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Femal genital HSV2 transmission to male
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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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Femal genital HSV2 transmission to male

Thank you for your time.

1.  Oral exposure 36 days ago.  Performed oral to genital sex on HSV2 woman, who was diagnosed 5.5 years ago.  No outbreak at the time.  My blood test=negative at 25 days out.  Dr. Leone says it's 99% impossible to transfer genital HSV2 to the mouth, and advocates taking these risks.  But Dr. Handsfield does not seem to echo that same position in his posts.
-What is the current consensus on that issue, are the risks of female GHSV2 to male oral virtually non-existant?
-Should I assume this is part of the 4% trans. risk to male, over a year when no outbreaks?  I have what looks like a very faint lip scab, and two small white dots, visible when my lips are dry, but no sore, puss, redness or bleeding.  Symptom?

2.  Vaginal intercourse, no condom 21 days ago (3/x, 12 hrs), woman on her period, & sufficient lubrication.  She started on Valtrex 2 yrs ago for one year, doctor says stop and take only when an outbreak.  Here, she started taking Valtrex again 9 days b/f sex when she noticed a "small skin colored bump" just above her vagina, when had a stomach flu.  Bump gone 6 days prior to intercourse.  I have not seen any genital symptoms.  Blood test=negative at 11 days out.  Concerned about exposure, since she was on her period, and whether Valtrex use was enough to mitigate risks by 50%.  Her prior boyfriend had unprotected intercourse (2x/wk) and performed oral sex on her (1/x monthly) over 3 yrs & claims no transmission.
-Did her period increase shedding here?
-Should I assume 4% trans. to male, over a year period when no outbreaks, then reduce it to 2% since on Valtrex, then increase it to 3% since on her period?  Can we say that if I were to do this 2x/week for a year, my risk would be 3%?

3.  Have you ever heard of transmission based on these facts?  I know it's possible.  I've read a lot of posts about people getting HSV2 genital and oral from one-time encounters with no signs of an OB.  How can this be if the risks are 4%?
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Welcome to the forum.

1) This was a nearly zero risk scenario for catching HSV-2.  I would have recommended against having a blood test. Your minor oral symptoms don't sound at all like a new HSV infection.

I'm not sure where or how you came to believe my perspectives on HSV-2 transmission are different than those of Dr. Leone.  (For other users, he's an STD/herpes expert at U of No. Carolina.)  It is true that genital to oral HSV-2 transmission is rare.  I suspect Dr. Leone's 99% figure was an off-hand approximation, and I don't know that either of us would say such transmission is "nonexistent".  There are no data on the exact risk, but such transmission is a lot less likely than genital-to-genital.  Oral infections were not common, if they occured at all, in the couples in whom there was an estimated 4% annual rate of HSV-2 transmission.

2) This was also low risk.  Even if your partner's genital symptoms 9 days before your exposure were from a herpes outbreak, with it having healed and her symptoms gone, it is unlikely she was infectious at the time of sex.  To my knowledge, menstruation does not increase HSV shedding or transmission risk in people with HSV-2.  As suggested by the study discussed above, her previous bf's history (not infected after 3 years of regular sex) is typical.  Your risk analysis (4% to 2% to 3%) is hair splitting and I can't endorse such a precise guesstimate of your annual risk.  But it's certainly under 4-5% per year.  (The figure of 4% per year translates to about one transmission for every 1,000 episodes of unprotected vaginal sex.)

3) There is no discrepancy between the low transmission risk overall and the occasional person who catches herpes after a single exposure.  That would be like saying that when someone gets struck by lightning, someone else's risk goes up.  Rare things happen. The person who catches herpes after a single exposure, like the person hit by lightning, was just unlucky.

Your risk of herpes seems far too low to warrant all these blood tests. And it's certainly too low to be quizzing your sex partners in such detail about their past sex lives!  (You learned that partner 2 had vaginal sex with her previous bf 2x per week and oral sex once a month???  Really, now.)

Anyway, I hope this helps put things into perspective.

Best wishes-- HHH, MD
5 Comments
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Avatar_m_tn
  Thank you doctor.  This was with one woman, not two. May I kindly ask that you comment on the Valtrex as relates to the intercourse exposure?  Some people say that you need to be taking Valtrex for a while, but her doctor seemed to believe use it on an as-needed basis to get the same benefits (hopefully reduced transmission too).  She did take it for a year straight about 2 yrs prior.  Was 9 days of Valtrex enough to get it's maximal benefit?

  As for the people who contract HSV2 on single events, I was thinking perhaps there may have been outbreaks, just no one was paying attention at the right time?  Perhaps alcohol or drugs compromised the situation.

  Also, as for the 4% risk figure, since it appears the study involved recent or newly diagnosed people (12 mos or less mostly), I was thinking that if the study was with people 5+ years out, that since there would be more time to develop antibodies, that the risk of transmission logically would be lower for people with longer term HSV2?  What do you think.

  Thank you for your time.  I do appreciate it
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Avatar_m_tn
  The above two exposures occurred prior to her disclosure of the HSV condition.  I represented I was tested for everything and was negative, and presented my documented test results, in an envelope, before intercourse.  I would not have engaged in the above if she made her disclosure.  

  Thank you again for your time and patience.
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Avatar_m_tn
May I kindly ask for a response regarding the efficacy of Valtrex when taking it for 9 days in this case, as set forth in my initial post.  How long does one need to take Valtrex to realize the maximal shedding and transmission reduction benefits here.  Please let me know if I have to pay a further fee?  Thank you again for your time, I appreciate it.
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239123_tn?1267651214
Sorry I missed that one.  Maximum suppression probably is achieved within 2-3 days.  It should be fully effective at 9 days.
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