HSV-2 Transmission Questions

[OneWithQuestions]

The woman with whom I fairly recently began a relationship has tested positive for both HSV-1 and HSV-2.  She had no symptoms, and never has had to her knowledge.  I believe the test was part of routine tests recommended by her gynecologist when he learned she was in a new relationship.  Given her history, the HSV-2 was contracted at least one year ago and perhaps up to 20 years or more (she

[H. Hunter Handsfield, M.D.]

As moet already replied (below), you need to have an HSV-2 blood test.  If you already are positive (there is a 25% chance you are), then you have no worries.  

1) To my knowledge, there are no data to answer your question.  The main studies that addressed transmission risk enrolled couples in which the infected person had symptomatic recurrent herpes.  However, asymptomatic shedding is just as common in persons with no symptoms as in persons tested between their symptomatic outbreaks.  So the transmission risk probably is about the same.

2) There are no data on this question either.  The longer a person is infected, the less frequent are symptomatic outbreaks.  Asymptomatic shedding probably also declines, but this has not been specifically studied.

3) I cannot advise specific therapy.  The 3 mainstays of avoiding HSV-2 transmission are symptom recognition with avoidance of sex during outbreaks; condoms; and antiviral therapy.  Asymptomatic shedding comes under control within 3-4 days of starting valacyclovir.

Good luck--  HHH, MD

[TLHSC]

Since there is an increasing incidence of concomitant seropositive HSV1 and HSV2 positive individuals having never experienced a genital symptom (but confirmed history of "cold sores"), could there be co-existance of  HSV 1& 2 of the oral mucosa? Could serology testing not be able to definitively differentiate between the two?

[H. Hunter Handsfield, M.D.]

I meant to add that, all things considered, your risk of being infected seems low.  If your partner's infection is several years old, and if she no longer has symptomatic recurrences, my guess is that your risk is well under the 3% annual transmission rate experienced by "average" couples.  So the odds are good you'll never be infected even if your relationship continues for years; and if your partner decides to take valacyclovir, that becomes an even better bet.  But definitely she should not start treatment until and unless you are tested; it would make no sense for her to take the drug if you already are infected.

HHH, MD

[moet]

HI: Why don't you get a blood test and then you may not need to worry ;)

[OneWithQuestions]

Thank you for your excellent comments.

[t1234]

I'm in the same situation as OneWithQuestions.  HSV2 negative-
HSV2 Positive partner identified as such during a STD Screen but has never had symptoms or any knowledge she was infected until the blood test.

I think it's imperative that a study be completed documenting
Transmission rates for asymptomatic people. Just identifying via random blood tests asymptomatic discordant married couples who have been monogamous would tell us a lot.  

They could be retested a year later to determine the transmission rate.

At this point we can speculate that because highly sensitive
PCR technology picks up shedding that they will transmit the
Virus.  But that assumes they shed with viral loads necessary
for transmission.

One argument against a study is cost.  But this, in my opinion,  has to be balanced against the cost of extending potentially unnecessary anti-viral therapy to the hundreds of thousands of asymptomatic persons not to mention the psychological toll.

The Second argument is the transmission rate will never be zero.
But what if the real transmission rate for asymptomatic persons
is 4/2000 vrs 4/100 for F-M.  If that were the case you'd probably die of old age before you'd ever get the virus.