I am a female with two male partners. Partner 1 and I are negative for hsv-1 & 2. Partner 2 is positive for both. I am inquiring to understand level of risk and proper mitigation efforts. Thank you! 

1. Partner 2 contracted hsv-2 from a prior partner's vaginal lesions over 15 years ago. Without medication, he averages two outbreaks per year. The outbreaks (prodrome symptoms of itchy tingling & sores/blistering) have always been confined to the head of his penis, beneath foreskin. During stretches of asymptomatic shedding, would the shedding occur at that precise spot? Or could there be shedding in areas that have never had any visible signs? Is it likely that the condom is covering the entire genital risk area?

2. He has never had any mouth outbreaks. A couple years back (& years after his initial genital outbreak), he started getting sores on the spot where his body would rub against the mat at the gym (very low back/butt). The first doctor gave him meds for MRSA. A later doctor said it looked to be herpes. It seems to respond to antivirals. It's my thought that this could be "mat herpes" and his point of hsv-1 infection. Would you suggest any additional testing to see if hsv-1 is active in the mouth? For the back area, my thought is that my risk of contraction is very low since it would only be my foot or leg brushing against the area. Correct?

3. Our current efforts to prevent spread: shower before & after, consistent condom use, daily acyclovir, no sex during outbreaks. I know this makes our risk low, but I'm unclear on how low...? Can you also advise on recommended dosage of acyclovir to lower shedding rates?   

1. Partner 2 contracted hsv-2 from a prior partner's vaginal lesions over 15 years ago. Without medication, he averages two outbreaks per year. The outbreaks (prodrome symptoms of itchy tingling & sores/blistering) have always been confined to the head of his penis, beneath foreskin. During stretches of asymptomatic shedding, would the shedding occur at that precise spot? Or could there be shedding in areas that have never had any visible signs? Is it likely that the condom is covering the entire genital risk area?

Shedding can occur anywhere on the penile shaft and the rectum in men.  Condoms reduce transmission of HSV 2 from men to women by 96% when used with every intercourse.

2. He has never had any mouth outbreaks. A couple years back (& years after his initial genital outbreak), he started getting sores on the spot where his body would rub against the mat at the gym (very low back/butt). The first doctor gave him meds for MRSA. A later doctor said it looked to be herpes. It seems to respond to antivirals. It's my thought that this could be "mat herpes" and his point of hsv-1 infection. Would you suggest any additional testing to see if hsv-1 is active in the mouth? For the back area, my thought is that my risk of contraction is very low since it would only be my foot or leg brushing against the area. Correct?

I strongly suspect that these outbreaks are HSV 2.  Outbreaks of genital herpes can occur anywhere between waist and mid thigh.  Butt herpes is genital herpes.  But the buttocks doesn't shed like the genital area does as the skin is too thick.  That area is infectious when there is a lesion arriving or present.  I seriously doubt that has anything at all to do with HSV 1.  So he's never had a cold sore on his lip or in his nose, is that correct?

3. Our current efforts to prevent spread: shower before & after, consistent condom use, daily acyclovir, no sex during outbreaks. I know this makes our risk low, but I'm unclear on how low...? Can you also advise on recommended dosage of acyclovir to lower shedding rates?

Those efforts are about all that you can do to reduce transmission.  The appropriate dose of acyclovir is 400 mg twice a day to reduce viral shedding rates.

Terri 

No, there is no research to suggest that you taking an antiviral would reduce the risk of transmission.  It is likely that the dose you would have to take would be very high and be taken regularly and we just have any suggestion that that would work.  That question, just so you know, is a common one.  Sure wish I had a different ansswer.

Terri

“You are correct that he has never had a sore on his mouth or nose. With not having noticeable outbreaks and already taking the antivirals for the hsv-2, what are my chances of getting hsv-1 via kiss? Via receiving unprotected oral sex? ”

Sorry I missed that part. 

Since he is on daily antiviral medication, it is also working to reduce viral replication of HSV 1.  We don't have any quantitative data on how likely it is to pass HSV 1 on via a kiss or via oral sex.  But if he has never had a cold sore, then as with HSV 2, it is likely that an asymptomatic person is going to give off virus less often than one who has symptoms.  Add on the medication, I think the risk are low but not zero. 

You and your other partner are going to have to decide how much risk you are willing to take with this third person.  I wish we had numbers to help you make that decision  - we just don't.

Terri