[Question #7316] Risk of Infecting gone?

5 months ago
I am 65 year old hetero male. I am in 1 year monogamous relationship with unprotected genital intercourse.  On 9/17, I had unprotected sex w a woman who has herpes.

My tests have been: 09/21 blood for HSV 1&2 AB IgG, 09/24 negative (<0.90) for HSV 1 but positive High (8.27) for HSV2. 09/24 blood for HSV 1&2 AB IgM ab scr test, 09/29 negative for HSV 1&2 ( Doctor’s explanation was that I was infected before my 09/17 encounter). Blood 10/01 for HSV 1&2 AB IgG, 10/09  negative for HSV 1 but positive (8.13) HSV 2.

My partner did blood 10/05; 10/08 negative for HSV 1&2 in AB IgM test & negative for HSV 1&2 in AB IgG.

I was 100% monogamous married 1981 to 10/2018 until 2019 relationship.  I had unprotected sex w women before to 1980. I don’t recall any severe-painful lesions or open sores, but I did have some sores years ago; no issues for at min. last 10 years. My PCP wouldn’t prescribe Acyclivor, indicating no active issue to address.

Qs

My partner is uninfected in our year of unprotected sex. Could continued unprotected sex infect my partner or incr. risk of infection?

I was likely infected years ago (certain > 3 years; probable 41 up to 46 years). I heard symptom severity & risk of infecting diminish over time. How probable is it that I am no longer infectious if I contracted Herpes many (40? 25?) years ago, or even 3 years ago? 

Can a new exposure to Herpes (such as my 09/17) cause a not infectious person w no symptoms to suddenly experience symptoms and “reactivated” Herpes?  

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
5 months ago
Your results indicate that you were infected long before the 9/17 encounter.  I completely agree with your physician. The thing I don't agree with is your PCP not agreeing to prescribe daily antiviral medicine for you.  This would reduce transmission to your partner.  The longer people have been infected, usually the less they shed.  But daily antiviral medicine will reduce the risk of transmission even longer than time passing alone.  However, if you've been with this 1 year partner and not infected her yet, perhaps you aren't shedding very often.

Your new exposure to herpes will not impact the course of your disease.

Terri

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5 months ago

Please provide some best guesses and probabilities regarding this:

Chances (x% probably) that I will not infect my 1 year partner with continued unprotected sex, both while taking the antiviral and secondly without.

How much does “length of time infected” affect/decrease the likelihood/probability of transmission? Can you quantify? Also, is there any possibility that I am no longer shedding or able to infect at all?

Also, what are the same probabilities of infection with protected (condom use) sex? Re condoms, we are trying this, and being careful to clean after every genital touch. Are there other recommendations re reducing the chances of infection during condom sex?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
5 months ago
These are just guesses.
Since your partner of one year has not already been infected, the risk is a bit lower.  I would say maybe a 6-7% risk without meds, maybe 4% with meds
Generally, people who have been infected longer shed virus less.  But we cannot know how long you have been infected, right?  3 months?  10 years?
I would say you are still shedding, although perhaps at a lower rate, depending upon the duration of your infection
Condoms reduce transmission from males to females by 96%.  When you add antiviral medicine, the reduction is greater.

Terri
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5 months ago

Terri – thank you so much for your help and guidance.  

I want to clarify duration of my infection. No, I do not know when I was infected. However, I am 100% certain that I was not infected after 10/15/2018 (2+ years), because my wife of 38 years passed away on that date.  Also, it is highly unlikely that I was infected anytime after 1981, as my marriage beginning that year was an almost certainly monogamous. Therefore, there is high probability that it was 39 or more years ago. How does this change/improve your estimates regarding risk of infecting my partner?

Also, I will have my physician issue prescription for Acycilvor (500 mg per day?). How long after starting med does it fully take effect as preventative med? Remember, no symptoms or episodes. 

Overall then, given all this info—my long duration infection likely 39+ years but certainly > 2 years,  no infection of partner in over a year, no symptoms whatsoever, and if I am taking the anti-viral med-- how would you rate confidence that I will not infect my partner with regular unprotected sex?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
5 months ago
I'm ok with your establishment of dates of infection if you can be sure that your wife was not infected with HSV 2 prior to your marriage.  The longer a person is infected, usually the less they shed as time goes by.  That's not hard and fast, but usually true. 
I would say you could get a script for valacyclovir, and take 500 mg once a day.  It is fully in effect after 5 days of dosing.
I would rate your confidence of not infecting your partner as very high.  it is not 100% but very high.  I'm sure she will want to participate in that decision making.

Terri
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