Herpes Transmission Questions

[c-biskit]

Back in July I started a thread (Herpes Exposure Timeline) asking when it was likely I acquired herpes. Since that time I have had a blood test confirming genital HSV-2, I was on Valtrex for a week, and everything has cleared up. Blood work for other STDs, including HIV, came back negative. I also got a bacterial infection from the same sexual encounter and I have found out I have high-risk HPV (colposcopy showed no abnormal cell growth).

I have been reading all the posts on the forum since I found out about the herpes and have also been doing a lot of reading on other websites. Unfortunately, the more I read the more confused I get...

In one of your recent posts you said, "Among couples in which one has genital herpes and the other does not, and who have unprotected sex 2-3 times per week, the risk of transmission is only about 3-4% per year. That translates to a very low risk for any particular sexual exposure." I acquired the HSV-2 after my third unprotected encounter with someone who swears he doesn't have it. So while the risk of transmission is very low, it can, and does, happen. On the three different occasions I was with him, we had sex eight times -- vaginal, receiving oral and arse play. (My partner did go to a doctor to get a blood test and the doctor told him it wasn't necessary because a test would be of no value, so he did not get tested. All I know is my status.)

Since this is the last time I can post a new question for a few months, I am going to make it count! Here are my questions (all assume that there is no outbreak during an encounter and that the other person is negative for either HSV):

1) If someone is giving me oral sex, can they get infected orally?

2) If I am giving someone a back rub and straddling their back, can I pass the virus on if that person has an open sore (pimple, ingrown hair, etc.) on their back? (My doctor said it is possible.)

3) During mutual masturbation, if I finger myself then touch my partner's penis, anus, or mouth, can the virus transmit that way?

4) Since my outbreak was genital, I am unable to pass the virus when I perform oral sex on someone else. Is that correct?

5) My doctor recommends I take Valtrex only if I get another outbreak, then see how it goes from there. Is it a good idea to take Valtrex on a continuing basis or just as needed during outbreaks? Does taking Valtrex continuously lessen the chances of an outbreak, or just keep outbreaks from lasting longer?

After the initial freak-out stage, I am sure that having HSV-2 is really no big deal. I just want to be able to explain to partners the risk and ways to prevent transmission, yet still have a fulfilling sex life.

Thank you in advance for taking the time to answer my questions.

c-biskit

[H. Hunter Handsfield, M.D.]

The fact that the overall risk of transmission is 3-4% per year in monogamous couples doesn't mean it never happens, and I never said that.  Someone hit by lightning can't rationally argue "I guess it wasn't lightning after all, because lightning strikes are rare".  In any case, herpes transmission tends to occur early in relationships.  Your story, cathing HSV from a new partner soon after a relationship begins, is very typical.

To your questions:

1) Yes, a partner can acquire oral HSV-2 by performing oral sex on you.  The risks seem to be lower than for genital sex; oral HSV-2 infection are uncommon despite the frequency of oral sex.

2) That sounds like a zero transmission risk to me.

3) In theory, genital-hand-genital transmission is possible.  But this also is too rare to worry about; I have never seen a case in which such transmission was plausible or even suspected.  You should avoid even this sort of contact when you are having a symptomatic outbreak, but otherwise I wouldn't worry about it.

4) That is correct.  If you don't have oral HSV infection, you cannot pass HSV by oral contact with someone.

5) The pros and cons of suppressive versus episodic treatment are complex.  In general, most experts lean toward advising continuous rather than episodic therapy.  Suppressive therapy totally prevents symptomatic outbreaks in 60-70% of people with recurrent genital herpes due to HSV-2, markedly reduces the frequency of outbreaks in the remainder, and shortens the duration of those oubreaks that still occur.  By contrast, episodic treatment reduces the average duration of the outbreak by only 1-2 days, i.e. from an average of 10-12 days to an average of 8-10 days.  The final big advantage of suppressive therapy is that it greatly reduces the risk of transmission to sex partners.  However, despite all that, some people prefer episodic treatment for each outbreak, especially if they are having infrequent outbreaks, or if their partners already are infected.

You definitely are on the right track, both in your perspective on the disease and your desire to protect your partners.  A final word about transmisison:  The maximum risk of transmission is in the first few months after a person becomes infected.  (The odds are pretty good that the partner you caught it from was infected fairly recently before that.)  Be compulsive about condoms for all sex and avoiding sex when you have symptoms, and consider suppressive therapy, or the next 6-12 months.  After that, the risks will be lower.

Regards--  HHH, MD

[c-biskit]

Thank you for answering my questions.

I wasn't implying that you never said that HSV transmission never happens in monogamous relationships. I was just pointing out that, while the risk is very low, it can happen. We did go at it like bunnies until all this happened. I guess it was just my lucky day (should have bought a lottery ticket that day -- Oh, wait, I did. Darn my luck!).

I am almost wondering if my (former) partner knew he was infected by his reaction and lack of concern. I hate to believe people would be like that, but that is for an entirely different forum.

I will talk to my doctor about giving me a Valtrex prescription for suppressive treatment for the next 6-12 months. Sounds like the better way to go to me.

Thanks again,
c-biskit