Spreading Herpes

[movingforward1]

I am female and have had Herpes for over 25 years.  When I was diagnosed it was believed that you could only transmit the virus when you had an active outbreak.

I have always made sure I didn't have an outbreak prior to being sexually active. I have always guided myself by that information, not knowing about the possibility of shedding. To date I have not spread the virus.

I am currently in an 8 year relationship, and we have never used protection and I wasn't taking anti-viral medication regularly (only when having an outbreak or feeling that one was coming on). We have done everything a healthy couple would do.  My partner has been recently tested for the virus and he does not have it.

My question is if he has not contracted the virus after 8 years what are the chances he won't, with the added precaution of taking anti-viral medication as a suppressive therapy? Are there some people who are immune to the virus and if so is there a test that will confirm this?

We have also enjoyed an active oral sex life.  Can he contract the virus by performing oral sex on me when there is no outbreak present?

Thank you for your help

[H. Hunter Handsfield, M.D.]

Your belief about transmission was perfectly accurate, according to medical knowledge when you were diagnosed:  25 years ago I told all my herpes patients they could only transmit when having an outbreak.  The current knowledge about asymptomatic shedding and transmission started to emerge about 15 years ago and became widely accepted in the middle 1990s.

You don't say whether or not you still have symptomatic outbreaks, but after 25 years, most people do not.  The frequency of asymptomatic viral shedding probably also declines over the years, but this has not been carefully studied.  Probably in part for that reason, the longer a regular sexual relationship continues without transmission occurring, the less likely it will occur at all--even without antiviral therapy.  However, nobody can say the risk is zero. If you still have noticeable outbreaks, you definitely still could transmit HSV to your partner.  That risk is further reduced by taking suppressive therapy.

You don't say how your partner was teated. If he had a proper blood test that was negative for HSV-2 (which presumably is the type causing your infection), he is fully susceptible.  (Actually, some experts believe some people may be inherently more resistant to HSV than others, but that isn't proven and in any case there is no test for it.)  He is susceptible to oral as well as genital infection, but oral transmission is uncommon--at least, STD clinics rarely see patients with oral HSV-2 infection.

In summary, having not transmitted after 8 years of regular sexual contact, presumably both oral and genital, I don't suggest you change anything, especially if you continue taking antiviral therapy.  Just avoid sex during outbreaks and don't worry about it much.  Anyway, if your partner gets infected, how big a deal would it be?  If he gets symptoms, they can be treated; and if he isn't having sex with others, there is no risk of transmission.  In that context, genital herpes is a trivial problem that should never be permitted to interfere with a committed couple's sexual satisfaction.

Good luck--  HHH, MD

[gracefromHHP]

I'm a numbers person - I have to see numbers to put it in perspective myself.  On average if you two do nothing but avoid sex during obvious lesions then he is about 96% likely each year NOT to contract hsv2 from you.  Suppressive therapy with valtrex has been shown to reduce that risk in half.  Statistically the difference between 4% and 2% isn't significant when you think about.  Yes indeed you'll hear us online (I do it myself ) advocate daily suppressive therapy in a discordant relationship but that's mostly because the folks who are posting on the boards aren't in established long term relationships so to me the peace of mind is worth it plus I like to make sure folks know that's an option even if they don't chose it now.  I think you and your partner have seen that it really is almost as much about bad luck when you transmit the virus to a partner as anything so as HHH said - if it's not broke why fix it? Don't feel that you HAVE to be on daily suppressive therapy.  If at any point in the future you are having ob's more often - it's always an option - for as much as when you are living with herpes for a lifetime who needs more ob's anyways?  I know I"ve sure had more than enough of them over the years myself!!

grace

[movingforward1]

Thank you Dr. HHH, I really like your site and and feedback is so prompt.

Without suppresive therapy I have 2 -3 outbreaks yearly lasting approx. 2 days.
When we are not expecting to spend time together I let them run there course, I figure it is better to build up my immunity.

My partner had a type specific blood test, for HSV2 with negative results.

He wasn't tested for HSV1 because he can remember having a cold sore or two about 20 years ago.  I have read that you are less prone to contract HSV2 if you are already infected with HSV1, is there any truth to that?

