Have I put my partner at risk?

[HeartMatters]

Dear Doctor,
I am hoping you can ease my mind. I tested positive for the herpes virus approximately 17 years ago. I am not sure if it was HSV1 or HSV2. I am assuming it is 2 because I have never had any oral s/s, only genital breakouts.
I have been taking suppressant therapy daily for years.
I rarely have any breakouts with this at all.
I am taking the suppressant therapy to prevent transmission to any potential partners.
My question, and I am ashamed as I thought I was being safe.
I have always told new partners that I have herpes, before any sexual intercourse so that they had the opportunity to use a condom.
However:  I was with new partner, and we did not have intercourse however
We both performed oral sex on each other. Until reading online this am, I was unaware that I could transmit genital herpes to oral,  I only knew that oral could be transmitted to genital. I have no current outbreak or any s/s . and on medication as above. (Acyclovir)
Please clarify for me. Have I put my new partner at risk before I was even able to discuss this with him prior to intercourse?
I am very upset, as difficult and humiliating as this subject is to talk about with anyone new,
I have been responsible and always discussed prior to intercourse, even knowing I may be rejected, because it is the right thing to do. Now I am
Afraid that I may have jeopardized someone else, and I really do like him a lot and there is potential for serious relationship.
Please help me doctor what is the chance that I may have infected my partner?
Or am I worrying for nothing?
I do not know his sexual history, not sure if he had unprotected sex prior to being with me. I know I should have discussed that. Like I said we only had oral sex both performing it on each other.
Thank you very much

[H. Hunter Handsfield, M.D.]

Relax.  You're overreacting to an essentially zero risk situation.  In a way this is good:  Obviously you have set high standards for yourself about putting others at risk, and until now you have adhered to them, i.e informing partners and all that.  But don't be so harsh on yourself for a rare lapse.

Among monogamous couples in which one has genital HSV-2 and the other does not, in which the infected person is not on treatment and the couple takes no precautions except to avoid sex during an obvious outbreak, and who have sex an average of 2-3 times per week, transmission to the uninfected partner only occurs in 5% of couples per year.  That is, only 1 in 20 susceptible partners becomes infected.  If you translate that to the risk for each episode of unprotected sex, it comes to something like one transmission for every 2,000 events.

And in your case, the risk to your partners has to be much lower than that.  First, the frequency of subclinical shedding of the virus declines with time, and after 20 years it might happen in you quite rarely.  Second, taking antiviral therapy reduces the risk still further.  So all things considered, you are to be congratulated for your responsibility -- but the chance you transmitted during this one lapse is truly too low to measure and certainly too low to worry so much about.

Another issue is whether you in fact need to be taking acyclovir after all these years.  If you haven't tried it, you might want to go off therapy one of these days to see if you still have frequent outbreaks.  You might find the problem has largely gone away, as it does in most people over time.  (But probably not just yet.  Don't make that change on your own just as you are starting a new relationship, and not unless/until you get such advice directly from your personal health care provider.)

It does seem, though, that you have never really reconciled with your own infection.  The notion that it is highly shaming to discuss it with your partner really has no basis.  You're dealing with an impersonal virus, not a blot on your character; not to mention the fact that yours is a very common situation, shared by at least 20% of the population (if you live in the US).  You should consier discussing this whole business with a senstive, knowledgeable counselor.  If you're not sure about finding one locally, call the Amercan Social Health Association's Herpes Resource Center (www.ashastd.org and look for the links), where you can get both personalized advice (not toll free, but a lot cheaper than a professional visit!).  ASHA also keeps lists of herpes-knowledgeable providers in various cities.  (Full disclosure:  I am on ASHA's Board of Directors.)

Finally, if you haven't done so, use MedHelp's herpes community forum.  The forum moderator and many of the regulars can provide very useful advice.

I hope this helps.  Best wishes--  HHH, MD

[gracefromHHP]

We all advocate here talking about your herpes before being intimate with a partner. It just makes it easier in the long run even though it might not seem so.  You seem to also follow that line of thought - don't be so hard on yourself because you didn't know that you could potentially transmit hsv2 to the oral area too. If you were diagnosed like I was all those years ago - you probably only got a dirty look and shoved out the door and haven't had much advice about your herpes from informed professionals since then to help you figure this all out.   You were taking precautions to protect your partner - you know you have herpes and you know you weren't having any obvious symptoms so you didn't put your partner at risk that way.  You also are on daily suppressive therapy.  Those are the 2 biggest things you can do to protect your partner from contracting hsv2 orally( and genitally ) and you were already doing them!  Could you transmit hsv2 to the oral area? Well yes you can but it doesn't often happen even without either of the precautions you were taking.  No contact during ob's and daily suppressive therapy means it's not very likely at all to happen.  

