chances of transmission

Hi Doc
You may remember me, I (female) had been a part of the Smith/Kline/Beecham (?) clinical trials for partners of infected HSV2 people. I have, unfortunately, since tested positive for HSV 1 and 2, and think I've had the virus for about 3-4 years.
My question is, what is the likelihood, percentage-wise, to the best of your knowledge, of transmiting the virus to an uninfected male partner, using condoms, even though I don't get actual outbreaks and am on daily Valtrex? What about with unprotected sex?  I DO, about twice a year, get prodrome-like tingling symptoms which never erupt into anything, which I treat as you would an outbreak, avoiding sex for ten days or so.
My new partner hates condoms and we haven't had 'the talk' or engaged in sexual activity yet. I would like to get my facts straight before diving into that unpleasant conversation.

Any insight would be helpful...
thanks

[Edward W Hook, MD]

I suspect you corresponded with DR. Handsfield previously.  This time you got me.

Here are the facts.  In a placebo controlled trial of valacyclovir suppressive therapy to prevent herpes transmission over 8 months 3.6% of uninfected people in the placebo group got infected over 8 months.  This translates to about a 5-6% per year transmission rate without suppressive therapy.  The participants were instructed to use condoms but clearly not all did.  Condoms reduce transmission by about 50-60% (estimates vary) and suppressive therapy reduces transmission by about 50%.  Clearly you are more likely to be shedding virus when you have a prodrome but you are also likely to be shedding asymptomatically as well.  Condoms and suppressive therapy act together additively to reduce transmission.

Those are the facts. How to use them is the hard part.  Clearly condoms, suppressive therapy and avoidance of sex during outbreaks or prodromes is the safest route and, in doing this, transmission becomes quite uncommon.  Each component adds something so not using one increases the odds of transmission, although not much.

One other thought.  Be sure your partner has been tested..  Odds are about 1 in 5 he already has the infection whether he knows it or not.  That would certainly simplify things.  EWH

[Willow1]

thank you...so let me get this straight. If we are having protected sex AND suppressive therapy is used AND avoiding sexual activity during prodrome, the likelihood of transmission drops to almost 0-3.6%?

[Edward W Hook, MD]

Yes, close to zero.  Certainly less than 3% per year  EWH

[Daniela22]

A related discussion, Transmission of HSV 2 in Asymptomatic Female x 10 + Years was started.

[Daniela22]

A related discussion, Transmission of HSV 2 in Asymptomatic Female x 10 + Years was started.