STDs Expert Forum
Stressed about HSV 2 Transmission
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Stressed about HSV 2 Transmission

I am a female who was diagnosed with HSV 2 eight years ago.  Since then I have not had anything I can recognize as a recurrent outbreak.  I did take medication for herpes after my initial out break and diagagnosis, but after consultation with my OB I stopped because of the lack of recurrent out breaks.  As I have gotten more information on HSV and asymptomatic shedding I have tried to share it with partners before the relationship developed into a sexual one. But my question deals with digital stimulation. Is there a risk of transmission if a partner stimulates me and possible touches himself using the same hand and is it something a potential partner should be aware of.  Also, since I'm asking, would a brief unprotected countact with my vagina and a partners tourso create a risk for transmission?  I'm currently starting a new relationship and I want to make sure I have information if the relationship does progress.  Thank you for your time.
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Welcome to the forum.  Your questions are reasonable and I'm happy to help lower your concerns about herpes transmission.

Assuming your original diagnosis is correct, you should assume that from time to time you shed virus in your genital tract in the absense of symptoms.  It is difficult to know how frequently; your lack of symptoms doesn't make much difference in transmission risk.

In theory, it would seem that hand-genital contact could result in transmission.  For example, a partner could contact infected secretions then scratch him- or herself and inoculate HSV at that site.  However, there are 3 lines of evidence that this does not occur, or at most extremely rarely.

First, if that happened, we should see occasional new herpes infections equally at all the sites where people normally scratch themselves -- an arm, a leg, the face, the abdomen, and of course on partners' fingers as well -- not only on the genitals, anus, or mouth.  But new herpes almost never first shows up at those sites.

Second, even with unprotected vaginal sex, with intercourse lasting several minutes, during which time there is continued, often vigorous contact of genital skin with an infected partner's genitals and secretions, the average transmission risk for HSV-2 is somewhere around once in several hundred to 1,000 exposures.  (In monogamous couples in which one partner is infected, who have unprotected vaginal sex 2-3 times a week, transmission occurs in about 1 in 20 couples per year.)  Given those statistics, what can the transmission risk possibly be with the sort of indirect contact you describe?

Third, even in busy STD clinics, with thousands of patient visits and hundreds of new genital herpes infections per year, we virtually never see someone with new genital herpes who didn't have vaginal, anal, or oral sex (usually unprotected) with an infected partner.  In 30+ years in the STD business, I have never seen a patient with new herpes whose only exposure was hand-genital contact.

All of these comments above should also apply to vaginal contact with torso or anywhere else.

You might wish to reconsider resuming anti-HSV suppressive therapy.  Controlling symptoms is indeed an important reason for such treatment, but doesn't apply to you.  But the other reason is to prevent transmission.  The overall transmission rate is reduced at least 50% (probably more than that), so that suppressive treatment with valacyclovir or acyclovir is a reasonable consideration for all HSV-2 infected persons who are dating or otherwise likely to expose new partners to the risk of infection.  (If sex with your prospective partner is really going to be limited to hand-genital contact, you needn't worry about it.  But of course most sexual relationships naturally include intercourse.)

Here is another recent thread that addresses other aspects of genital herpes transmission:    http://www.medhelp.org/posts/STDs/Herpes-Transmission-to-an-unaffected-partner/show/1421367

I'm going to also bookmark this thread as well, to aid in future responses to questions specifically about hand-genital contact.

I hope this helps.  Best wishes---  HHH, MD
5 Comments
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Thank you for the insightful response. There's a lot of great information there. I have just one more question.  A little over a year ago I had what turned out to be an HSV 2 infection near the corner of my left eye.  Not actually in my eye, but very close.  I know that at the time that I first discovered the Genital HSV 2 I was crying, and more than likely wiped my tears without knowing better.  In your opinion would this lead to the secondary infection I mentioned above?  Or could the possibly be an exception to the information you provided?  I definitely respect ur expertise and I hope this follow up question isn't disrespectful.  Thanks Again.
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239123_tn?1267651214
Thanks for the thanks.  This isn't disrespectful in any way.  Reasonable follow-up questions are always welcome.

That's interesting information; thanks for sharing it.  How was the diagnosis of the facial lesion made?  Positve test for HSV from the lesion?  And confirmed in the lab as HSV-2?  If so, that's solid evidence.

Assuming you indeed have facial (and therefore perhaps oral) HSV-2, my comments above about hand-genital transmission still remain valid for transmission from someone with longstanding HSV to another person's hands.  Your eye/facial HSV-2 has 2 possible sources.  First, you could have acquired an oral infection at the same time as genital, if you had both oral and genital sex during the exposure -- then you had a recurrence near your eye.  Second, you could have auto-inoculated your face/eye during your initial genital infection, before your immune system produced antibody and other defenses.  But auto-inoculation is very rare, if it occurs at all, among people who have had their HSV infections for more than a few months.
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Avatar_f_tn
Thanks, and to answer ur question.  Both HSV 2 Infections were confirmed by cultures.  I have so had multiple blood tests.
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239123_tn?1267651214
OK, thanks.
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