How Can I Keep Myself from Getting HSV-2?

[izzy160]

My boyfriend of nearly two years has antibodies for both HSV-1 and HSV-2. To his knowledge he has never had a genital outbreak but he does get cold sores on his lips. Up until a few weeks ago, I had neither H1 nor H2 but a few weeks ago, much to my horror and after a very painful initial outbreak in my vagina, I was diagnosed with genital Herpes 1. The diagnostic tool was a culture taken from the active sore. I acquired H1 through oral sex -- my boyfriend did not have a sore at the time but there must have been asymptomatic shedding (a phenomenon that I have read a lot about recently). The initial H1 genital outbreak triggered flu-like symptoms and the first migraine of my life. I was ill for several days.

My question is twofold:

1) How do I protect myself against acquiring HSV-2? My boyfriend will take Valtrex when we are together and we will use condoms as well but, from what I've read, even with those precautions, I am still vulnerable to getting H2. As far as I'm concerned, H1 in the genital area is plenty bad enough. I cannot face having H2 as well. And if we do not use condoms each time we have sex, does the risk of transmission become significantly higher? In a committed, monogamous relationship, I find it sad that we'll have to use condoms all of the time for the rest of our lives, especially when it is unlikely I could become pregnant (I just turned 50). Keep in mind, my BF does not get sores on his penis so if I get H2 from him I assume it will be through asymptomatic shedding.

2)  How do I prevent the fear of acquiring H2 from destroying my otherwise loving and passionate relationship? How do we work together to keep the relationship together? My boyfriend and I have talked about marriage but this Herpes situation has truly thrown me. I am worried my fear of getting H2 is going to destroy our once-happy sex life.

Would it be useful for my boyfriend to have another round of blood tests? If so, why?

[Terri Warren, RN, Adult Nurse Practitioner]

The first question I would ask is what are the value on his test results.  These test results come with a numeric value called an index value.  If the value for his HSV 2 test is between 1.1 and 3.5, he needs a confirmatory test.  There are many false positives in this range.

Your genital HSV 1 first outbreak was bad, but you are unlikely to have a lot of trouble with this in the future.  HSV 1 genitally recurs infrequently.  

If he does have HSV 2, which you DEFINITELY need to confirm, he can take daily antiviral therapy and reduce the risk of transmission by almost 50%.  If you really love this man, herpes need not be a huge deal at all.  It is controllable with medication both in him and you, if you should acquire HSV 2.  You can take daily medicine or treat outbreaks only.  

In the big picture, dealing with a benign skin problem is a minor inconvenience compared to the difficulty finding a person you love and want to spend your life with.  I know right now it might be hard to see this right now, but I do believe it is true.

Let me know about the value on his blood antibody test.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

You're welcome.

Terri

[izzy160]

Thank you for the information, Terri.

[Terri Warren, RN, Adult Nurse Practitioner]

HSV 1 recurs infrequently in the genital area - perhaps about once every other year.  It is unlikely that you have both - the idea that HSV  recurs in the same spot is only true for about 50% of those with genital herpes.  .

the website ahsastd.org is very good.

Terri

[izzy160]

I see that the quote that I excerpted from your response was not included in my post above. The information that I thought was reassuring was the fact that if i am having sex with a new partner who has HSV-1 -- either oral or genital -- I would not transmit to them and it is not a worry.

[izzy160]

This is reassuring:  

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So, the first thing to do in a new sexual relationship is to find out if my partner already has HSV-1. Got it.

Please explain how HSV-1 operates in the body once acquired. As you know, I now have genital HSV-1. Can I also expect to have cold sores on my mouth at some point or have I been "saved" from that joy by getting genital HSV-1 first?

My boyfriend can no longer harm me -- or infect me anew with HSV-1 -- during oral sex, correct? Is there any reason to avoid oral sex at this point?

And here's another related question: Is there a chance that I could have HSV-2 as well?  The culture taken from the recent sore on my vulva was HSV-1 but a few weeks earlier, I had a sore spot on the other side of my vagina. I went to the doctor to have that spot looked at as well but by then it was nearly healed -- too late for a culture. My understanding is sores re-occur in the same spot so I am concerned. I think I'll have another blood test as well. That first spot may have been a bad reaction to the cream medicine I was inserting vaginally for the yeast infection. That was my assumption at the time.

I think my vagina was vulnerable to the HSV-1 because I had had 2 recent yeast infections during the past few months. The area was stressed and the skin probably had some small abrasions. I went all of my reproductive life without any problems "down under" but in recent months I've had several problems and now I've been saddled with lifelong genital HSV-1. It's hard for me to believe.

Thank you again for your help. Is there also a good resource on the subject with up-to-date, detailed information that I can read?

[Terri Warren, RN, Adult Nurse Practitioner]

IF, and that is certainly an IF, your boyfriend has HSV 2, and he takes daily therapy, there is something like a 5% risk in a year that he will transmit to you if he doesn't use a condom.  That is having intercourse twice per week.  Condoms reduce that more.

If you don't stay together and you only have HSV 1 genitally, yes, I think you should disclose.  but remember if you are having sex with someone who already has HSV 1, either orally or genitally, you won't transmit to them and it isn't a worry.  The majority of people in the US have HSV 1 infection.  If they aren't infected with HSV 1, yes, genital to genital transmission of HSV 1 is small but definitely present.  Also, if you have sex with someone who is HSV 1 negative, you should consider taking daily therapy to reduce the risk of infecting someone else.

First infection with HSV 1 or 2 can be uncomfortable, probably equally so.

He definitely needs a second blood test or just to get a copy of his first results.

Terri

[izzy160]

Thank you,  Terri. I appreciate your response.  

I doubt my bf knows the value of his blood test results (he had the test more than a year ago) so I'll urge him to do the blood test again.

Please speak frankly with me about the use of condoms in our monogamous relationship. If he takes Valtrex whenever we are together, but we do not always use condoms, what kind of risk am I exposing myself to for getting HSV-2? I've read that the severity of my initial HSV-1 outbreak is similar to the typical outbreak for women with HSV-2 -- and those HSV-2 vaginal outbreaks can happen a few times a year. That prospect truly frightens me.   But I am a realist -- in a monogamous relationship it is not always feasible to use condoms 100% of the time. Please give me your thoughts on the subject of condoms and HSV-2 transmission in a committed, monogamous relationship that will probably lead to marriage.

If my b.f. and I do not stay together, how do I handle future partners with my HSV-1 diagnosis? I've read a few different things so would like to get the straight scoop from you. I assume I will need to tell any future partner, before we become sexual, that I have genital HSV-1, correct? I've read that it is extremely rare for a woman with genital HSV-1 to give it to a man? Is this correct? If so, why? If the relationship becomes serious (exclusive), and we don't want to use condoms anymore, what then? What kind of risk am I exposing my partner to? And if he does get genital HSV-1 from me, how painful or inconvenient will it be for him? How does it compare to genital HSV-2 for men?

Thank you in advance for your response. I appreciate the help very much.