Risk of infection from long-term asymptomatic HSV-2 positive female

[AdAlta]

I am a 48 year old male, not immunocompromised, STD (all) negative.  She is 47, HSV-2 positive, negative for other STDs, not immunocompromised.  She contracted HSV-2 sometime around 1982.  She had what she thinks was a very mild initial outbreak at the time of infection (never diagnosed).  Since then (i.e. for 26 years), she has had no outbreaks, no prodrone symptoms, no symptoms of any kind remotely attributable to HSV-2.  She has had two 10 year partners since 1982 and neither has contracted HSV-2 (confirmed by recent PCR and HerpeSelect tests).

I know that sub-clinical shedding diminishes over time, but I've not been able to find any study that correlates duration of infection (26 years in her case) and frequency of outbreaks (zero in her case) to the risk of transmission.

What are my risks of contracting HSV-2 from her if we engage in UNPROTECTED sex (including intercourse and oral sex)?

If she were to begin a regimen of daily acyclovir, how would that change the risks?

If we used a condom during intercourse only, how would that change the risks?

[waringblender]

There aren't any studies about which you are referring, length of infection/outbreaks to the transmission risks.

What's your herpes status? Do you even know?

The  risk is about 5% rate of infection over the course of a year. The study that the number comes from translates out to about 1 infection for every 2,000 episodes of sex.

Daily medication drops that risk by 50%. Probably more. I'd say it drops it by AT LEAST  50%.

A condom drops the risk by about 50% as well, although that could also be higher. According to the STD docs on the other forum, it's well over 50% protection.

If you use  condoms and she takes medication, well, you can see how low your risk actually is.

She may be shedding less because of her particular circumstances (long duration of infection, no outbreaks or symptoms), but there's just no way to know because no clinical studies have been done on those infected for long periods of time, like over a decade or 2. You should assume she still sheds virus sometimes, even if it might be at a lower rate than the average shedding rate, which is about 15% a year.

You should get tested if you don't know your own status yet.

Even if you do nothing -- no condoms, no medications - you still have a higher chance of NOT contracting it than of getting it. 5% per year? Those are damn good odds.

Why were her former partners PCR tested? Any idea?

[gracefromHHP]

If your gf has never had a herpes blood test to see what type(s) of herpes she has she should think about getting one. When she was diagnosed it was assumed that all genital herpes infections were due to hsv2 and that's not the case at all. Only 1 ob in all these years easily could be hsv1 or even not herpes ( if she was only diagnosed with a visual exam and no testing ).  

As far as overall viral shedding decreasing over time - well we really don't know that at this point. A substudy of the valtrex and transmission study showed that on average folks infected anywhere from 1 - 10 years with hsv2 were still shedding about the same amount - 7-8% ( you shed at least double/triple/quadruple that the first year ).  A study was recently done that looked specifically at # of ob's in folks with hsv2 >10 years and the rate of shedding but it hasn't been published yet so I"m not at liberty to discuss specifics from it yet.  

Just keep in mind that if indeed your gf does have hsv2 genitally and you don't - you will always be FAR more likely NOT to contract hsv2 from her than you will be to get it even if the only thing you do is avoid sex whenever she has any genital symptoms ( itching, redness, abnormal for her discharge etc ).  I'm sure if someone told you you had a 96% chance of being the big winner in the powerball tonight you'd run right out and buy a ticket to play right?

grace