HSV/ Antivirals

Dr. H,
Thank you in advance for answering my questions. I was diagnosed with genital HSV over 10 years ago. I started dateing my boyfriend last summer.  I told him about my diagnosis. He could not maintain an erection when we used condoms. He said he could not feel me. We have tried numerous condoms and the most recent was Pleasure Plus with the pleasure pouch, but to no avail. So we began having unprotected sex. To our knowledge he has not contracted HSV. I am on antiviral therapy and remain outbreak free. I frequently check myself before we have sex. When i have had outbreaks in the past they are small and appear isolated to one area. We had a break up a month ago, but are talking of getting back to together. But if/when we do, he says he wants to again try condoms. If I had it my way we would always use protection. We have used the female condom once and he was able to have an orgasm. He is a wonderful man and I would hate to transmit this to him. my questions are:
1. Is there any quantifiable statistics for chances of transmission using antiviral therapy and visual inspection. And not having sex during outbreaks. (i have not had visual evidence of an outbreak since I began antiviral 500mg QD of valtrex. Only 1-2 a year with out therapy. I have been looking on line but I can't seem to find anything written in language that I can understand.
2. Do you know of a condom that could possibly work for him? We have tried various different condoms supposed to be micro thin.
3. Do you have any words of advice for him as I will show him this post?
Thank you again

[H. Hunter Handsfield, M.D.]

This message should have been in the STD Forum. But this question was posted twice (you probably hit Return an extra time) perhaps incurring a 2nd charge on your credit, and I don't want you to do a third one.

1) Ten years after diagnosis, you might have asymptomatic shedding pretty infrequently, even without antviral therapy.  On Valtrex and with no symptomatic breakthrough episodes, most likely the risk of transmission is very low, even without condoms.  Nobody can guarantee that, and there are no definitive data to give you a numerical estimate of the risk.  But the risk averages 3-5% per year (with sex an average of 2-3 times a week) even on no treatment.  With treatment, and given the duration of your infection, most likely there is less than 1% chance per year.

2) I'm not a condom expert.  But a lot of people like the newer polyurethane condoms, which are said to retain a lot more sensitivity than latex.

3) My advice to both you and your partner:  First and most important, your partner needs a blood test for HSV-2.  There is a good chance he already is infected, since 25% of the population has it (even without symptoms).  If so, you need take no precautions at all; he cannot be reinfected with the same HSV type.  But if he is negative for HSV-2, then....

Second, herpes simply is not a serious enough health problem to stand in the way of a promising relationship.  The risk of transmission seems to be low, but even if it occurs, you might never know it (most cases are asymptomatic); and if you get symptoms, effective treatment is available.  The big deal about herpes is the risk of transmission to others.  So if you guys aren't certain about your future together, i.e. your partner might have other partners someday, then you should take reasonable steps to reduce the transmission risk.  But it seems to me you already are doing that.  Even if condoms don't work out, the odds are you won't catch it anyway.

I hope this helps. Good luck to both of you.   HHH, MD