I am 48 year old white female. About 3 1/2 years ago, I contracted genital herpes (HSV-2) in the anal area. After the initial outbreak of blisters outside the anus, I had two subsequent minor outbreaks in the same area of the skin (anus). The last outbreak was over two years ago. I now have a partner, 51 white male, and we have had unprotected vaginal sex about five times. He has been tested and is negative for herpes. He will have another test soon. We are trying to gather information to assess his risk of future infection.

We have gathered information and understand that there is about a 4% risk of female to male transmission without condom, 2% risk with a condom. Is the 4% figure accurate that he might contract herpes from me if we have unprotected vaginal intercourse? (I thought there was no risk since the infection entered my body in the anus and not the vagina). What does that 4% figure mean? It would seem surprising to me if it were 4% whether one has sex 1 time or 100 times.

Reading blogs gives an indication that some people have debilitating symptoms from herpes. Is there knowledge available about why the symptoms are debilitating for some but not for others? What are the known risk factors, both for transmission and for having a more severe experience of herpes? This excerpt from a NYT article suggests that it may be that the risk may diverge widely according to known factors: "Transmission of HSV-2 to an uninfected partner depends on many different factors, and it is difficult to give precise figures." It would be great to have a list of those factors.

Can you point to a resource to that gives detailed, comprehensive data about risk factors from clinical studies?

Thank you very much for your help in this.

NOTE: here is the link to the pamphlet with the 4% risk statistic:
http://herpesopportunity.com/downloads/herpes-opportunity-disclosure-handout.pdf

I agree about the 4% risk and here are the circumstances for that transmission rate estimate:
No sex with recognized outbreaks, no condom use, no antiviral therapy, sex about twice per week, and, importantly, your partner knows about your genital herpes - good job on that one. 
If you add antiviral therapy daily, it reduces the risk to about 2% per year, and if you add condoms with every intercourse, it drops it closer to 1%. 
Even though your outbreaks have been anal, there is certainly still a risk with vaginal intercourse as the virus is in the entire nerve group which supplies sensation to the area from waist to mid-thigh.  The virus is not shed (given off) from thick skin like thigh, buttocks or abdomen when there are no symptoms, but virus can be given off with no symptoms from the vagina, labia and anus.  It is not really known why some people have bad outbreaks and others do not.  One thing we do know is that people who have HSV 1 before acquiring HSV 2 have fewer symptoms with their first infection.

I think if you look at the website pubmed you will find lots of technical studies depending upon what you search for.

Please let me know if you have other questions.

Terri
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Thank you Terri for your response. The pubmed website is very helpful and looks like a great resource. It was hard to find any statistics for risk factors outside specific geographical areas, certain at risk populations in China and Africa for example. I also couldn't find much about who might be susceptible for bad reaction. For follow-up, I am looking for resources for the emotional health of the relationship of a new couple dealing with one partner being infected with herpes. If a 4% risk is too high for the partner, what are the ways that we can practice intimacy while safeguarding the partner. For example, if the penis is close to my genital area at all, even without intercourse (say at night while sleeping or spooning), is there any risk of transmission? What does "coitus" mean in the studies? Does oral sex have possibility of infecting my partner? What are the risks that oral sex or using hands would transfer the herpes from the anal area to the vagina or mouth? Is there any risk of transmission with kissing?

So you can lower the 4% to lower than 2% with you taking daily antiviral therapy and using condoms.  So that's really pretty good!  I would point out that if a man is having sex with a woman who has herpes but she doesn't know she has herpes (which is 80% of those infected) he is at far greater risk of acquiring herpes than he would be with you, who knows, recognizes outbreaks and likely takes daily therapy (which by itself, reduces transmission by almost half).  So when you talk about that with a partner you can mention that. 
In terms of who might have a bad reaction, I don't think we specifically know that except, again, people who have HSV 1 have less severe reactions, in general.  I think you are trying to predict something that can't be predicted here.  Spooning without no or minimal genital contact is not a risk.  Rubbing genital together without penetration has some small risk (in my opinion).  You giving oral sex if you only have genital HSV 2 is risk free.  Him giving you oral sex is small risk.  Coitus is intercourse.  No risk of kissing.  No risk of masturbation from you to them and no risk of masturbation from him to you if skin on the hands is intact. 

The emotional component is essential.  If you two are not emotionally involved, wouldn't he be less likely to take a risk?  You are taking care of his health by telling him about your herpes.  You are taking care of his health by observing for symptoms, taking antiviral therapy daily (and easy cheap safe way to help dramatically reduce transmission), and requesting the use of condoms.  You are doing a lot!  What more can you possibly do?  And remember - everybody brings things to relationships - not good things.  Your thing is physical but some of the emotional ones (cheapness, over attachment to your mother, OCD, lots of things) can be a lot more difficult.  Don't feel one down for this. 

Terri
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