HSV 2 transmission

I was informed in 1997 that my previous partner had exposed me to HSV 2.  Because I did not have symptoms, the clinic did a blood test, which came back positive.  Since that time, I have never had a blister, sore, or lesion in the genital area, but neither have I been in a sexual relationship.  I am now involved again in a monogamous sexual relationship (we are both mid-50s) and would prefer not to use a condom all the time.  I know the risk is never zero, but I am wondering about the relative risk of transmission to my partner.  Even though I do not have lesions, would taking acyclovir (or a similar drug) regularly reduce the risk to my partner?

[Edward W Hook, MD]

Welcome to the Forum and thanks for your question.  You ask a post important question for which you can also get much misinformation.  Here are the facts:

1.  Most herpes transmission occurs as a result of asymptomatic transmission of the virus from the normal appearing skin of the infected partner.  Asymptomatic shedding occurs in the neighborhood of 10-12% of the time and is independent of the duration of infection after the first year, as well as whether or not the person with infection has recurrences or not.
2.  Interestingly,. most exposures to sex partners who are asymptomatically shedding the virus do not lead to transmission of infection.
3.  In the largest study of HSV-2 transmission, the rate of transmission to un-infected partners who were aware that their regular sex partner has HSV was about 5% (1 out of 20) per year.
4.  Among persons who took 4 precautionary steps - 1.  Disclosure that they were infected to their sex partners, 2.  Avoidance of sex during clinically apparent recurrences, 3  Correct and consistent condom use, and 4.  taking daily suppressive therapy with valacyclovir, the infection rate was reduced by about 50%.  Which of the 4 components contributed the most and whether persons followed their instructions is unknown.

In your situation, I would recommend the following:
1.  Discus this with your partner.
2.  She should have a type-specific HSV blood test.  There is about a 1 in 4 chance that she has HSV but does not know it.  If she is, nothing to worry about, she will not get infected twice
3.  Based on these results, decide your course of action.

Hope this helps.  EWH