[Question #5899] Risk of Transmission

20 months ago
Recently, I was involved in a week-long sexual relationship with a woman I now know is infected with HSV2, and I am extremely worried. My activities with her were as follows: Seven to eight acts of vaginal sex with a condom (intact the whole time); several acts of unprotected oral sex (about two times on her, and four or five times on me; a brief (regrettable) act of frottage, in which I believe she used the tip of my penis to rub her clitoris for maybe about two minutes at most; and mutual masturbation. 11 day since incident, no signs of blisters or sores on genitals. I check myself twice a day, but try not to get carried away. I do have a general tingling sensation in the genital area and on my lips, seems to be constant not intermittent,. The women told me she contracted HSV2 8 years ago, and no outbreaks in 5 years.

My questions are:
1. How often is HSV2 transmitted via frottage (I am particularly worried about my tip coming into contact with her clitoris)?
2. How often is HSV2 transmitted orally when a man performs oral sex on an infected woman?
3. How big of the risk was the condom-protected sex? I have read that efficacy differs with an infected woman compared with an infected man.
4. How long should I continue my self-checks? Is there a certain period of time after which I could “relax” a bit if no sores/blisters ever appear?
5. I am worried about being infected without symptoms. As I am fairly sure this would be my initial exposure to the virus, how often do initial exposures not produce symptoms?
6. The tingling feeling concerns me, but it almost seems constant not intermittent, and I find if I do not focus on it (say I am busy with work), I do not seem to notice it as much. Is tingling alone a common symptom of HSV2?
7. Given the nature of my activities with this woman, would you recommend testing for HSV2 if no sores ever present themselves (I understand I would need to wait at least 12 weeks to do so).
8. Could the hand situation I described above present a risk?
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Welcome to our Forum and thanks for your questions.  Before I get to your specific questions, let me provide some background.  I also want to congratulate your partner is her decision to inform you of her HSV infection- it was a right and brave thing to do as many people who learn that a partner has HSV may over-react.  Genital herpes causes by HSV-2 is present in at least 17% (about 1 in 6) American adults of whom only about 10% of those are aware that they are infected.  Thus if you have had other partners, they (or even you) may have HSV and not know it.  This fact is also evidence that genital herpes is just not the awful process that is widely believed but, in fact, is an often minimally symptomatic, widespread infection which sometimes recurs.  Further, while there are no specific studies of transmission through different sorts of sexual activities, in general, it is estimated that fewer than 1 in 1000 unprotected exposures lead to transmission of infection (condoms reduce the likelihood of infection, as does the duration of infection prior to exposure).  Thus, is all likelihood, you were not infected through the activities you describe.  Let's now work through your situation:
1. How often is HSV2 transmitted via frottage (I am particularly worried about my tip coming into contact with her clitoris)?
Herpes is transmitted through direct contact with a site of infection.  You do not know that her clitoris was infectious (and in fact it probably was not).  HSV can be transmitted through frottage but this sort of transmission is likely less common than through direct genital-genital contact.

2. How often is HSV2 transmitted orally when a man performs oral sex on an infected woman?
Almost never.  HSV-2 VERY rarely infects the mouth and is not transmitted by oral sex.  I would not worry about getting HSV-2 from either giving or receiving oral sex. 

3. How big of the risk was the condom-protected sex? I have read that efficacy differs with an infected woman compared with an infected man.
Women are more likely to acquire HSV from an infected male than an uninfected male is to acquire infection from an infected women.  Condoms reduce the already low risk for infection by more than 60%.

4. How long should I continue my self-checks? Is there a certain period of time after which I could “relax” a bit if no sores/blisters ever appear?
Relax.  If you were going to develop lesions, you would have done so by now. Most people who develop lesions do so within 10 days of exposure.

5. I am worried about being infected without symptoms. As I am fairly sure this would be my initial exposure to the virus, how often do initial exposures not produce symptoms?
About 25% of infections seem to occur without symptoms.  What is more common is that symptoms are mild and missed or attributed to other causes.

