[Question #633] How much risk of infection?

43 months ago
Found out my boyfriend of 3 months (he's 59, I'm 57) has had herpes for almost 30 years. And yes, I've already been exposed, unfortunately. He feels this isn't a "big deal." He says he has outbreaks once a year or less. He is adamant that is only transmissible during the prodrome (?)  and during actual outbreaks.  I *think* he bases this on the fact that his ex wife never got it (?) although they never used protection for 9 years......BUT The CDC and other sites (yours) states that asymptomatic viral shedding also can happen at other times when I *could* contract the virus. He says the CDC is the "most strict." I really want him to take valacyclovir to reduce my risk but he doesn't seem inclined to do so (but this only has been discussed briefly just today--he may change his mind). He may be concerned about side effects, cost, etc, although he does have insurance, I don't know if it's covered.  He's a wonderful man and we have much in common. I feel our relationship is a good one with long term/permanent potential (and so does he) and don't want to throw it away over this. It's not life threatening BUT there's no cure, and if I get it and we break up...then I have to deal with this problem with other partners the rest of my life. I understand it's manageable with antivirals but still, I could be one of those people who have very painful symptoms. What exactly is my risk if he doesn't take this suppressive therapy and does NOT use condoms but we only have intimate relations when he is not having prodrome signs or an actual break out? 30%? or less? 50%? 70%? Thank you for your timely response!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
You are correct and he is incorrect.  The fact is that most transmissions of herpes occur when the person has no symptoms at the time they transit.  That's probably because people who have outbreaks may avoid sex.  If you have sex only when he has no outbreaks, he doesn't take suppression, and he doesn't use condoms, the risk of you acquiring this, having sex about twice per week, is about 10% or so in a year.  If he takes daily antiviral therapy, it is reduced by about half - very effective.  He can get acyclovir for a month for $16 dollars at most pharmacies if he is prescribed 2-200 mg tablets to take twice per day.  I think at least taking daily antivirals is a safe, effective, inexpensive way to reduce your risk of infection.  I do not think it is unreasonable at all to expect this from him - there are very few side effects with this medicine and it is safe for long term use.  I think he is just uninformed, which is pretty common! 

Terri
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43 months ago
Thanks. Thus far, blood tests show I haven't contracted the virus (yet.) Re the 10% chance. That makes it sound not *too* likely..that is, a 90% chance that I would NOT acquire the virus. What would be the risk if he  used condoms during asymptomatic periods---and no relations when there were prodromes or breakouts?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
If he used condoms with all encounters, it would reduce the risk greatly - a new study shows a 96% reduction in transmission if the male uses condoms with every intercourse.  Is he willing to do that do you think? And yes, that's avoiding sex with outbreaks and hopefully with prodrome as well.

Terri
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40 months ago
So, we broke up yesterday and two previous herpes tests have been negative. When do you recommend having a final blood test to make sure I haven't contracted the virus before I embark on any new relationships? I think I've read that you can have a positive result up to 12 WEEKS after an encounter. Is that correct?? Thank you so much for providing this service.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
I would say a final test should be done 12 weeks from your last sexual encounter with him.  That's correct, and obviously, if you have any sores develop before that, have them swab tested right away.

Terri
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