[Question #8969] HSV exposure and transmission risks

37 months ago

Hello,

Thanks for offering this service. I have some general HSV questions/concerns-

I recently started seeing a woman with genital hsv. She says she has both 1 & 2. She has not had an outbreak in over 2 years. I do not believe she takes suppressive drugs. We had sex the other night and we did use a condom, but the condom slipped forward on my penis a bit and it as a while before I had noticed it. So we had “half protected sex” for a while. There was also some masturbating of her and then later touching myself with no hand washing in between.

I believe I already have hsv-1. I have tested positive once via swab on my buttocks, and have also had outbreaks on my lips, although nothing in either area in years. Oddly my blood tests for 1 & 2 were always negative and I have had multiple swab tests on my buttocks…only one of which was positive. So that’s unclear to me but I’m assuming I have it.

Questions-

What is my risk of acquiring hsv-2 from the single encounter described above?

Statistically what are my chances of acquiring it from ongoing encounters like the one described above? I like this woman and would like to keep seeing her and of course sleeping with her. I have been trying to find basic “% chance of transmission” numbers for both protected and unprotected sex between man to woman and woman to man, but have surprisingly been unable to do so. I’m thinking of numbers for transmission between infected to uninfected persons as I don’t have simplex 2. I guess just generally- is it “safe” for a person without herpes to date/regularly have sex with a person with herpes? Anecdotally I would think yes? And based on my number of partners statistically I’m guessing I have slept with others who have herpes and either didn’t know it or didn’t disclose it, and so far no hsv-2.

Just seeking a bit of clarification on risk. Thanks.

Terri Warren, RN, Nurse Practitioner

37 months ago

If you are going to continue to see this woman and have sex with her, I think you should consider asking her to go on suppressive therapy. Even without outbreaks, she is intermittently shedding virus and meds reduce transmission by almost 50%. A single encounter with a condom, albeit imperfect fit, is very low indeed.

The average transmission rate from females to males, having sex about twice a week on average, not with outbreaks, is about 4% per year. With meds on board daily, 2% and with a condom, about 1%. New partners likely transmit a bit more than that. I think it's great that she disclosed this information to you - says a lot about her character. Please let me know what other questions you may have.

Terri

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37 months ago

Hi Terri,

Thank you for that.

Just a couple follow ups…does my (probably) having hsv-1 decrease the risk of acquiring hsv-2?

My doctor has never said anything to me about suppressive valtrex. Do people take that for hsv-1? Is there any evidence to show that taking daily valtrex acts as a prophylactic for an uninflected person (or in my likely case uninflected by one strain)?

The 4% transmission rate you mention…is that for unprotected sex? My concern (and I will try to be delicate here) is that my anatomy is such that my penis is wider enough at the base compared to the rest of it that condoms don’t roll down all the way, and larger sizes tend to slip if they dislodge from the base at all. So I usually go for the normal size but that only covers about half of the penis. So I am always “half exposed”.to skin related infections. But I’m assuming halfway is better than not at all.

I will ask the woman if she takes suppressive meds. She may. She just seemed very nervous about sharing her positive status in an intimate moment and I didn’t want to seem unsympathetic in the first discussion.

Thanks

Terri Warren, RN, Nurse Practitioner

37 months ago

You having HSV 1 doesn't reduce the risk of you acquiring HSV 2 but it does mean that if you do, you are less likely to have symptoms and if you do have symptoms, they would be milder.

The medicine would be taken daily by HER, not you, sorry if that was confusing.

The 4% is unprotected sex, yes.

The condom issue is a bit complicated. I would suggest that you try different brands and types - you may have done that already but perhaps you could continue to try out different brands. Some men also use a cock ring to stabilize the condom at the base - just a few thoughts about that.

It would be good to discuss this issue at a non-sexual time, for sure. just an open and frank discussion. You sound very kind and I suspect you will have this discussion in a nice way

Terri

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37 months ago

Thanks Terri

Regarding the suppressive meds, I was a bit unclear I think. I understand they are taken by who has the hsv virus. I was wondering if there is any evidence that an uninflected person could take them as a prophylactic. I have some I hand for my cold sores that I never use, but was wondering if they’d help prevent an infection if taken by me, similar I’m the way that someone who happens to be taking the right antibiotics for another reason might not catch chlamydia, etc from an infected person during an encounter.

The condom issue is a lifelong thing for me. Still looking for a good solution but so far female condoms seem to be the safest bet.

Regarding the stats I’d assume that a protected sex with a person not on suppressives would drop the number to ~ 2-3% transmission rush?

Thanks for your help. I find herpes confusing to be honest. I have close friends who have been in relationships with hsv-2 infected partners for decades. None use suppressive drugs. They simply avoid sex during obvious outbreaks and use condoms during questionable instances and so far non word them have caught herpes. But I have other friends who have caught it from a single encounter. So go figure. But I find the statistics somewhat reassuring at least. Thanks.

37 months ago

Many typos! Sorry! :)

Terri Warren, RN, Nurse Practitioner

37 months ago

There is no evidence that someone who is uninfected would benefit from taking suppressive meds to reduce the risk of transmission, no, I'm afraid not

Condoms reduce transmission from females to males by 65% so yes, very useful.

You are most welcome

Terri

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