[Question #6246] HSV2

69 months ago

I’ve tested positive for genital HSV2 10 years ago. I took 500mg of Valtrex daily for approx 2 years and had no future outbreaks, except a couple of times when I had some major stress. However, the outbreaks would clear much sooner, like 3-4 instead of a week, with the medicine. I then stopped taking the medicine after about 2 years, and an outbreak returned within about a month of my stopping the medicine. I resumed taking the medicine, and the outbreaks stopped. I discontinued taking the medicine again about 2 years ago. Basically, I didn’t want to take a pill for the rest of my life. I haven’t had an outbreak so far. Also, I’ve experienced some pretty stressful events over the past two years (was laid off, moved to a different state for a new job, death in my immediate family), and I had no outbreaks. Again in the past, I had noticed that stress would sometimes lead to an outbreak even with medication.

Here are my questions:

1. How likely am I to be shedding on average, since it’s now been over 2 years without medicine since I had an outbreak?

2. I’m a heterosexual male. How likely am I to transmit HSV2 to a partner orally? Vaginally? From her masturbating me? Esp in light of #3 below?

3. My outbreaks always occurred somewhere in the same general area, in an area near the pubic line itself. So a condom alone wouldn’t protect a partner. With that said, does a condom even serve any purpose in limiting my chances of transmitting HSV2? Can HSV2 be transmitted to others from areas on my skin where I’ve never had outbreaks?

4. Related to the above, if I put a barrier around my entire genital region (say a dental dam or a sheet of latex, etc) would that protect partners?

Terri Warren, RN, Nurse Practitioner

69 months ago

1. How likely am I to be shedding on average, since it’s now been over 2 years without medicine since I had an outbreak?

The asymptomatic person who is infected with HSV 2 sheds virus on about 10% of days, on average, but the duration of your infection suggests that you may be shedding even less than that.

2. I’m a heterosexual male. How likely am I to transmit HSV2 to a partner orally? Vaginally? From her masturbating me? Esp in light of #3 below?

So the transmission rate from male to female, having unprotected intercourse twice per week with no condoms and no antiviral medicine, is about 10% on average. This includes an average of symptomatic and asymptomatic people. If you only have HSV 2 genitally, then you giving someone oral sex is no risk. We don't know what the risk of you transmitting HSV 2 to someone is if they give you oral sex. There is no risk of masturbation

Absolutely condoms would reduce transmission for you as well, the main site of viral shedding in men is the shaft of the penis, even if you have never had an outbreak there, yes.

4. Related to the above, if I put a barrier around my entire genital region (say a dental dam or a sheet of latex, etc) would that protect partners?

The best way to reduce transmission for you would be to take 500 mg of Valtrex daily and use condoms regularly. This would reduce the risk of transmission to about 2. I'm not sure why you don't want to take Valtrex but it reduce transmission by almost half, so a very useful tool and would be attractive to someone to whom you disclosed that you have herpes but have useful tools to reduce transmission.

Terri

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69 months ago

So to be sure I’m clear:

1. the statistical probability of my transferring HSV2 to someone giving me oral sex is unknown? There are documented cases of people having HSV2 orally?

2 if a person has HSV1 orally or genitally, does that increase their ability to be protected from contracting HSV2 orally or genitally?

3. Also, I can shed even in areas where I’m not having outbreaks, but primarily the shaft of the penis? What about other areas like my thighs, scrotum, etc, which is why I asked the question about using some type of barrier in addition to a condom.

4. How do we know shedding happens (ex: shedding on the shaft of penis even if there’s no outbreak)? Is there a way to tell that I’m shedding if there’s no outbreak?

Terri Warren, RN, Nurse Practitioner

69 months ago

1. Yes, it is unknown and yes, there are documented cases of people having HSV 2 orally. It is uncommon for sure

2. It is possible, only possible, that someone with HSV 1 genitally may be less likely to acquire HSV 2 genitally

3. The skin of the thigh, scrotum, bell, is too thick for viral shedding to occur there

4. We do studies where we ask people to do daily home swabbing of the genitals, every day, looking for shedding. It's very expensive and the vast majority of people could not afford to do this daily for any extended period of time, except through a research study

Terri

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69 months ago

Ok, thanks for your answers. Here’s something I didn’t understand in your first response now that I’ve reread:

“The best way to reduce transmission for you would be to take 500 mg of Valtrex daily and use condoms regularly. This would reduce the risk of transmission to about 2. I'm not sure why you don't want to take Valtrex but it reduce transmission by almost half”

1. Not sure I understand what is meant by “2” and also “by almost half. You said that using no condoms and no antivirals would be about a 10% chance.

2. Also, would it decrease my sexual partners’ likelihood of contracting HSV2 if they also took Valtrex as a preventive?

3. Lastly, I haven’t taken Valtrex in years and haven’t had an outbreak in years. Is it possible that my retaking it could do something to make me more dependent on it, basically, needing to take it or I’d have outbreaks? Or could taking it after all these years possibly do something to cause me to need a higher dose? Again, I haven’t had an outbreak for years and haven’t been taking it, so my concern is that by taking it I could possibly trigger something in my system causing dependency or maybe an outbreak unless I increased the dosage. I haven’t been taking it for years because I was previously in a monogamous relationship and my partner also had HSV2. Now that I’m dating again, I don’t want to put partners at risk.

Terri Warren, RN, Nurse Practitioner

69 months ago

1. Not sure I understand what is meant by “2” and also “by almost half. You said that using no condoms and no antivirals would be about a 10% chance.

Sorry, there should have been a % sign after the 2

2. Also, would it decrease my sexual partners’ likelihood of contracting HSV2 if they also took Valtrex as a preventive?

None of the above concerns are real, no. Not at all. You can take a normal dose and it will be successful in helping to reduce transmission and you will not become dependent upon it nor will you have to use a higher dose.

Terri

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