Removed lymph nodes and genital herpes

[Canadienne]

I have been a genital herpes carrier for the last 5 years. My outbreaks are very mild and very infrequent. I am in a very happy (but not sexually intimate) relationship with a non-carrier partner. It is my understanding that his immune system is severely compromised because he had one of his under jaw lymph nodes removed about 15 years ago. He is quite prone colds and infections. I am afraid to seriously damage his health if we were to become sexually active and if he were to contract herpes from me. I am well aware about the management of the transmission risks, however, as there is no 100% reliable protection, I would like to understand to what kind of dangers he will be exposed if he were to become a herpes carrier as well. Frankly, I am looking for a hope - I am very much in love with him - but if there were no hope, I would rather leave him than endanger. Your kind advice will be highly appreciated. Thank you.

[Edward W Hook, MD]

I realize my answer was a bit convoluted but I did answer this as well.  To expand a bit:

1.  There is no reason to think that the mechanical act of taking out a lymph node will change his ability to fight infections.  Should he get infected, there is no reason to think either the herpes or his vulnerabiltity to either future herpes outbreaks OR to other infections would be increased.
2.  Not necessarily.  Most herpes transmission occurs when individuals are asymptomatic and in the study which showed that suppression reduced risk for HSV transmission there were still some transmissions, just fewer.  FYI, there are now polyurethane condoms which some people think are better than latex, albeit a bit more expensive.
3.  Yes, if you are having a genital outbreak there is no reason to think that oral sex on your part would place him at risk.

Hope this helps.  EWH

[Canadienne]

Thanks a lot for the clarification and the advice! You have been very helpful!

[Canadienne]

Dear Dr. Hook,

My apologies, when I was talking about the health risks to my partner, I meant not his increased risk to acquire herpes, but the complications to his health in case all precautions fail and he would contract genital herpes from me.

1. Will the fact that he becomes a herpes carrier trigger him ever further weakness of the immune system and open him to more infections? His lymph node was removed due to the perceived inflamation in the node at the time when he was 19 (actually, nobody remembers anymore clearly, it has been more than a decade since then).

2. Unfortunately, I have a mild allergy to latex. Would it be fair to consider that the transmission risk during unprotected sex (no condoms) is very low if I am consistently taking suppressive therapy medication and very sure that I am not anywhere an outbreak (even though it is subjective, I do know extremely well how my body responds to the virus)?

3. Would it be fair to say that, at the time when I am in an outbreak, his risks to aquire herpes during oral sex given by me to him (I know, no contact with the impacted area on me!) are very low?

Thanks a lot for the clarification!

[Edward W Hook, MD]

I think his risk is very low.  You did not say why had the lymph node removed or how old he was when this occurred however, once a person is a teenager, their immune system is pretty much established unless they incur some sort of disease (cancer, other) which impairs their immunity, there is no reason that the simple, mechanical act of removing your partner's lymph node should put them at greater or lesser risk for herpes or, should he acquire it a different (i.e. more severe) natural history of infection.  

Finally, I would add that lymph nodes act regionally to fight infections so the severity of your friend's sore throats and colds may reflect a regional variation in his ability to fight infections, rather than a more generalized, systemic one.

It goes without saying, as you've already mentioned, that in any relationship in which one partner has genital herpes, appropriate precautions, i.e. condoms and possibly suppressive antiviral therapy are to be recommended.

Hope this helps.  EWH