6. The tingling feeling concerns me, but it almost seems constant not intermittent, and I find if I do not focus on it (say I am busy with work), I do not seem to notice it as much. Is tingling alone a common symptom of HSV2?
Tingling of this sort is most likely a heightened awareness of normal sensations, not a sign of infection.  Further, symptoms of genital herpes do not come and go over the course of the day.

7. Given the nature of my activities with this woman, would you recommend testing for HSV2 if no sores ever present themselves (I understand I would need to wait at least 12 weeks to do so).
Testing serves several purposes.  If you test now, you could find that you already have HSV-2 and are unaware of it.  It this occurs, no problems going forward since you cannot acquire the infection more than once.  In my opinion, other than testing for this reason, I'm not sure there is much to be gained from testing as your risk for infection is low.

8. Could the hand situation I described above present a risk?
No.

I hope this information is helpful to you .  EWH
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20 months ago
Thank you Doctor Hook for your reply. Reading your answers takes a huge weight off my shoulders. I am also very happy this partner opened up to me about her condition. I do understand there is a stigma regarding genital herpes that really makes it sound far worse than it actually is. I suppose the lack of a cure is what weighs on me the most, and obviously it is something I would rather not have, but anyway, I feel much more at ease now.

Since I do have a chance to follow-up with you, I did want to clarify just a few things. When I mentioned frottage, I just want to confirm that it was the tip of my naked penis going against her naked clitoris, which I assumed  was genital-to-genital contact? Does this change your assessment much at all?

Also, as I have been checking fairly regularly and thoroughly and not noticed anything out of the blue, it is probably safe to say I would not be missing any mild symptoms, correct?  I have heard that the first infection always occurs at the site where the virus entered, so hypothetically this would either be my tip (unlikely) or the base of my pens (also unlikely), yes?

Lastly, thanks for you advice on testing. I suppose at some point it would be good to know as I have had many partners throughout my life (always with condoms, but still).

Thanks again for your responses and allowing me to follow up. In general I am very much at ease, just wanted to make sure to clarify.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Thanks for your follow-up.  sorry If I was unclear.  I understood your description of frottage.  No change in my assessment.  In fact, the clitoris is not typically involved with HSV outbreaks.  

Your note indicates that you have been looking for possible symptoms and I am confident you would have noted them if they had been there.  Symptoms are most often missed when they are attributed to another cause, i.e. the proverbial "zipper cut", a rash from "tight underwear", etc.

Your information on the location of an outbreak, had it occurred is correct.  most initial outbreaks occur near the head of the penis.

Thanks for your thanks.  I'm pleased you found the information I provided helpful.  EWH
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20 months ago
Thanks for your detailed follow up. One last thing I would like to mention is that over the past few days the tingling has gotten more intense and tends to be focused on my scrotum. Is the scrotum commonly infected by herpes since it is exposed even with a condom? 

I have had NSU in the past, possibly from oral sex, and this tingling sensation feels farmilar. I plan to get checked for NSU this week, but just would like to hear your thoughts, if any, on whether the scrotum could be a place for intial exposure. 

Thanks for your time. 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Thanks for the additional information.  The scrotum is relatively rarely infected with herpes.  Tingling as a symptom tends to be rather non-specific and is very rarely related to STIs.  When there are scrotal symptoms, there are typically lesions present at the same time.  

NSU can certainly follow oral sex.  Fortunately, even when it does, unlike urethritis due to gonorrhea or chlamydia, it is not transmissible in the traditional sense (since it is due to the presence of what are normal mouth bacteria that have simply wound up in the wrong place) and does not pose a risk for sexual partners.  I'd be a bit surprised if you are found to have NSY.

Hope this final comment is helpful.  As I suspect you know, we provide up to three responses for each client's questions.  This is the 3rd, thus there will be no further follow-up comments and the thread will be closed shortly. Take are.  EWH
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