Anxious

I am currently seeing a girl who recently told me she had been diagnosed with HSV2 and HPV from a single unprotected sexual encounter approximately 5 years ago.  She only suffered one initial outbreak of both and has not had any outbreaks since.  I am looking to pursue a relationship with her, but have some questions regarding possible transmission.

1. We would obviously use condoms during intercourse, however, what are the chances of me catching either HSV2 or HPV with condom use (when symptoms are obviously not present)?

2. How about oral sex?  If I go down on her, what are the chances of HSV2 being transmitted to me (again, assuming no symptoms are present)?  I've had cold sores since I was a young boy.  I'm assuming that has no bearing as this is a different strain of the virus.

3. If somehow transmission did occur, do recurrences occur in the same area as the initial infection?  Do symptoms of both usually appear on the penis?

4. One more...What are the chances of transmition if our genitals rubbed together during an encounter, but without actual penetration (again, no symptoms present)?  I think this may have occurred on one occasion.

Thanks so much for addressing these questions.  Just need to put my mind at ease.

[H. Hunter Handsfield, M.D.]

Among herpes discordant couples--that is, when one person has HSV-2 and the other does not--there is a 3-5% risk per year that the infection will be transmitted, even when the couple takes no special precaustions.  Those odds are reduced by consistent condom use and by avoiding sex when the infected person has symptoms.

Similar data do not exist for HPV. However, the likelihood is your partner's HPV is no longer transmissible at all.  Anyway, nobody should go out of their way to avoid HPV.  Getting that virus is inevitable, i.e. everybody gets genital HPV at one time or another, and you probably have already been infected with one or more HPV strains.  If it happens again, you'll probably never know it.

1) Low risk with condoms; see above.

2) Oral HSV-2 infections are rare.  There is a theoretical risk from performing cunnilingus on your partner, but it is very low if you avoid contact if/when she is having an outbreak.

3) Most initial HSV-2 infections involve the genitals per se, i.e. penis, labia, etc.  However, recurrent outbreaks are more variable; mostly on the genitals, but can occur anywhere in the "boxer shorts" distribution:  buttocks, anal area, scrotum, etc.  But still mostly on the penis in men.

4) Genital apposition without penetration is a lower risk than intercourse, but still possible.

A word of semi-philosophical advice:  Although nobody wants to get herpes, for most people it's just no big deal.  Like your partner, if you get it, you might have no further problem except the inconvenience of dealing with new partnerships.  Nobody should ever avoid starting a new, promising relationship because of herpes.  Of course, if the relationship you describe is not likely to evolve into a long-term, committed one, you'll want to take precautions.  But if this is likely to be "the" relationship in your life, I suggest you just forget herpes and build the relationship, both personally and sexually.  (And in any case, totally disregard HPV.)

Good luck--  HHH, MD