[gracefromHHP]

hsv1 doesn't offer any significant protection against contracting hsv2.

grace

[H. Hunter Handsfield, M.D.]

From a practical perspective, Grace is right.  Actually, there are conflicting data on whether or not HSV-1 provides partial protection against HSV-2. It probably does, but with only a small effect. You cannot count on it to provide meaninful protection.

[movingforward1]

Dr HHH, your advice and information has been great. I have been reading some of your responses to other concerned individuals.

My partner is very concerned about contracting this virus and having said that I notice another individual (Englishman from Mar 27, 07) enquired whether him (HSV2 negative) taking an antiviral (valtrex) prior to exposure would reduce his chances of contracting the virus.  I know you said that testing has not been done on humans but on animals it did work.  If that is the case would you advise someone who is concerned about contracting the virus to take the valtrex to ease their concerns?

[t1234]

I think it's correct that HSV-1 provides a level of protection against
HSV-2 especially in women.  You may be interested in the following
if you haven't already seen it.

"Seroepidemiology of Herpes Simplex virus type 1 and 2 in Western
and Southern Switzerland...." BMC Infectious Diseases 2004, 4:10
online http:/www.biomedcentral.com/1471-2334/4/10.

I think reductions in HSV-2 infections in women with HSV-1 infections
were > 20 per cent . In men this difference wasn't nearly
as great.  The gender differences in levels of protection are interesting.

[gracefromHHP]

The argument about hsv1 protecting against hsv2 at all has been going on for a long time back and forth in the journals. One study shows it protects somewhat then another says not at all then another says maybe and so on and so on.   The reason I personally always say it doesn't offer any significant protection is because in the groups who have the highest hsv1 infections - they also have the highest hsv2 infections so therefore any teeny bit of protection it might offer isn't enough to stop using additional precautions against with a hsv2+ partner.  Even a 20% reduction isn't much better than just crossing your fingers each time you have sex with a hsv2+ partner.

grace

[H. Hunter Handsfield, M.D.]

I agree exactly with Grace.  Also, data from the sort of study cited by t1234 can give only very soft clues.  Several other similar reports have had results both for and against the notion of cross protection.

There are only 2 strong scientific studies on the issue.  Both were based on large numbers of placebo recipients in research studies of experimental vaccines against HSV-2.  The two studies had almost identical study designs and very similar numbers of patients (including placebo recipients), and the study subjects were very similar demographically (age, sex distribution, etc).  One study showed apparent protection:  people with HSV-1 had a lower rate of catching HSV-2 from their infected partners; and the other showed no difference whatsoever, not even a hint of cross-protection.

For a variety of reasons, I believe the study showing cross-protection probably more reliable, but that's a soft judgment.  And even in that study, the degree of protection was modest.  Grace is exactly right in how patients at risk should be counseled.  If there is a protective effect of HSV-1 against HSV-2, it is not sufficient to be useful.

The issue is further confused, be cause there IS a well-documented CLINICAL effect:  When people with prior HSV-1 acquire HSV-2, they tend to have less severe initial symptoms than those without HSV-1.  Some people citing a protective effect probably are confusing these results with the studies above.

HHH, MD

[t1234]

For me this study was interesting because of the gender specifics, but you can look at it for yourself and draw your own conclusions.

I was fairly large scale:

A total of 3,120 sera were analysed by typespecific gG-based ELISA and seroprevalence was correlated with available volunteers characteristics by logistic regression.

I mean large scale when compared to many of the studies we "hang our hats on" which involve less than 100 people.

This of course should not be intrepreted as  meaning HSV-1 infections
will prevent you from acquiring genital herpes.  That's nonsense.

[H. Hunter Handsfield, M.D.]

The size of the study you cite, with which I am very familiar, actually reflects its weakness.  The numbers are big because the authors analyzed community-wide public health database, not a research study.  There are giant biases that go into every public health database.  That study has at best one tenth the significance, as an indicator of the relationships between HSV-1 and HSV-2, as the two studies I cited above.  If offers only weak support, at best, for the idea that HSV-1 protects against HSV-2.