Herpes HSV2 Transmission in herpes-discordant couples

[sleepless71]

I recently read a post, dated 4/21/2005
Topic: STD - General
Subject: Theoretical herpes question

Dr. HHH, in one of your responses you indicated "...most transmissions occur early in new sexual relationships. It is likely that most people who have been infected for many years are not highly infectious (but the risk is never zero!); and in many (most?) herpes-discordant couples, if transmission doesn't occur in the first year or two, it will never happen."

I have been involved in a relationship where I didn't know I was infected with HSV2 and we were not taking any precautions, other than birth control, or using condoms.  After 2 1/2 years into the relationship and both professing how great this relationship is, I learned of my infection.  I believe I was probably infected during my college years and part of the 90% who didn’t know.  Both tested w/HerpesSelect IgG I am + and she -.  My girlfriend freaked and wanted out of the relationship for fear of contracting it.  Subsequently, we have been together, but not sexually.  Should my girlfriend be willing to consider intimacy again, how factual is your statement and is there any substantiating information I could find?

Also, you stated that you counsel herpes-discordant couples.  Is there a way I could find a counselor in my area from which we could seek counseling?

If I could acquire this kind of information, I think it could calm my girlfriend’s fear and we may be able to resume our relationship.  Dr. this gives me a bit more hope in this regards.  I really appreciate your response.

Thanks, Sleepless71

[H. Hunter Handsfield, M.D.]

You don't need counseling as the first step; what you need is for your girlfriend to be tested for HSV-2.  Considering a 2.5 yr relationship with a man now known to be infected, it's a pretty good bet she already has it.  If so, she need not worry about catching it again, and if she has no symptoms, she probably will never get symptoms.  And if not, the two of you can take precautions to help prevent future transmission.  Regardless of the result, any counselor will be much more able to help if the two of you know one way or the other whether she is infected or susceptible.

Anybody who would break up a long-term, committed relationship because of herpes is behaving inappropriately, either because they don't understand the disease or because they are immature or have other problems.  With rare exception, herpes just isn't that big a deal.  But of course sometimes herpes just becomes an easy out for someone who is already unhappy.  I can't judge which of these scenarios might apply to your partner.

[bogie2767]

I have been with only 2 people for the last 30 years. 26 with my ex-husband and 4 years with my new partner.I was recently diagnosed HSV-2. I never knew this until I had a recent mild outbreak and 2 subsequent positive blood tests. I do not know if my ex is positive, but I will assume for the moment I contracted it from him given the length of time with one person. I never noticed any lesions on him or me prior to this recent outbreak of mine. My new partner has not tested positive. I have had unprotected sex with both my ex when we were together and with my new partner (for the last 4 years).
Four questions:
1)What are the chances that I contracted this prior to the 26 years with my ex;
2)If my new partner has not contracted it with shedding and 2 outbreaks, and unprotected sex all this time, what's the chance that he will never get it;
3)If I take Valtrex daily, will that eliminate the risk of transmission; and
4) If my new partner and I take Valtrex daily, will that eliminate the risk of transmission?

[H. Hunter Handsfield, M.D.]

1) From the history you provide, I can say nothing about how long you have been infected.  But if your new partner has had a proper test and the result was negative, you clearly didn't catch it from him.  That leaves either your ex-husband or some other partner, perhaps in your distant past.

2) Among most herpes-discordant couples, transmission eventually occurs.  But I can't put a number to the risk it will occur in your case.  You can reduce the risk by avoiding sex when you have outbreaks; and by using condoms, if acceptable to both of you

3) Valacyclovir (Valtrex), and probably acyclovir or famciclovir, would reduce but not eliminate the risk of transmission.

4) There are no data on whether a person EXPOSED to herpes while taking antiviral therapy has a reduced risk of infection.  The only research has been done with the infected person taking the drug.  It probably is sufficient for you to take the drug, not both of you.

Remember, if your partner gets infected, it likely will be so mild he doesn't even know it.  And if he gets symptoms, effective treatment is available (althought it's not a cure).  So most committed couples in your situation shouldn't care very much whether transmission occurs, as long as there are no other partners at risk.

