[Question #8123] HSV Transmission Risk in Serodiscordant Couples
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48 months ago
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I have a new partner who is positive for HSV-1 (IGG of 41) and HSV-2( (IGG of 2.41). Despite the low HSV-2 level, it was confirmed as positive in a follow-up “reflex” test done by the lab. She is female and I am male. She has never had an outbreak of any kind (oral or genital) that she was aware of. She learned of her positive HSV IGG during a regular screening we both did.
We are trying to gain clarity on the transmission risk from female to male in a serodiscordant couple like us. In doing research (which is wildly confusing) we have learned that the risk is lower in Female to Male transmission. She has also started viral suppressive therapy.
Our question is:
1) What exactly is the HSV-2 transmission risk? We have read that it is something around 3-4% per year for Female to Male transmission. Is this correct?
2) What is the HSV-1 transmission risk with regular asymptomatic contact (i.e. kissing)?
3) How much does viral suppressive therapy reduce the risk? We have read about 50% so would this then make the risk 1-2% per year for HSV-2?
4) Do condoms have meaningful efficacy in preventing female to male transmission? I have read a variety of things (some saying yes and some saying no) and it sounds like the benefit is at best 40% reduction. Is that right? And then would that 40% make the risk .5-1%?
5) What is the risk of oral to genital transmission without condoms? I have seen no data on this.
6) If I have other partners, does this new partner present a statistically significant risk to them (assuming based on the answers to the above that the risk of transmission to me is actually quite low)?
You can assume in all cases we would abstain form any sexual contact during any visible outbreak.
Thanks you in advance!
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Terri Warren, RN, Nurse Practitioner
48 months ago
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First of all, let me ask you this: was the confirmatory test done by LabCorp? If yes, then I now have 29 patients who were positive on the LabCorp supplemental test who are negative on the western blot for HSV 2. It wouldn't believe it if I were her. Even the Quest confirmatory test, the inhibition assay, has issues with validity. Does she have symptoms of genital herpes? If not, I would strongly recommend the western blot for her
I will answer your questions AS IF she has genital herpes.
1) What exactly is the HSV-2 transmission risk? We have read that
it is something around 3-4% per year for Female to Male transmission. Is
this correct?
Yes
2) What is the HSV-1 transmission risk with regular asymptomatic contact (i.e. kissing)?
We don't have any data about that one, unfortunately.
3)
How much does viral suppressive therapy reduce the risk? We have read
about 50% so would this then make the risk 1-2% per year for HSV-2?
Correct
4)
Do condoms have meaningful efficacy in preventing female to male
transmission? I have read a variety of things (some saying yes and some
saying no) and it sounds like the benefit is at best 40% reduction. Is
that right? And then would that 40% make the risk .5-1%?
Condoms reduce transmission from females to males by about 60-65%
5) What is the risk of oral to genital transmission without condoms? I have seen no data on this.
There is no data on that one.
6)
If I have other partners, does this new partner present a statistically
significant risk to them (assuming based on the answers to the above
that the risk of transmission to me is actually quite low)?
Well conceptually, yes,she does. If you use condoms when having sex with her and she takes daily antiviral therapy and you avoid sex with symptoms, the risk is really low but not zero.
Terri
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48 months ago
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Thank you for your quick reply. Yes, the confirmation test was done by LabCorp. Is the Quest one any better or is the only reliable confirmation test the Western Blot? We were stunned the confirmation came back positive given the extremely low IGG reading relative to the HSV-1 reading. It seemed logical it was just cross contamination. I am also shocked there is so little data on the oral to genital transmission risk. It is written and talked about so much you would think there would be more money put into studying it to really understand the risk. Thank you again!
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Terri Warren, RN, Nurse Practitioner
48 months ago
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No, I don't find he Quest inhibition assay to match any better with western blot results than the LabCorp one. We are not in a good position with herpes antibody tests that are readily available through larger labs right now.I would strongly recommend the western blot. At her index value, there is about a 50-50 chance that she will confirm as having HSV 2 by western blot.
Terri
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