Transmission Question

[Francis2]

I am a 61 year old male with no STD.  I recently fell for a lovely lady, and after a month we were going to be intimate when she told me that 30 years ago she contracted HSV from her husband, who apparently had oral sex with her during a "cold sore".  He had never told her about his situation.  We have not been intimate.

1.  The frequency of her outbreaks has increased this year, 3 in the last 4 months.  She claims it is her stressful job.  Any comment on why the frequency has increased?

2.  I understand from this forum that in such a situation (30 years ago), the HSV is less likely to be transmitted.  Is it really a remote chance?  Even during outbreaks?

3.  Is cunninglingus risky during Prodrome?  During an outbreak?  Right after the sore has healed?

4.  We just got a prescription for Valtrex. Should she take Valtrex every day?  Should I take it (I assume no)?

5.  HSV-1 vs HSV-2.  Does she likely have HSV-1?  Will it help me to find out which one she has for sure?

6.  I surmise the symptoms of an outbreak can be rough as people age.  Any comment?

7.  Any suggestions?

This forum is simply wonderful !  Thanks !

[H. Hunter Handsfield, M.D.]

At age 61, you probably have been through a lot more serious issues in your life than genital herpes.  Since you "fell" for a "lovely lady", presumably you're thinking this could be a long term, committed thing.  In that case, I suggest you simply disregard herpes, knowing that 1) you may not be susceptible; 2) if you get it, the odds are you won't know it (since most cases are mild or asymptomatic); and 3) if you get symptoms, treatment is available.  The only important downside if you catch genital herpes most likely would be the risk of transmitting to someone else--and that's not an issue if you're getting into a committed relationship.  Right?

Second, if you're going to worry about it, you and your partner need to know her virus type and you need to be tested as well.  It seems a fair bet she has HSV-2, if she indeed has been having recurrent outbreaks after 30 years.  (That's rare for HSV-1.)  Blood tests will tell which type(s) of HSV she is infected with, and whether you are susceptible.

So on to your questions:

1) I'm skeptical she is having such frequent recurrences all of a sudden.  It's uncommon for the recurrence pattern of genital herpes to change after so many years.  And contrary to popular perceptions, stress is not proved to cause recurrences.  She needs to see a knowledgeable provider to see if she really is having herpes outbreaks.

2) Transmission risk declines with time. But that doesn't count if she really is having herpes episodes.

3) Cunnilingus is low risk in general.  But transmission could occur.

4) I cannot advise your partner about suppressive therapy.  That's up to her and her provider, if/when her diagnosis is confirmed.  But it probably would help prevent transmission to you.

5) See above.  HSV-1 rarely causes frequent genital recurrences.  HSV-2 seems more likely.  But only specific testing can tell.

6) I'm not sure what you mean. I'm unaware of any difference in severity of outbreaks--either less or more severe--in relation to age.

7) See above.

Thanks for the thanks.  I hope this helps.  Best wishes--   HHH, MD

[sadwife2006]

Hi there- there is no telling what will make a person experience more outbreaks, sometimes it can be stress, diet, there are so many factors. The thing is you need to protect yourself. This is not something you want to contract and there is no fool proof way of doing that if you two are sexually active. Basically avoid any sort of contact with the sores from the moment she feels one coming on to days after they heal. Along with that she should be taking valtrex daily as a suppressant and use condoms the rest of the time. If you are very cautious hopefully you will not contract the virus. It doesn't really matter if she has HSV 1 or 2 as they both will cause the same symptoms.

[Francis2]

My major concern is that one can never really be sure how a relationship will turn out.  If I did get herpes and we break up, it will be so hard to find someone else.  The irony is that, at the moment, this fear prevents me from having full intimacy, which would help us really go forward and find out if we are truly meant for each other.  

1.  "May not be susceptible".  Does that mean, for example, if I already happen to have HSV-2 (low level, no symptoms), that catching it from her or developing symptoms is impossible for me?  In that case, I can just get tested.  

2.  Or is it that some people just have a strong immune system?  This is my major question.  That is, is the risk to me so very low, say less than 1% per year, that it is foolish to be concerned?

3.  Condoms.  Really dislike them, and understand they do virtually nothing to protect a man, since the infection is at the outer area of the female genitals.  True?

4. Cunnilingus.  Is the risk really low?  This seems odd, as mouth to genitals is intimate skin contact.  Would it be relatively safe even during an outbreak?

[H. Hunter Handsfield, M.D.]

Certainly having genital herpes is a negative in forging new sexual relationships, but properly handled, mostly not as big a barrier as you imply--probably especially for more mature people and potential partners.

1,2)   The former.  There is at least a 25% chance you have HSV-2.  If your test is positive, you cannot get infected again.

3) Wrong about condoms.  They are highly protective against herpes, for both men and women.  Many people who dislike condoms are quite happy with polyurethane or natural membrane condoms.  The latter are said to be less safe, but any barrier at all undoubtedly provides substantial protection against HSV and other STDs.

4) It is possible to get oral HSV-2 from oral sex, but is quite uncommon.  Oral tissues seems to be somewhat naturally resistant to HSV-2.

HHH, MD

[Francis2]

Clarification:

1.  So if she is HSV-2 and I turn out to be as well, then I cannot be infected and develop sores, even if we have intercourse during outbreaks?  Is so, that is a real relief.

2.  Cunninglingus.  If she is HSV-2, then are the odds less than 1% for my getting oral HSV-2?

Note:  Took a blood test yesterday.  Hope to ask her as well.  

Thanks HHH.

[H. Hunter Handsfield, M.D.]

Only a limited number of new threads can be accepted, so unnecessary or repetative ones block people with new questions, therefore aren't allowed.  I deleted your new question.

Once a person has HSV, s/he cannot catch the same type again, anywhere on the body.  (If not totally immune, at least highly resistant, and I have never seen such a case.)  In other words, if you both are positive for HSV-2, any sexual practice between you is safe with respect to transmission.

HHH, MD

[Questions101]

Dr,

You stated in an old thread "Finally, to put genital herpes transmission into perspective: Among monogamous couples in whom one person has genital HSV-2 infection and the other isn't, who do not use condoms, and who have sex at average frequency (3-4 times per week), there is only a 3-4% risk per year of herpes transmission. The risk for any single episode of sex, therefore, is very low."

1. Is this for couples on suppressive therapy or NOT on suppressive therapy. I'm assuming this is without therapy. Do you know the transmission rate for those on therapy then?  

2. "Per year," means that 3-4% risk at year one becomes a 30$-40% risk at year 10? I'm trying to get clarification on what "per year" means.  

3. I always see the "4-6 outbreaks" for suppressive therapy used in literature as a recommendation for suppressive therapy helping reduce outbreaks/viral shedding, does this mean that therapy is less effective if you have less outbreaks?  I'm 30, contracted at 23, started out having about 4-6 outbreaks per year in various places in my genitalia. Now I have them about 2 times per year pretty much at the exact same spot.  I'm considering therapy for reduction in transmission (the frequency of outbreaks really doesn't concern me as much as keeping my partner safe).

Overall, wondering how helpful suppressive therapy will be.  And hoping and praying that my decrease in outbreaks, severity, and places on genitalia is an indication that I'm shedding less as well.  So, hopefully coupled with suppressive therapy will decrease transmission rate. Your thoughts?

[Questions101]

Dr,

One more question, this one is actually for another couple that I know. So, it is unrelated to my first question.

If a man contracts ORAL HSV-2 from his partner that has Genital HSV-2.  Does this decrease his risk of acquiring Genital HSV-2. Or is he still susceptible since he has it orally vs on his genitals?