Good luck--  HHH, MD

[t1234]

I may be reading Sleepless71's question incorrectly, but I
think he's saying his girlfiend was tested for HSV2 and
she is negative.  As Sleepless71 apparently never had
systems it's interesting his girlfriend didn't get HSV2 from him after 2.5 years.

I think Bogie71 reported an outbreak so unlike Sleepless71
she was symptomatic.

As a side note• The USPSTF just came out with a recommendation against routine serological screening for HSV in asymptomatic adolescents and adults. Apparently, they found no evidence that screening asymptomatic adolescents and adults with serological tests for HSV antibody is of benefit or that's their opinion.

They claim "Potential harms of screening for HSV-2 include labeling, anxiety, and disrupting partner relationships. A qualitative assessment of the psychosocial impact of a serological diagnosis of HSV-2 concluded that patients may experience strong psychological responses to their diagnoses...."  Apparently this is current
March 2005 and can be referenced at www.ahrq.gov/clinic/uspstf05/herpes/herpes.htm

As you know, I never miss a change to argue for a Clinical trial
or exhaustive statistical study to determine once and for all if
members of the asymptomtic population represent a health risk
to their partners and if so to what extent.

I noticed one of the members of the task force was from a major Managed Care Provider who has in the past financed unrelated studies. I wish someone like them would get interested in doing it.

Hope you will take this in the spirit it's offered.

[H. Hunter Handsfield, M.D.]

I think you're right; I mis-read sleepless71's message about his girlfriend's negative test. Apologies to sleepless.  But his and his GF's options for protecting her are unchanged, and the consequences of transmission will not necessarily be serious.

The USPSTF recommendations against routine HSV blood tests, they indeed are controversial.  But that debate really isn't pertinent to sleepless71 and his partner, or to the large majority of questions on this forum about HSV blood tests.  The USPSTF recommendations relate only to screening--i.e., testing people without a particular suspicion of infection, such as all sexually active persons or those with other STDs.  There is no debate about the value of testing when a person at risk specifically asks to know whether s/he has HSV-2; for diagnostic testing, i.e. when a person has symptoms that suggest herpes; or when one member of a couple is infected and they need information on whether the other person is infected or susceptible.

And as it happens, in the debate about routine testing of all sexually active persons or all those attending STD clinics, I am on the side that agrees with USPSTF, that is not to routinely test.

Thanks for bringing it up.  Apologies again to sleepless71 for the confusing initial response.

HHH, MD

[sleepless71]

Dr. HHH, thanks for your response, but I am confused.  The reason for my inquiry is based on what I quoted in your answer on 4/21/2005,..."most transmissions occur early in new sexual relationships. It is likely that most people who have been infected for many years are not highly infectious (but the risk is never zero!); and in many (most?) herpes-discordant couples, if transmission doesn't occur in the first year or two, it will never happen."

Now in your answer to my post you are saying "Among most herpes-discordant couples, transmission eventually occurs."  

These seems to be conflicting comments.  Could you please clarify?

Thanks,  Sleepless71

PS: By the way, I was on of those tested, found HSV-2 + and went into a highly anxious depressed state, lost 15 lbs and couldn't sleep for a month and have been in counseling for my self. I don't think testing should be done!  It does couse extreme pshchological stress if found positive!

[t1234]

Sounds like Sleepless was "caught up" in a STD Screen that included a Herpes Test without realizing the implications

[sleepless71]

Do you think I have to create another question to get a response to my last comment?

Also, t1234, you seem to be very up on this stuff.  When diagnosted, it was after having some symtoms that I never had or knew of, I studied this and was over obsessed.  Since I have backed off a bit, but an curious about asymtomatic transmission as you.  How does the medical community really know the risk?

Thanks, Sleepless 71

[t1234]

One question, why did you originally get the Herpes Test?

I'm not a doctor, but my understanding is that asymptomatic
transmission in people who have physical symptoms (ulcerated
sores) is well documented.  This most likely occurs right
before a breakout. So if you have breakouts you  can transmit herpes to your partner even during periods when you are not
experiencing breakouts.