So what do you do now? Well if you had oral sex that means that more sex is probably in the future for this relationship.  Get together with your man and have "the talk" as we all tend to call it. Don't just focus on your own herpes though - also talk about all the rest of the std's and ask when he was tested for them all. It's so much more than just about what you know you have!  Just be honest with him about the herpes part- tell him what you told us.  You really didn't put him at risk so far.  It also doesn't sound like he initiated any talk about std's either right? Nor did he want barrier protection either correct?  

Hang in there - sometimes it's a fine line between wanting our partners to be aware of what we  have and labeling ourselves with that giant scarlet H.  You were thinking about your partner whether you realize it or not with the precautions you were already taking.  Focus more on the positives about the situation and go from there.

grace

[H. Hunter Handsfield, M.D.]

Thanks to grace for the additional comment. She moderates the herpes community forum.

I forgot to specifically comment on the oral-genital aspects.  Although genital to oral HSV-2 transmission certainly is possible, it is uncommon.  In my STD clinic, in 30+ years we have had only a small handful of patients with new oral HSV-2, and every one of those also had newly acquired genital infection.  HSV-2 doesn't "like" the mouth and throat and doesn't cause many infections there.

[HeartMatters]

Thank you so much for the information. As I said reading online, I was  certainly highly upset after reading the articles about the possibility of oral transmission. I would have never had the oral sex until talking with him if i thought there was any chance at all to jeopardize him. Yes, Grace there is potential for future sex, and he was willing to have intercourse without proctection that night without any discussion of testing on mine or his behalf, but I would not allow, especially because I had not discussed my exposure with him. I thought I was protecting him totally by not having intercourse only.
I guess you are saying then, that I should not even have any oral sex until I have the talk? and Dr, I have not come to grips with my infection. It is very traumatizing to me. I was married when I found I was exposed, and it was never an issue at all, until recently I got divorced, and my now ex called me a herpes infested s*o*b* in front of my children, and I can still hear his voice and see the look in his face when he said that to me, and I can cry everytime I think of it and it really messes with my head. I would never want anyone to feel that, so I would never put anyone at risk on purpose. THank you very much for your time and help, and I have to just prepare myself to sit down and talk with him and hope that he understands and likes me enough to want to proceed with our time together. I had the chance the other night to bring up the subject, but something he said stopped me that night. He said one of his friends said she might have some disease, If she was having oral sex so soon? ( I cant blame him for discussing with close friend, as on my end myself i discuss thing with my very best girlfriend. But you see once again, that was a very NEGATIVE approach   "a disease". I think I may go to the forum you suggested as I certainly would like to feel better about this. Thanks again for all your help.

[gracefromHHP]

You let your ex husband treat you that way?  He's your ex for a reason.  Set up ground rules and don't waiver on them. Neither of you should be trashtalking the other in front of the kids.  It's absolutely uncalled for. He's saying what he is because he knows it hurts you.  You are ex's now so the focus should be on raising the children, not on name calling. Remind him to act like a grown up now and then.  Don't put up with that kind of ****!

Herpes is incredibly common but no one talks about it. We don't have a telethon. We don't get very special episodes of tv shows that deal with herpes in an accurate way.  Oprah hasn't done a special on us yet.  We get negative, derogatory comments on House.  We get comments on "will and grace" like sweetie you have a herpes on your lip.  That's all.   Sex ed for our kids - hardly mentions genital herpes at all and forget about mentioning oral herpes to them.  We can't even get tested for it most places when we go for std testing.   That said - millions of people are infected with hsv1 and hsv2 in the US alone.  1 out of 4 females has hsv2. That's a heck of a lot of gals you know.  1 out of every 2-3 of us has hsv1 orally.  It's THAT common.  It doesn't say anything about you as a person though - it just says you are infected with a virus that took the opportunity to infect you when it had it.  Don't let the IDEA of having herpes have that much power in your life.  Your nickname here says it all - heart matters. The heck with a pesky virus as common as herpes is- it's what you are as a person inside that counts the most :)  

No reason to assume that your current man will hear herpes