HSV2(neg) woman considering intercourse with HSV2(pos) man

NOTE - I first posted this in the free Support forum, but realized I meant to post it here, in the paid Expert forum.

Anyways - I have been dating a man who disclosed to me he is positive for HSV2.  He contracted it many years ago and currently has 1-3 outbreaks per year.  He takes suppressive medication off and on (currently on).

I have been tested for HSV2 (IGG) and am negative.  (Although as an aside, I do suspect I have HSV1 as I remember having a cold sore once on my mouth as a young person.)

Currently, due to concerns about transmission of HSV2, we are not having intercourse at all.  We kiss, etc, but our genitals never touch without underwear on.  I do stimulate his penis manually and orally while he is wearing a condom.

We are now thinking about having vaginal sex, with a condom of course.  However, I don't feel I fully understand the risks of doing this.

Questions:

1.  I've seen stats that say the risk of male to female transmission of HSV2 during a year of unprotected sex is 10%.  But by adding condoms and suppressive therapy, this risk is reduced (by half?)  True?

2.  Currently, I stimulate his penis manually and orally while he is wearing a condom (but never during an OB).  However, during manual stimulation, my hands do touch skin in his genital area that is not covered (eg: scrotum).  I wash my hands immediately after stimulation.  Are there any risks to me here?

3.  If we decide to proceed with protected vaginal intercourse, I know that condoms only cover the penile shaft, so I'm concerned about transmission from the other parts of his (uncovered) genitals that would be touching my uncovered genitals.  We would never have sex during an OB, but I am worried about prodromal periods and asymptomatic shedding.  This is probably what frightens me the most.  Thoughts?

4.  If I *did* somehow contract HSV2, how would I know?  I am concerned about the possibility of passing it on to others.

5.  Anything other advice?

[Terri Warren, RN, Adult Nurse Practitioner]

1.  I've seen stats that say the risk of male to female transmission of HSV2 during a year of unprotected sex is 10%.  But by adding condoms and suppressive therapy, this risk is reduced (by half?)  True?

Yes, daily antiviral therapy reduces the risk of transmission by about half, and condoms probably reduce that even further, though the studies don't include enough people who used both daily therapy and condoms to determine that for sure.  It certainly can't hurt.  And your statistic of about 10% per year is correct.

2.  Currently, I stimulate his penis manually and orally while he is wearing a condom (but never during an OB).  However, during manual stimulation, my hands do touch skin in his genital area that is not covered (eg: scrotum).  I wash my hands immediately after stimulation.  Are there any risks to me here?

No, there are no risks there is the skin on your hands is intact.  At some point, the immediate washing of your hands after sex might start to feel uncomfortable for him, you might want to play that by ear.  In fact, with intact skin on your hands, I personally don't feel there is any need for him to use a condom.  Am I reading this wrong or are you saying he uses a condom for receiving oral sex from you AND masturbation?

3.  If we decide to proceed with protected vaginal intercourse, I know that condoms only cover the penile shaft, so I'm concerned about transmission from the other parts of his (uncovered) genitals that would be touching my uncovered genitals.  We would never have sex during an OB, but I am worried about prodromal periods and asymptomatic shedding.  This is probably what frightens me the most.  Thoughts?

There is some risk of transmission, yes.  I think with condoms and daily therapy it is low, but not zero.  At some point, you are going to have to decide to take some risk or not be with him.  Its actually pretty much that simple, in the end.  Is the relationship important enough to you to take the risk - that's the bottom line and only you can make that decision.

4.  If I *did* somehow contract HSV2, how would I know?  I am concerned about the possibility of passing it on to others.

You might know, you might not.  But if you don't stay together, I would recommend that you get HSV 2 antibody testing about 3-4 months after your last sexual encounter.  If you have HSV 1, you are less likely to know that you are infected with HSV 2.  

