[Question #8695] Transmission of HSV2 by kissing
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41 months ago
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I am a heterosexual female, I was diagnosed with HSV2 over 35 years ago by a swab. I got it from my then husband, so he had it too. My next partner also had it, so the concern for transmission has not been an issue for me til now. I used to take 500mg Valtrex for episodic treatment, I would have about 4-6 outbreaks per year, usually triggered by stress. I get lesions on the vulva and anus. I have now started taking it daily for suppressive treatment, and to minimise transmission, as I am ready to start dating again. I have just started dating someone, and plan to tell him if it is getting to an intimate stage, before we have sex. In the meantime, I would like to know the risks of transmission to him through kissing, but only on the lips, not the genitals. I have never had any lesions on my lips or face. Yeah so basically I want to know, is it ok to kiss, I’m talking about it may be just a peck on the lips, or it may be a more full on French kiss. I just want to be prepared if it happens and not put anyone else of risk.
Thank you.
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Terri Warren, RN, Nurse Practitioner
40 months ago
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If you have HSV 2 genital infection, there is no risk in kissing this new partner - zero! I don't know if you have HSV 1 oral infection or not, so you?
Terri
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40 months ago
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Thanks for that Terri, that’s reassuring to know. Never been tested for HSV1, but my Mum has cold sores, kissed her all my life, so probably been exposed during asymptomatic shedding, but never had noticeable symptoms myself. I have some follow up questions.
In your podcast you said the probability of woman’s transmitting HSV2 to a male partner with twice a week intercourse is only 4-5% if doing nothing, but suppressive treatment cuts it by 50%, so that would be 2 - 2.5%. Barrier methods and abstinence during symptoms cut it even more. Am I understanding this correctly?
Assuming the given factors in my first question, and assuming I’m taking my daily suppressive treatment, can you give a guideline on the probability me transmitting HSV2 to a male partner through oral sex, or are they roughly the same as for intercourse?
1. If he performs oral sex on me?
With or without using any barrier method or abstinence?
2. If I perform oral sex on him?
With or without barrier methods or abstinence.
I read somewhere that HSV2 is rarely transmitted to the facial area, so would it be a lower chance with oral sex?
Also, he tells me he rarely gets sick and has a good immune system. Could this be a factor in further reducing the chances of him getting it?
Thank you in advance for your expert opinion.
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Terri Warren, RN, Nurse Practitioner
40 months ago
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Yes, you are understanding this correctly. Condoms used by a male partner also reduce transmission to him by 65% so you can get very low rates in terms of transmission by using both things.
If you only have genital HSV 2, there is no risk of you giving him oral sex . If he gives you oral sex, you are correct, oral HSV 2 is uncommon and is almost always acquired by someone with HSV 2 receiving oral sex. A barrier like Saran wrap between his mouth and your genitalia provides barrier protection.
We don't know if having a good immune system helps to not get herpes or not - an impaired immune system results in more outbreaks, that we do know.
If you have oral HSV 1, and we don't really know that simply because your mom did, that could be transmitted by giving oral sex to someone.
Terri
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40 months ago
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Thanks for that Terri, just a couple more follow up questions.
As I already said, I take 500mg valtrex daily as a suppressive treatment, which cut risk of transmission by 50%.
I read somewhere that taking 2 x 500mg daily can increase the effectiveness, is there any studies or evidence about this?
Also, does the effectiveness of valtrex in decreasing transmission risk increase over time, ie the longer it is taken?
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Terri Warren, RN, Nurse Practitioner
40 months ago
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I think our data suggest that it might help but just a little, nothing remarkable. If someone is breaking through 500 once a day, I like 500 twice a day vs. 1000 mg once a day as I think it keeps the blood levels of the drug a bit more even. We have no evidence that the effectiveness of Valtrex decreases over time, no, which is good news!
Terri
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