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Risk of Herpes Transmission
I was diagnosed with HSV2 (genital herpes) in 1992. Initially I had many outbreaks per year but now I have very few outbreaks (haven't had one in more than a year). I got married 4 years ago and we have a beautiful 3 year old son. I have managed not to infect my wife by avoiding sex when I have an outbreak. We do not use condoms or I am not taking any medication like Valtrex. I have never take any medication for my HSV2 infection.
My question, is what is the risk of infecting my wife with HSV2 if we continue to have vaginal sex 2-3 times a week without a condom and while I don't have an outbreak. I know that there is still a risk but I read in a previous post that Dr. HHH said it is between 3-4% annually. Can you explain further ? Also I would like to know if the risk is minimized further by using condoms ? In addition, I would like to know if I should look into treatment with Valtrex to minimize the risk of infecting my wife ? She has never been tested for HSV2 but has never complained about pain or blisters in her vaginal area. Is there a chance that is is infected already? I would really like to avoid infecting her but at the same time believe that sex is a very important part of marriage.
My question, is what is the risk of infecting my wife with HSV2 if we continue to have vaginal sex 2-3 times a week without a condom and while I don't have an outbreak. I know that there is still a risk but I read in a previous post that Dr. HHH said it is between 3-4% annually. Can you explain further ? Also I would like to know if the risk is minimized further by using condoms ? In addition, I would like to know if I should look into treatment with Valtrex to minimize the risk of infecting my wife ? She has never been tested for HSV2 but has never complained about pain or blisters in her vaginal area. Is there a chance that is is infected already? I would really like to avoid infecting her but at the same time believe that sex is a very important part of marriage.
MEDICAL PROFESSIONAL
Most people with symptomatic genital herpes have declining frequency of outbreaks as the years pass. You are typical; even busy STD or infectious disease specialists rarely seen persons who are say 40 years old, had genital herpes at age 25, and still are having frequent outbreaks. The biological reasons are not well understood. There have been no studies to know whether asymptomatic shedding (and thus transmission risk) also declines with time, but most likely it does.
Corey L, et al, New England Journal of Medicine, 2004;350:11-20 (the issue of January 22, 2004). Monogamous heterosexual couples, average frequency of sex 2-3 times per week, generally no condoms, generally avoiding sex with symptoms (pretty much like you).
Corey L, et al, New England Journal of Medicine, 2004;350:11-20 (the issue of January 22, 2004). Monogamous heterosexual couples, average frequency of sex 2-3 times per week, generally no condoms, generally avoiding sex with symptoms (pretty much like you).
Thanks Dr. HHH for your thoughtful reply. Just wanted to know why my outbreaks are a lot less frequent now compared to when I first got infected ? Has the HSV-2 virus gotten "old" and deteriorated in my system ? Does this mean it is less likely to infect my wife ?
Also I wanted to clarify the 5% annual transmission risk. The study was done on heterosexual couples engaging in unprotected vaginal sex when no outbreaks ocurred ? Can you give me the link to the study to obtain the details ?
Also I wanted to clarify the 5% annual transmission risk. The study was done on heterosexual couples engaging in unprotected vaginal sex when no outbreaks ocurred ? Can you give me the link to the study to obtain the details ?
MEDICAL PROFESSIONAL
The opening sentence of my reply is supposed to say "You cannot know that your wife hasn't been infected, since she has NOT had a negative antibody test...."
MEDICAL PROFESSIONAL
You cannot know that your wife hasn't been infected, since she has had a negative antibody test for HSV-2 and most infections are asymptomatic or unnoticed. As a sexually active person (presumably) before you got together, there's at least a 20% chance she had it before your marriage; and after 4 years of unprotected sex, she could have acquired HSV-2 from you, regardless of the precautions you have taken. Your next step definitely is for her to be tested. If she is positive for HSV-2, nothing more need be done, i.e. you need take no precautions at all.
Even if she is negative and therefore susceptible, the transmission risk might be quite low. Given the natural course of genital herpes and your history of declining and now infrequent outbreaks, you might not have frequent asymptomatic viral shedding--but there is no way to know with certainty. The available research suggests that if you avoid sex when having a recognized outbreak, the chance of transmission in couples like you is somewhere around 5% per year. You could reduce that risk still further by taking valacyclovir (Valtrex) or one of the other anti-herpes drugs. And yes, consistent condom use also is highly protective. Neither treatment nor condoms are foolproof, but used together--along with avoidance of sex if/when you have an outbreak--will reduce the risk to very low levels.
However, you should not make a unilateral decision about the importance of avoiding transmission and what precautions to take; it's a decision for you and your wife to make together. Studies show the greatest fear most people have about herpes is the impact on dating and developing new relationships. Assuming you have a mutually committed relationship and don't need to face the herpes/dating issues, maybe it doesn't matter much. If your wife gets infected, it might be so mild she never knows it; and if she gets symptoms, effective treatment is available. In your situations, some couples just decide to not worry much about it, especially when the risks of transmission are fairly low, as in your case. Don't get me wrong: it's best for your wife to not get infected. But it is worth considering whether it is worth consistent condom use and/or taking a relatively expensive drug on a daily basis for years on end.
In other words, suggest to your wife she be tested, then figure out together what you want to do. It's a personal choice, not primarily a medical one.
I hope this helps. Best wishes-- HHH, MD
Even if she is negative and therefore susceptible, the transmission risk might be quite low. Given the natural course of genital herpes and your history of declining and now infrequent outbreaks, you might not have frequent asymptomatic viral shedding--but there is no way to know with certainty. The available research suggests that if you avoid sex when having a recognized outbreak, the chance of transmission in couples like you is somewhere around 5% per year. You could reduce that risk still further by taking valacyclovir (Valtrex) or one of the other anti-herpes drugs. And yes, consistent condom use also is highly protective. Neither treatment nor condoms are foolproof, but used together--along with avoidance of sex if/when you have an outbreak--will reduce the risk to very low levels.
However, you should not make a unilateral decision about the importance of avoiding transmission and what precautions to take; it's a decision for you and your wife to make together. Studies show the greatest fear most people have about herpes is the impact on dating and developing new relationships. Assuming you have a mutually committed relationship and don't need to face the herpes/dating issues, maybe it doesn't matter much. If your wife gets infected, it might be so mild she never knows it; and if she gets symptoms, effective treatment is available. In your situations, some couples just decide to not worry much about it, especially when the risks of transmission are fairly low, as in your case. Don't get me wrong: it's best for your wife to not get infected. But it is worth considering whether it is worth consistent condom use and/or taking a relatively expensive drug on a daily basis for years on end.
In other words, suggest to your wife she be tested, then figure out together what you want to do. It's a personal choice, not primarily a medical one.
I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