5.  Anything other advice?

My advice is pretty simple.  If you end up really loving this man and he really loves you, go for it if you can handle the small risk.  There are so many other things that are harder in relationships to handle than herpes.  But take your time and think it through.  Don't make a decision that you will regret later.  In the big picture, herpes can be managed well, even if you did contract it.

Terri

[Onlytime]

I think you are doing the right thing getting the facts first. You should go to a GP and sit down and have a proper one on one talk with the DR.

As a HSV1 (Genital) sufferer, I strongly recommend you ask yourself are you willing to risk exposure?

Herpes is one of very few STD's that cant cause further health issues, it is merely a virus that causes an ongoing superficial skin condition, however in some cases, symptoms can become quite severe, causing pain and discomfort. After a breakout (2-3 weeks on average) one's life is back to normal.

Some people have frequent outbreaks, some people have very few outbreaks, some people have less outbreaks over time whilst others find outbreaks occur when they eat certain foods or lack sleep etc.

Herpes has a bad reputation and this is one thing you should definitely consider. If you are exposed, can you see past the hype and misconception that is portrayed of Herpes by the small minded public?

If you are exposed can you forgive him? he has been honest and taken all the precautions to keep you safe, it would be hard not to blame him if you were exposed, but its your choice to take this risk.

If you were exposed, and the two of you broke up, how would this affect your future choices in a partner?

As mentioned before, Herpes cannot cause any life threatening conditions, its a virus which affects the skin.

If you feel this man is worthy of a relationship, is a skin condition going to stand in the way of what could be a great relationship?

My non affected Partner saw a doctor and got the facts, he and I engage in a healthy sexual relationship practicing safe sex, he has accepted the risks involved and we have normal happy lives!

I hope this helps,

Good Luck

[Wilwisp]

Thank you for your informative reply.  :)

Yes, we are currently using condoms when I stimulate his penis manually.  It's good to know you feel this is unnecessary assuming the skin on my hands is intact (it is).  I'm sure he would enjoy that!  lol

Yes, I love him and he is special to me.  I think I am now convinced that the risk of transmission of HSV2 to me during protected vaginal intercourse is small (say ~5% per year with no sex during OBs, condoms and suppressive therapy).  I would have never known/believed this if I had not taken the time to really look into this and get all the facts.

However, we are not in an exclusive sexual relationship.  So I feel like I have people other than myself to consider when I am deciding whether or not to take the risk of exposure (ie: my other partner(s)).  This is the biggest struggle for me.

New question:

1.  I trust condoms to protect my uncovered genital skin from his penile shaft.  But I am still concerned about his uncovered genital skin touching mine.  I found data that says in men, the penis is the part known to shed asymptomatically the most (+ maybe the anus area).  I've read that thicker skin areas (eg: thighs, buttocks) do NOT shed (they can have lesions though of course, but we can watch out for that.)  So - I guess that leaves just the scrotum... does it shed?  I guess maybe it must, since some women will still get HSV2 from men even when using condoms.  Any thoughts?

[Terri Warren, RN, Adult Nurse Practitioner]

I would say that the very base of the penis and top of the scrotum shed some.  Otherwise, people who use condoms every time would never get herpes and they sometimes do, as you mentioned.

Yes, I agree if you have other partners, this is something to consider.

Terri

[Wilwisp]

Just a quick update that I decided to proceed with protected vaginal intercourse.  It has been going well and I am comfortable with my decision.  I chose to accept the relatively low risk of transmission.  We are taking all practical measures to reduce risks (condoms, suppressive therapy, no sex during OBs).  Sex has been enjoyable, and normal.  I am so glad I did my research to become properly informed!  :)

BTW, Onlytime - Thank you for pointing out how herpes is really just a virus that affects the skin periodically.  It's true.  It's really stigmatized unnecessarily.  You helped me see it for what it really is.  :)

[Terri Warren, RN, Adult Nurse Practitioner]

I'm glad you made this decision and I'm glad that you are comfortable with it, as well.

Terri