[Question #7622] Area of general location left buttocks, can I pass it vaginally?
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53 months ago
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Hello, I have a burning question that I need answered. Over 20 years ago I began getting a bump on my left buttocks I always thought it was a boil. In 2016, I got a bump on my left buttocks same place but found out it was actually herpes. Since my diagnosis I have never had an occurrence/blister or whatever anywhere on/in my vagina, thigh, or groin area just my buttocks; which may happen once a year. My question can I give someone herpes through vaginal sex if that has never been where breakouts occur? Do I shed virus vaginally although my location site is my buttocks? I’m very stressed, frustrated, confused. I had unprotected sex recently although I take daily suppressive therapy. We had sex vaginally! Could I have passed it to him? I’m afraid.
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Terri Warren, RN, Nurse Practitioner
53 months ago
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Yes, you can shed virus from the genital tract even though your outbreaks have been only on the buttocks. If you are on daily Valtrex, this risk of transmission is cut about in half. I know this is difficult news for you to hear. Please let me know what other questions you may have.
Terri
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52 months ago
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Okay, but my breakout on my buttocks may occur once a year or less. I am on Valtrex suppressive therapy. What is the likelihood that I transmit the virus to someone without condom use since my HSV2 is established and without an active outbreak on my buttocks? I understand you can shed virus during symptoms, however; is viral shedding before or after and active outbreak? Or does your body just shed virus randomly/random days out the year? When exactly does viral shedding occur? Also, I get a breakout on my forehead region at least once a year, is this HSV1 or HSV2 and if it’s HSV2 am I shedding in my genitals? So so so confused? Please help!
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Terri Warren, RN, Nurse Practitioner
52 months ago
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About half of asymptomatic viral shedding happens before or after an outbreak and half is random. Obviously, you also shed virus during outbreaks as well.
The outbreak on your forehead, if it is herpes, is more likely to be HSV 1 by far, but one cannot know without a swab test of the lesion to determine the type. We do know that people who have both oral (or facial) and genital herpes often shed virus from both locations at the same time.
If you are having outbreaks only once a year or less, you probably aren't shedding virus very often but it's not zero
Terri
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52 months ago
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A few more questions but I still feel confused because the answers are kind of ambiguous. Like viral shedding happens before or after or randomly, so I feel like I can never have intercourse without a condom being used. So I feel like I can never be in a relationship or have sex ever again. If I have both I shed at the same time at both locations? What? Make no sense to me. But basically you are saying when I have the breakout on my forehead I am shedding virus through my genitalia and on my buttocks? Does that also mean my entire face, lips, etc. is shedding virus while the outbreak is on my forehead? Also, from my experience with HSV1 and HSV2 I always have prodrome systems, the burning sensation in my left leg, tingling/itching on my forehead, swollen lymph nodes, if I get a breakout on my buttock I feel the itching also. So with that being said is that the beginning of viral shedding or am I contagious way before that even occurs? Does the Valtrex suppressive therapy work to prevent transmission. Do I have to use condoms in a monogamous relationship? With knowing what you do how likely am I to pass it to my partner? It is so confusing because there are no concrete answers. Please advise?
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Terri Warren, RN, Nurse Practitioner
52 months ago
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What I am saying is that whatever immune suppression or alteration in the immune response allows the virus to emerge at one location, can also allow it to emerge in the other. It's not about the locations specifically, it is about the immune response taking care of the viral response that is the factor.
It feels like you are just now becoming aware of the knowledge set about the natural history of herpes, and I'm glad that you have to come to talk about this with me, though I know some of this is really difficult news for you to hear.
We've known that the virus can be given off from the body with no symptoms since 1982 but still, many providers tell people that they are only infectious during an outbreak. That's just not so. You can certainly have sex again but there are a few things that will help reduce the risk of transmission. One is taking Valtrex or acyclovir, both work when taken as directed. This reduces transmission by almost 50%. Another is to have your partner use condoms or you use a female condom. Male condoms used when having sex with an HSV 2 infected female reduce transmission by about 65%. Telling partner before having sex also reduces transmission, in a far more subtle way. It probably allows people who have herpes to tell their partners it's not a good time to have sex quite freely if they are experiencing prodromal symptoms as you have. Prodrome symptoms like itching or burning in the leg do signal viral activity, yes, and if you are taking daily suppression, this is the time to think about increasing the dose, as your would for an outbreak
Whether you and your partner decide to use condoms in a monogamous relationship is totally up to the two of you. If you make your partner aware of the statistical benefits of antiviral medicine and condom use and you both decide not to use condoms, that's totally up to you. If you are asking if doing those things, or one or the other alone, makes transmission impossible, the answer is no.
Having sex about twice a week, with a woman on daily antiviral medicine, and no condoms, there is about a 2% transmission rate in our study of couples where the woman is infected and the other is not. Keep in mind that these are couples that have been together for a while before they enter a study, so these numbers may be a little low for a new couple. Transmission very commonly occurs in the first three months of a relationship so the time together does seem to lower the risk.
You should also be aware that since you've had herpes for 20 years, you are very likely shedding far less than someone who is newly infected, for example. So that's very good news.
Terri
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