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Confusion about HSV2 and Condom Use
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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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Confusion about HSV2 and Condom Use

Hey Docs,  I'm confused about the effectiveness of condoms during vaginal intercourse as protection against HSV2.  Both Dr. Handsfield and Dr. Hook say that condoms (used properly) reduce the risk by 'at least 90%.'  In other posts the risk has been described as 'virtually zero' or that there was 'no risk because you were condom protected."  Here's the confusing part.  Recently, Nurse Warren said that, in fact, condoms only reduce the risk of transmission by 30-50% based on a recent and seemingly reputable study.  Thats a drastic drop!  Ultimately, my concern is not only for myself, but also when conveying information to others about the effectiveness of condoms.  Thanks a lot.  Your sagacity is always appreciated.  

Best,
Jim
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Welcome back to the STD forum.  Presumably you're a fan of "The Grapes of Wrath".  For users who are unfamiliar, Jim Casy is an important character in the book, and in my opinion one of the great characters of American literature.  Anyway, thanks for this question, which gets to some important issues about condoms and STD in general and herpes in particular.

Proper use of a condom that remains intact is virtually 100% protective against pregnancy; that figure is the "biological effectiveness".  However, among couples who rely on condoms for contraception, the pregnancy rate is reduced by 90% compared with people who use no contraception.  This is "use effectiveness", which takes into account that condoms can break and, more important, not all couples use them correctly and consistently.  

For some STDs, especially those transmitted by semen and female genital secretions, the biological effectiveness of the male condom approaches 100%, like pregnancy prevention -- gonorrhea, chlamydia, and HIV, for example.  For STDs transmitted by skin-to-skin contact, the biological effectiveness is lower -- e.g., HSV, HPV, syphilis.  That's because infection can involve skin above the area covered by the male condom.  For all STDs, however, use effectiveness is lower than biological effectiveness -- because people, being human beings, simply do not always use condoms properly and consistently.  Even people who claim 100% correct use without breakage usually are forgetting or not being completely truthful.

The research on condom efficacy for herpes is not very precise.  For a number of reasons, it is very difficult to come up with truly accurate figures.  Even the "seemingly reputable" research studies, the data can only be considered approsimate.

So what do the admittedly imprecise data show?  Until I referred to your discussion on the herpes forum, I was unaware of the recently published study in Archives of Internal Medicine, showing 30-50% efficacy against HSV-2 transmission.  This is use effectiveness, not biological.  I have only scanned it briefly, but the work was done by the world's premier research group on genital herpes in general and HSV-2 transmission in particular (headed by my colleague and friend at the University of Washington, Dr. Anna Wald), so I'm sure it is valid.  Importantly, it is not a research study per se, but a systematic review of other published work.  Therefore, the conclusions embody all the uncertainties of all those other studies.  However, based on my brief scan, the study does not undermine the general estimate of around 90% biological effectiveness of condoms to prevent transmission.

As a person with HSV-2, if and when you have sex with an uninfected partner, for each event you can expect a 90% reduced chance of transmitting the virus compared with sex without a condom.  The new publication suggests that if you have a regular partner with whom you have sex repeatedly, there is something like a 30-50% reduction in her risk over time. That's not as good as 90%, but it still shows a substantial level of protection.  As you probably know, you can reduce the risk still further by learning to recognize mild symptoms of an outbreak and avoiding sex at those times; and by using anti-herpes therapy, such as valacyclovir.  When couples use all these methods together, most continue rewarding sex indefinitely without the virus ever being transmitted.

Importantly, regardless of which prevention strategies you and your partner(s) decide to use, you are ethically obligated to inform any and all partners of your HSV-2 infection.

I hope this helps sort things out.  Best wishes--  HHH, MD
6 Comments
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Avatar_m_tn
Thanks a lot for the thoughtful response.  If I'm understanding correctly, the new work estimating a reduction of transmission by 30-50% doesn't undermine your responses or Dr. Hook's responses regarding 'per act' transmission which is still as you both have advised, 'virtually no risk'  provided the condom is/was used correctly.  

Based on the collective advice in this forum I assume that I'm being safe from STD's in general including HSV2 provided I'm using protection.

On the other hand, the stigmas I've had concerning HSV2 have been lessened considerably since reading the responses on this forum.  Before, I don't think I could have considered entering a relationship with someone who had HSV2, but now, provided there's a genuine emotional connection, I'd definitely give it a chance.

And yes Doc, you guessed correctly.  Steinbeck is, perhaps, the greatest American writer in my humble opinion.
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Avatar_m_tn
I suppose I should add that, on a personal level, I worry that I may have been exposed to the virus under the assumption that I was being safe by using a condom.  Perhaps, my moments of promiscuity were not as safe as I'd assumed from the information I'd gathered :).

Take Care,
Jim
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Thanks for the follow-up comments.  You'll likely never know when and where you acquired your HSV-2, whether due to acquisition despite proper condom use, an unappreciated lapse (you're the best judge of whether that's possible), or perhaps from a then-regular partner with whom you didn't use protection.

I'm glad you're learning that herpes isn't necessarily such a big deal.  Most people with HSV-2 are like you, i.e. no recognized symptoms.  That's how mild the disease usually is.

Jim Casy, considered by some reviewers as a Christ figure (note his initials), was probably speaking Steinbeck's thoughts.  He states the central philosophy of this forum:  "There's no bad folks and no good folks, there's just stuff folks do"  (approximate, from memory).
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Avatar_m_tn
Actually Doc, as far as I know I DON'T have HSV2.  I did get checked once and was told, rather appropriately, that my 'symptoms' were, in fact, a normal variance and not indicative of any type of STD but, sadly, hypochondria!  I'm simply concerned about the possible risks despite consistent condom use.  I have become rather anxious at times even after consistently engaging in protected vaginal intercourse.  And this recent study gave me a great deal of second thoughts about what, in fact, I'm doing.  Monogamy is the ideal, but often eludes some of us.  Such is life I suppose.  

"I says, 'What's this call, this sperit?' An' I says, 'It's love. I love people so much I'm fit to bust, sometimes.' . . . . I figgered, 'Why do we got to hang it on God or Jesus? Maybe,' I figgered, 'maybe it's all men an' all women we love; maybe that's the Holy Sperit-the human sperit-the whole shebang. Maybe all men got one big soul ever'body's a part of.' Now I sat there thinkin' it, an' all of a suddent-I knew it. I knew it so deep down that it was true, and I still know it." -- JC

Sorry for prolonging this thread.
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Also a good quote -- but not the one I was thinking of.

Sorry, I misinterpreted the thread in the herpes forum where you sort of started this discussion. I didn't look carefully and thought you were the original questioner, who is HSV-2 positive.  My mistake.

Take care.
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