cross-contagion of HSV type 1 and 2

[worriedchad]

In Seattle. I‘m a 28 yr old white male and my girlfriend is a 26 yr old white. We were together for 3 years until we broke up in Oct. We both dated and had limited, but unprotected intercourse with others, most recently about 2 mos ago. We just got back together and went in for full STD screens before having sex. My latest test was a while after we broke up and everything was fine except for what my doctor claimed was a false positive IgM. I’ve never had any herpes symptoms. She had an HIV test years ago while we were together and everything was fine, but no other tests to her knowledge. Yesterday she got a positive for HSV2. I am still waiting for my test results. She can't recall ever having a Herpes test. During our 3 yrs together we had an active sex life and didn’t use protection, just the pill. I know there’s no way to tell when she contracted HSV2. So its possible that she’s had it for many years and I just never got it. Our main frustration comes from the fact that we always were able to enjoy our sex life without using condoms, getting that increased intimacy, and not having to worry about STDs. This is coming in the way of all that. My question(s): I’m a bit confused on the whole exchange of type 1 and 2 from oral to genital and vise versa. From what I’ve read and been told by my doctors is that it’s possible for either type in either place. I’m trying to relate this to our dilemma; if my girlfriend , or anyone has HSV2, then the advise of condom use, safe oral sex, etc for prevention, is partly void, because I could just as likely get if from kissing her–there’s no way to tell where she has it because she’s never had any symptoms. But if YOU know that its just VERY improbable (I understand that doctors will say it’s POSSIBLE, if it is at all) to have type 2 infected orally, then that advice makes more sense. I guess I’m hoping that the chances of it being oral vs. genital are more equal so I wouldn’t be so concerned about precautions. i.e. If I know there’s a 50% chance of getting it just from kissing her, then I’m not gonna be so worried about condom use. Also, she recalled her 4 yr ex before me always having cold sores. Another possibility that that was type 2 and she simply got it from him? Or faulty thinking? I certainly do not want to put myself at risk, and need time to mull over the entire situation and our strategy. Any possibly related exposure was a couple months ago and she hasn’t had any symptoms, so it’s also possible that the near future may reveal more information(an outbreak). My PCP once told me of other couples where they’ll be protective during outbreaks, then don't worry about it otherwise (including shedding), and they go on like that fine. Any other obscure, but pertinent knowledge on viral shedding and varying susceptibility would be helpful too. –if certain people, maybe myself, just are sometimes less susceptible to viral shedding. I’ve read some info that has eluded to this. Any guidance is appreciated. -Chad

[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