Female to male transmission

[Confused458]

I am a 43 year old woman, diagnosed 20 years ago with Herpes 2.  I had one outbreak  and never experienced another one for the entire time.  From what I've read, this is highly unusual but I have defnitely never seen or felt the lesions as I did for the first outbreak.  I have had few partners and was married for seven years.  My ex husband and I had unprotected sex and he never contracted herpes....but, we didn't pursue a blood test either.  He didn't have any obvious symptoms.  I have not had sex in 10 years (not kidding) and recently had intercourse with a man.  I didn't tell him before we began that I had herpes and we did not use a condom right away.  About 15 minutes into sex, I told him to put on a condom and we continued.  I told him two days later that I had been diagnosed several years ago (yes, I know it was wrong).  I am not on suppressive therapy and never had taken drugs.  What are the chances that I've given him herpes.  I know there are no guarantees, I would just appreciate some stats and your professional opinion.  I had a doctor's appt. the very next day for routine pap and she told me everything looked good and no signs of herpes were present.  I did have bacterial vaginosis which she prescribed medication for but she told me that was unrelated to herpes.  My doctor told me there is a very, very small chance I could have passed this along to him.  He is worried sick and so am I............I'm trying not to overreact.  Thanks.

[Edward W Hook, MD]

It is possible but unlikely.  It seems as though you would have seen something.  EWH

[Confused458]

Dr. Hook,
could you address my questions regarding the "mild" herpes outbreaks that might have been missed?  Is it possible in twenty years that my outbreaks were so mild that I missed them?  I can't imagine this.......

[Edward W Hook, MD]

Your test certainly does indicate your infection was HSV-2.  

Sorry about that last sentence.  I was rushing for a plane and did not proof it.  What I meant to say was the further out from the sexual encounter your partner is without developing lesions, the less likely it is that he acquired HSV from you.  Most initial herpes outbreaks occur 3-10 days following exposure.  EWH

[Confused458]

I had a blood test last year to confirm it for myself.  Twenty years ago the doctor looked and said "yep, herpes"...no test at that time.  My readings were HSV1  1.6, HSV2  10.44


I've accepted this despite the fact that I've not had obvious lesions.......I wish someone could tell me how I would know if I had a "mild" case of recurrence.  Maybe I've had them and never knew they were herpes becoming active.  Have I had burning, itching/redness in my vagina.....yes, but usually due to increased sugar intake.  Once I would stop with the sugar, the itching would stop immediately (itching for maybe a day or two)....can that be a herpes outbreak?  

I need to question your last few sentences because I'm not sure what you meant to say.  You say "The longer you are out of your sex, however, the less likely he is infected".  I don't understand that statement.

Thank you for all your help with this.  I truely appreciate it.  

[Edward W Hook, MD]

I agree with your doctor.  The chances that you infected your partner are very, very small.  Let me make a number of comments, then a suggestion or two:

1.  While most people with HSV-2 have regular recurrences some people do not.  Your history is not the norm but it is by no means unheard of.
2.  The history you give suggests that you are not highly contagious for partners; that is likely to still be the case however that does not mean that you could not transmit to a partner.
3.  In general, most people do tend to have fewer recurrences as the years pass.  While we can also suggest that the likelihood of transmission decreases over time, it does not eliminate the possibility.  None the less, I suspect your "transmissibility” has decreased over the years.  

So what would I do?
1.  Are you 100% sure you had HSV-2?  If it was a culture diagnosis then OK.  If not, I would get a serological test.
2.  Your partner may want to get a test.  If you have HSV-2 and he does not, then precautions, including condoms and suppressive therapy are recommended.  On the other hand, he has an at least 1 in 5 chance of having HSV-2 but not knowing it.  If he already has it, no need for precautions.
3.  In the interval, I would suggest condoms.  The longer you are out from your sex however, the less likely he is infected. Most HSV does produce lesions on first episode and they are most likely to appear at 3-10 days after exposure.

Hope this helps.  EWH