous membrane contact and more friction.
If you have HSV 2 orally, it could be spread from your mouth yes, though that is unlikely as HSV 2 rarely recurs orally and is rarely shed
You should assume that you are infected genitally, per the CDC recommendations, as almost everyone who has HSV 2 sheds virus from the genital tract when they do daily home swabbing using the most sensitive test that we have for four months.
it is possible, if you transmit, that your partner would have symptoms though you do not
See above about oral HSV 2.
You can work with your own provider and the University of Washington to get the test or I can order it for you through our research program at www.westoverheights.com.   You would need to have a video conference with me prior to my ordering the test to establish our relationship.  The cost if $314 for the consult and the test itself.
Let me know if I can help more.

Terri
---