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Conflicting information - Risk of transmission

Dr.-

I am a 43 yr old male and new to the HSV-2 club.  I have been researching "H" and how it will affect my sex life going forward.  As a responsible adult I want to protect future partners, and to do this I need reliable information.  One of the topics where I see the most inconsistency relates to the transmission risk of H via intercourse versus transmission via petting or genital to genital contact.  Opinions seem to vary widely on this.  I am hoping for some Facts instead of opinion if possible.  

Can you please clarify if and when petting / mutual masturbation is safe or low risk?  If this is low risk, is there a brief explanation as to why?  I would like to understand this not only for myself, but so I can discuss this intelligently in the future.  Any light you can shed on this subject would be greatly appreciated.

Best regards,

NewToHClub
8 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
OK, this sounds real, regardless of the atypical location for an initial outbreak.  I'm sure you are right about the anticipated quality of lab tests at URMC; most likely the positive test was a viral culture, or perhaps a polymerase chain reaction test (PCR).  That your partner was found to be infected is corroboration.

There is nothing to "leave alone" in regard to your partner's story.  Most new genital herpes is transmitted by someone who didn't know s/he was infected, so this is a very typical situation.  Unless you have reason to doubt her story, you should believe her.

Most people with newly diagnosed genital herpes can benefit by seeking out a provider with lots of experience with the disease.  Brief online messages cannot substitute for interactive discussion.  If you aren't confident in your own GP's expertise, you might want to ask around.  Probably you could find a U of Rochester infectious diseases specialist who is familiar with the disease.  Or call the Herpes Resource Center of the American Social Health Association (www.ashastd.org and look for a link) for expert telephone counseling.  They also might be able to recommend a herpes-knowledgeable provider in your community.  (Full disclosure:  Dr. Hook and I serve on ASHA's board of directors. But it's a nonprofit and we are not compensated.)

Finally, in case you didn't know:  herpes is not transmitted back and forth between partners.  Your partner is immune to re-catching her infection from you, and you will not be reinfected by her.  As long as she is your only partner, all your original questions about transmission don't matter.  For comfort, you might want to avoid sex during recurrent outbreaks, but otherwise don't worry about it.

Cheers--  HHH, MD
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Hmm.  Indeed, a positive test for the virus plus a negative blood test generally means a brand new HSV infection.  However, it is especially atypical for an initial herpes infection to involve the scrotum; the penis (or the anus in gay men) is by far the usual location.  It would be of interest to know exactly what test was used, and also some details about your symptoms.  If you had a positive culture for HSV, the diagnosis probably is solid.  But certain other tests are unreliable, especially examination of scrapings under the microscope, called a "Tzanck test".  You might check with your GP about it.  If there is any doubt, then a repeat blood test should be done in 3 months, with the expectation it will have turned positive.
Helpful - 1
Avatar universal
Just to fill in the blanks:  Forgive me for not knowing the different test types-  My GP gave me a blood test which was HSV2 negative.  He perfomed another test concurrently where a sample was scraped from the affected area.  This he said was HSV2 positive.  He attributed the discrepancy to the fact that I was probably recently infected and that the virus was not yet showing up in the blood test.  So here I am.

At any rate, thank you for the follow up comments.  This is a tough time and the support and information are appreciated.  Great site, great info.
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Thanks for your kind comments about the forum.  We take it seriously.

Symptomatic herpes recurrences certain can occur on the scrotum, but it is not an especially common site.  If there is any doubt about it, discuss it with your provider.  Assuming that is the case, you cannot conclude that the scrotum is the only spot where viral shedding may occur.  This has not been well studied in men, but in women with recurrences on, say, the labia, asymptomatic shedding commonly occurs from the cervix.  My guess is that the chance of HSV transmission to partners is lower when men's overt outbreaks involve the scrotum, buttocks, etc rather than the penis, but it is not possible to know if this is true or how much lower the risk might be.
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
There is conflicting information because clear data don't exist.  The data on risk of transmission by vaginal sex are helpful, but not definitive.  More important, there simply are no available data on transmission by genital apposition without insertion (sometimes called "outercourse") or by hand-to-genital contact.  The best any herpes clinician or other expert can offer is reasoned judgment plus his or her personal experience in patient care.  Logically, such exposures probably carry some risk.  However, few STD professionals or herpes experts have ever seen patients who report mutual masturbation or "outercourse" as the source of their infections.  To my knowledge, I have never seen such a case.

