HSV Tranmission in discordant relationship

[real1119]

Hello Doctor.  I need to thank you and this entire community for the service that is provided!

I am a 28 year old male.  I'm sure that I have HSV1 orally since I used to get cold sores, but haven’t in 10+years. I would think that due to a limited sexual history and no symptoms that I do not have HSV2 genital. (I do plan on getting tested soon to make sure because I know there is a chance.)

I am currently in a relationship with a woman who has been diagnosed with HSV2 two years ago.  I love her and accept her for who she is.  We have been dating for a year and I will hopefully marry her.  My question is what are the odds of her giving me HSV2 from unprotected sex?  I have read this answer many times on here, but get confused that it would be 4% because the study that is always referenced says that the participants were told to always use condoms, but many did not at times.  In my thinking, that would mean this rate of transmission would be higher because of some condom use?

She takes daily Valtrex and we have used condoms, but during special occasions I would like to go unprotected.  If/hopefully we get married, I will 100% accept the risk of acquiring HSV-2 to have unprotected sex and a healthy and rewarding physical and emotional lifestyle.  I am whiling to accept some risk now, I would surely take my chances with this girl unprotected if the risk truly is <5% annually.  My family Dr. who I am very close to tells me to be sure I wear a condom every time and never go unprotected.

Any details of the data for unprotected sex would be appreciated and any other medical/personal advice to help me handle this situation is appreciated.  Thank you!  

[Edward W Hook, MD]

Glad to help.  Take care.  EWH

[real1119]

Thank you! This is pretty much what I was thinking.  You comments and insight are very helpful!

[Edward W Hook, MD]

Welcome to the Forum.  I understand the dilemma you have and congratulate you on your approach to it.  The transmission of HSV-2 in discordant couples is a "numbers game".  As you note, the rate of infection from the best study of discordant couples (the one which proved the utility of valacyclovir suppression) was about 6% per year over the course of the study. On the other hand, I have cared for couples in which there has been no transmission for years despite no use of any protective measures at all.  That your partner is taking suppressive therapy is very helpful and reduces your risk of infection by about half.  Avoiding sex when and if she has outbreaks will also help.  That you have HSV-1 is also statistically associated with decreased risk of acquisition on your part.  

Obviously, I cannot tell you how to be completely free from risk of infection.  I think you are doing the right things and can understand if you opt not to use condoms.  Chances are that will not lead to infection (most exposure to infected partners do not led to transmission), given the other precautions you are taking.  Even should you become infected, while I do not mean to minimize things, this is by no means the end of the world.  I hope this comment is some small help.  EWH