cross-contagion of HSV type 1 and 2

[worriedchad]

In Seattle. I

[H. Hunter Handsfield, M.D.]

There are several questions embedded in your post.  I'll try to answer them.  But my first advice is that you need to know whether or not you already are infected with HSV-2.  (If there is any doubt about the type of test your GF had, it would be good to confirm her infection as well.  But I'm going to assume your GF indeed has HSV-2.)  You need a proper HSV blood test; the fact that your earlier test included IgM testing indicates you had an older, unreliable one.  A quartner of the population has HSV-2, and you have had an active sex life (plus sex with your GF, who is infected) - so your odds of being infected probably are around 50:50.  If your test is positive, your worries are over; you need not worry about getting infected from your girlfriend.

My second suggestion is that you take advantage of your location.  The world's premier herpes clinical resource, the UW Viral Disease Research Clinic, is based at Harborview Medical Center (although the actual location is off-site); and that clinic has a non-research arm called the Remington Clinic. (You could even ask to be seen by Mike Remington, who probably has seen more patients with genital herpes than any other living person.)  Or you could go to the Public Health STD Clinic, also at Harborview.  Either place will give you truly expert advice, and you will get proper testing.

The rest of this response assumes you are not infected and are susceptible.  Most important, there is no risk of HSV-2 infection from kissing.  Although it is theoretically possible to get either HSV type at any anatomic site, oral HSV-2 infection is exceedingly rare.  You can safely assume your GF's HSV-2 infection is strictly genital.  If it happens that your GF also has (oral) HSV-1 and you do not, then there is a potential risk you could acquire genital herpes due to HSV-1.   But that is an unlikely outcome; statistically speaking, the odds are strong you already are HSV-1-positive, as most people are.

So the only risk worth worrying about is genital HSV-2, transmitted during genital intercourse.  You can reduce that risk to low levels by 1) avoiding sex when nproved effective to prevent transmission-- and the easiest to take, once daily).  But you also need to consider whether it is worth the hassle.  If you get infected, the odds are it will be so mild you don't know it; and if you get symptoms, effective treatment is available.  So lots of monogamous couples just don't worry about it.  Of course, that leaves the problem of future relationships, if your present one doesn't work out - so it would be perfectly understandable for you to try hard not to get infected.  But it's a very personal choice and there are no clear answers.

As to how frequently your partner is shedding HSV-2 genitally, there simply is no way to know with certainty.  But if she has no symptoms, and if she has been infected for several years, it might be quite infrequent.  But on average, you should assume she has transmissible virus something like 5% of the time.

Finally, if some people are just less susceptible to being infected if exposed, there is no way to predict who and why.  Probably there is no such thing.

I hope that helps.  Good luck--  HHH, MD

[HHH,MD]

I hate laptop keyboards; a couple lines got deleted by error.  The paragraph starting "So the only risk" should read like this:

So the only risk worth worrying about is genital HSV-2, transmitted during genital intercourse. You can reduce that risk to low levels by 1) avoiding sex when your partner has symptomatic herpes outbreaks (which in turn depends in part on her ability to recognize subtle symptoms); 2) consisteng use of condoms; and/or 3) your partner taking suppressive antiviral therapy (preferably with valacyclovir [Valtrex], the only one proved effective to prevent transmission--and the easiest to take, once daily). But you also need to consider whether it is worth the hassle. If you get infected, the odds are it will be so mild you don't know it; and if you get symptoms, effective treatment is available. So lots of monogamous couples just don't worry about it. Of course, that leaves the problem of future relationships, if your present one doesn't work out - so it would be perfectly understandable for you to try hard not to get infected. But it's a very personal choice and there are no clear answers.

Sorry for any confusion.  HHH, MD