The other part of your question is that if in fact the risk is low, what is the biological explanation?  This also is somewhat speculative.  Nonprofessionals often assume that "just one" virus (or bacteria, for non-herpes infections) is sufficient to cause infection to take hold, if introduced to the exposed person in the right way.  For most infections, including herpes, this is not true.  Transmission frequency is related to the amount of virus involved.  Even when someone's hand is contaminated with infected secretions, the dose of virus transmitted to a partner's genital area undboutedly is much smaller than through insertive intercourse.  Also, it is easy to imagine that if viral shedding is occurring at a particular spot on someone's genitals, that area might not contact a partner's genitals during outercourse, but would do so with penetration.

In summary, nobody can say that mutual masturbation or "outercourse" carry no risk for transmission, but they clearly are much less risky than insertive vaginal, anal or oral sex.  Most likely mutual masturbation is nearly zero.  Logically, the risk from outercourse probably is somewhat higher, though not as high as for vaginal, anal or oral penetration.

Every person with genital HSV-2 should routinely inform their potential sex partners, even if safer sex practices are planned.  The risk isn't zero, and in fairness the partner needs to know the situation.  And good intentions often are forgotten in the heat of passion, and condoms can fail.

I hope this helps.  Best wishes--  HHH, MD
Helpful - 1
Avatar universal
Thanks for the advice.  Again- great stuff.  To bring this full circle,  I was aware that we could not re-infect one another.  We are no longer together, and the split up was totally independant of the H issue.  Since I no longer have the benefit of a partner who shares the H virus, I was asking questions to improve my understanding of the infection.  I want to be able to convey all of the possible risks to any future partner.   There are a lot of false stigmas attached to this condition as you know, so I figured a little knowledge may go a long way.  You were a big help.

Thanks again Dr.
Helpful - 0
Avatar universal
Not to drag this thread out, but you seem a bit curious so I'll try to fill in the blanks- probably too much info, but you said it sounded unusual so I thought it may be helpful to someone else down the road:  

The outbreak first became active 2 months into a new heterosexual relationship.  I immediately sought out my GP when I thought I had a rash. He rean 2 tests,  I believe the second test was a culture as it took 10 days to receive the results. My GP's practice is under the University of Rochester (NY) Medical Center, so I'm thinking they use state of the art testing (I hope and am going to ask!). My GP was confused by the conflicting results (he had prematurely told me it was HSV1 and not to worry...) and I think he spoke to an immunoligist as well- which is how he landed on the "new infection" diagnosis.  Symptoms start with tingly/hot sensation then several very small blisters form a couple of days later.  Gone is 7 days or so.  Affected area is is about a 1/2" long area of skin.  Not all that dramatic really (compared to some photos I have seen).  My penis has never been affected with an outbreak or discomfort. Long story short, I had to tell the girlfriend and she also tested positive (said she never knew about it- but we will leave that topic alone though!!))   Hope this may be helpful- I know you have been.  I am going to check on the test though!
Helpful - 0
Avatar universal
Great information and insight.  I had been under the impression that even the slightest exposure to the virus would result in infection in a partner.  One follow up question.  It seems that direct contact with the affected area poses the greatest risk.  My H manifests itself on my scrotum- would this lessen my partners risk of exposure (when the virus is "sleeping") since the viral area never actually penetrates her?  I suppose this assumes (maybe incorrectly) that viral shedding only occurs at or near the infected area.   I understand there are no absolutes here, just curious if the location of the infection makes one more or less prone to transmitting the virus.

On another note- this is by far the best informational site I have found for H.  Keep up the good work and thank you for doing what you do.
Helpful - 0

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