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Avoiding transmission to uninfected partner
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Avoiding transmission to uninfected partner

I was diagnosed with genital herpes 20+ years ago.  I have not been in a sexually intimate relationship for the last 14 years due to this disease, but have now met someone very important to me that I would like to be sexually intimate with. When originally diagnosed, I had one negative followed by a positive culture.  Since that initial outbreak, I have not had a recurrence of blisters or lesions in all this time.  The two partners I had years ago did not get infected, but both left when I told them about my infection.  That is why I have avoided all relationships since then, until now.  I have experienced some symptoms (pretty much just some tingling or a feeling of an onset)on very limited occasions over the years when under extreme stress.

When I met the person that I am now in a relationship with, I brought on symptons when I realized I needed to tell him that I am infected (which I did) - too much stress!  He is very anxious now about becoming infected, and does not wish to have intercourse at all until he can be assured that he is safe.  He also wanted to engage in cunnilingus, until learning about my infection. I just got a HerpeSelect blood test just to confirm that I have it, and I tested positive (>5.00) for HSV2, so there is no doubt unfortunately.  He was tested about 10 months ago, and was negative. We had a consultation with my gynecologist, who indicated that there would probably be little or no risk in doing cunnilingus, and that if I began suppressive therapy with Valtrex that my partner would be 100% safe from acquiring the infection, even in unprotected intercourse, given my history.  Do you agree with this?

Is there any way for us to have a complete sexual relationship without fear and/or risk of transmission?  Since I have not had symptomatic outbreaks (other than tingling mentioned above - only about 2-3 times) in 20 years, the concern is with shedding. I am happy to say that my partner seems determined to continue in our relationship, but we have limited our sexual activity to fellatio, fingering, and mutual masterbation (masturbation).  How can we have more than this, without worry?  Thank you for your help.
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Yours is the second question today on almost exactly the same subject.  See "Transmission after 15 years" and my response.  That person's situation was somewhat different; I suspect the infection of concern actually was genital HSV-1, not HSV-2.  I might have had the same suspicion for you, because of the infrequency of outbreaks after the initial one--but your blood test indeed shows you have an HSV-2 infection.

But in that reply I also pointed out that subclinical shedding of the virus probably declines with time.  It is possible it is very infrequent in you, although unfortunately there is no way to know for sure.

Your options to prevent transmission include both condoms and suppressive therapy with an antiherpetic drug such as Valtrex.  However, your gynecologist is wrong about 100% protection from Valtrex; it's good, but some transmission still occur on the drug.  But also please see my coment in today's earlier theread about how important it is or isn't to avoid transmission.  Would it really be that big a deal if he got infected?  A big enough deal to forego a promising relationship, especially if it looks like the real thing, i.e. a potential lifelong one? Herpes just isn't that important! Many couples in your situation will decide to take some common-sense precautions, such as Valtrex, or maybe none at all; if infection occurs, it occurs--and usually no big deal.

Finally, for further advice and information, consider contacting the American Social Health Association (www.ashastd.org).  In addition to good info on the website, ASHA has a herpes help telephone line, with truly expert counselors who are very used to dealing with these issues and providing practical advice about herpes.

Good luck--  HHH, MD
3 Comments
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Apologies, it was some other thread in which I commented more extensively about how important it is (or isn't) to avoid transmitting herpes to a monogamous, committed partner.  But search the forum for "Herpes transmission" and "Preventing herpes" and you'll find several such comments in recent months.

HHH, MD
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I seem to be in a similar situation to you. Like you, I believe I was infected approximately 20 years ago. I say believe because at the time I was diagnosed with NSU. I'm unsure why but it appears that the herpes test was not undertaken. About a month ago, I had a test which indicated "previous exposure to HSV2". Apart from the original infection (discharge) I've never exhibited any symptoms. I'm aware of the asymtematic nature of the virus, however I had 3 different partners since the original infection. All 3 women have been tested and all 3 have returned negative results to HSV1 and 2. While I have no reason to doubt the validity of my own diagnosis, I'm having difficulty getting my head around the idea that I can be as infectious as someone who has 6 episodes per year. I can't seem to find any medically qualified comment indicating that the longer you've had the virus, the less likely it is that you will pass it on. My wife of 6 years (the 3rd partner in the last 20 years) has just returned a negative result after unprotected sex (and the birth of our lovely daughter) last year. Comments Doc?
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