[Question #6391] HSV-2 transmission rates with condoms

15 months ago

First some background. My committed partner has HSV-2. She had an initial, minor, outbreak in 1998 (which was not recognized at the time). Since then she has had no known recurrent outbreaks. She is taking 500 mg valtrex to protect me. Currently we have condom sex but unprotected oral. We have been together for 9 months but live in different states so are together 5-15 days a month. We plan to come together permanently. Another perhaps relevant item, she had unprotected sex (no condom nor valtrex) with a previous boyfriend of 6 years and didn't take valtrex at the time and after he tested negative for HSV-2.

We are considering ditching the condom. It seems the risk of transferring is very low given her history and being on valtrex. However, I haven't seen anything to support this reduced risk potential other than reports that the risk goes down with time. Also reading Wald et al "Effect of Condoms on Reducing the Transmission of HSV-2 from Men to Women", JAMA 2001 it doesn't appear condoms offer much protection for men. Corey et. al, "Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes", NEJM 2004 is a rich study and indicates males with partners with long term infection in long term relationships have reduced chance of infection. The data on condom use in this study seemed inconsistent and ultimately the data was not broken out by male/female. Overall it appears we are in a very low risk group for transmission. I realize there remains a risk and it may be difficult to quantify.

Can you offer us any insight into the real risks if not using condoms? Are we correct to believe that the additional risk on transmission is minimal?

Terri Warren, RN, Nurse Practitioner

15 months ago

Condoms reduce the risk of transmission from females to males by about 65%. That's not perfect by any means BUT it is cumulative benefit when combined with daily antiviral medicine. I am an author on the 2004 paper with Dr. Corey. Condom use in this study was inconsistent at best and as I recall, the numbers of regular condoms users was not large enough to be able to do good statistics on these subjects. I would agree that you are in a low risk group. And it is true that the longer someone is in a sexually active relationship with someone who has HSV 2 and does not become infected, the less likely they are to become infected. This is due to an immune response acquired in sexually active uninfected partners of people who have HSV 2. There is much to learn about this response for certain.

I am going to assume that you have actually been tested to know that you are not infected. I think that your risk is minimal, true, but you will need to make a very conscious decision that lessening the use of tools to prevent transmission is truly OK with you, if you drop the condoms. I have been where you are. When you first abandon condoms, I'm guessing that you will be very aware of any odd genital sensations and will think about this a lot. But eventually, I think the worry decreases considerably. Here's the bottom line with this: Would you rather be with this partner with naked penis skin and risk getting herpes or continue to use condoms and have a somewhat decreased risk or not be with this partner. There's really no other way to look at this, I don't hink

Terri

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