However the problem is that only 20 per cent of the people
who test positive to a HSV2 Blood test actually have symptoms
or even realize they have the herpes virus in their systems. In this population the transmission rate has not been determined to my knowledge.

It's possible that even if persons in this population shed the virus its at such a low viral load, etc. (their immune system obviously has the virus "under control") that its transmission rate would be unmeasurable.  But at this time who knows.

In my view, a clinical trial needs to be ran
before we "charge out" and tell people who have never had symptoms they are contagious, destroy their relationships, etc., or for that matter put them on expensive antiviral for purposes of suppressive therapy.

But that's just my opinion.  

I think the important thing for yourself, is why you had the
test.  Was it because of a physical symptom, or was it because it was included in a "packaged STD screen", or because you saw
something about Herpes on an "alarmist web site" or  an advertisement selling testing?

[bogie2767]

Thanks Dr.H...the relationship may fall apart because of the Herpes even after much research and explanations. It's a matter of "I don't want to get it". It's sad but true as we were planning to get married. Condoms, spermicides, latex gloves (yes, latex gloves!), Valtrex, and an attitude that makes me feel like I have leprosy have all contributed. It's just not the same anymore. Our lives have been forever changed because of a virus I contracted somewhere along the line and never knew I had or even worse, don't know where I got it from. Being a 'good' girl in 2 relationships over 30 years did me no good. At this point, the bottom line is, I would like to see more research done, but the medical community seems to have become desensitized to this virus. This IS a big deal in a relationship where one is infected and the other is not. It effects you emotionally, mentally, and physically in the relationship and just in everyday life.

[sleepless71]

I agree, despite my girlfriend being with me for 2 ½ years and not contracting it, she wanted to break up with me because of it.  I was devastated and went thru all those things you said, emotional and physical anxiety, depression, feeling like I have leprosy,  and losing 15 lbs.  Since this disease does is not lethal and most people do not exhibit symptoms, I would not want anyone to get tested and go thru what I went thru.  

I have been persistent in continuing to pursue my relationship with my girlfriend and I have made progress.  We don’t have the physical relationship we had, but the emotional relationship is building back to what we had.  Oh, by the way, tell your boyfriend that transmission from women to men is half that of men to women.  The stats are with valtrex and condoms 1 ½ % or you could say 98.5% risk free.  Good luck to you.

[sleepless71]

I may have had physical symptoms, but was ignorant of them.  In the last year, I noticed the some type of sores on my shaft and showed them to my girlfriend.  At first it was dismissed.  I even should them to my primary physician who also dismissed them.  It reoccurred several months later and I again showed my girlfriend and asked what it could be and herpes came to mind so we got tested.  The rest is history at this point.

[bogie2767]

Thanks Sleepless....I wish I had had symptoms long ago because then I would know - I would know when I contracted it and from whom. My ex is still the primary suspect, but of course it could have been contracted when I was in my late teens for all I know. After all Herpes acts as Herpes wants to act and when.  I have had zero, zippo, nada symptoms until recently and I believe the outbreak was brought on by the significant stress and strain of being a full time parent, working full time and getting a masters degree in a very short 10 months. Felt more like being close to a nervous breakdown. I survived it and my life is so much easier and simpler now that I have graduated. I think it is just too hard for some to overcome the fact that you can't just take something to make it go away or wash it off. The virus and the stigma of having an STD is with you for life. There are no guarantees except the partner will eventually contract it. Like he said, what happens if I get it and something happens to you?

[t1234]

It's too bad herpes is being viewed in a sexual context instead
of just a skin desease.  I assume you've seen your partners
blood test lab results, and he is indeed negative.

Depending on the study referenced, after age 30, 30 per cent of white women and 60 per cent african american women (in spite of the fact, statistically speaking, they have less sex partners than white women)  are seropositive to HSV2.

I've just guessing, but I suspect after age 50 (I'm in my late fifties, a great age!!!) , most single people have been married and divorced at least once, so the HSV2 positive rate for them must be much higher.

So your friend may find (outside of ignorant bliss) that
it will be harder than he thinks to find an available
seronegative partner.

Hopefully, he will reflect on this.  But if not, I don't think
you'll have any problems finding a good man who doesn't care
about your HSV2 status.