1. not sure
2. If you both have it then you cant get it again so no danger.
3. highly unlikely to transfer it orally with an established infection.
5. with new partners you should tell them as a risk does exist.
6. most recuring outbreaks would be in the same spot and future outbreaks would be less as a general rule but shedding and outbreaks can occur anywhere below the waist.
Grindcore, some clarifications:
1) It's the same in the US. HSV is not on the standard STD testing panel - it has to be asked for specifically.
2) You CAN re-contract the same HSV type in the site you have not yet contracted it (above or below the waist) within the first 4 months following infection. After that time, you are likely to have generated enough protective antibodies to prevent re-infection. The risk will be quite low.
3) You can contract Type 2 orally, but this is hard to do. A percentage of H+ positive folks do have HSV-2, but it's rare. If she's had it for a while, she is not in danger of re-contracting it anywhere else.
After 4 months, our experts posit that you will not contract HSV-1 on top of HSV-2. Anna Wald at the University of Washington confirmed to me a few months ago that she had never seen a proven case of such transmission.
4) Statistical percentages are almost meaningless in the large scheme of things. All it takes is one time for conditions to be right in order for the virus to transmit. Asymptomatic shedding (shedding without symptoms) is how the virus is mostly passed.
However, yes, oral HSV-2 is hard to contract, and almost never recurs, even when contracted.
5) There is never a justification for having sex with an uninfected person without disclosing. Always disclose before sexual contact. There is never a zero percent risk - never. You want to always give your partner the choice of whether or not to take the risk. If anything, failing to disclose, then transmitting, perpetuates the stigma that people with herpes are of questionable morality.
6) Condoms only protect about 30% of the time, against transmission. This is because shedding can occur anywhere that the nerve pathways reach from the nerve bundle. In the case of genital herpes, an outbreak can occur anywhere in the "boxer short" region between belly-button and mid-thigh, and more rarely below, on the legs and feet.
Thank you both for your replies. I have actually posted this to a doctor aswell and got somewhat different answers, especially about the risk of passing it on in asymptomatic phase with a condom. The numbers really are so low that chances of getting pregnant when using a condom on a casual encounter are equal or higher.
Having said that I have not made up my mind yet as to whether disclosure on casual encounters when there are no symptoms and when a condom is used is really something that is required, morally and practically.
The chances of the other person already having hsv are higher (!) than the chances of me passing it on. In a way the curse here is that I know, not that I have it. My behaviour never was unreasonable or dangerous, and whenever I had sex with anybody I always accepted that there is small chance of something going wrong. I think if you sleep with somebody that you only just met, one night stand or after a few casual dates ... then you have to take responsibility, both. The idea that either side needs full disclosure at all times is a bit strange to me given the context and the numbers. I will do everything that is reasonable to not put anybody at risk, but there is a risk at having sex, and most of the time that risk is unknown. The idea that you have to discolose herpes at all times is like saying that NOW that you know you are more dangerous than before. Well the opposite is actually true, isnt it?
I haven't made up my mind, but I can definitely see the stigma being applied to the "carrier" here and no responsibility being applied to the person that has sex with a stranger.
I think this thinking needs more space and time, and the conclusions that lead to the idea that disclosure is the only option make not always sense to me. It also makes the whole experience a lot worse and takes away responsibility from people that should carry some themselves.
I think this is a response based on facts in context, keeping in mind likelyhoods and actual real world outcomes. Not just medical facts and possibilities.
Dr. Hook's answers are not contradictory to mine. Also, not once does he call the statistical risk in any situation "zero percent." All it takes is one time for the factors to align - for that "less than 1% probability" to be happening at the point of sexual contact - for the virus to transmit.
The condom does not cover every area of possible shedding - we can shed anywhere between the belly-button and the mid-thigh. In fact, I get half my outbreaks near my tailbone. The suppressive meds only reduce the risk about 50%.
Here is something else Dr Hook says in his responses to you: "...when possible and appropriate, disclosure is always the best practice."
Though HSV is a non-fatal, mild skin condition for most, a percentage of HSV+ patients have adverse reactions to the virus. It's not possible to determine who will and won't beforehand. HSV also can cause neonatal herpes, which can be fatal to newborns. Though rare, it happens.
Because all these possibilities exist, everyone has the right to be allowed to make decisions directly related to their own sexual health. I'm at a loss to understand why you think your non-H partners don't deserve that choice. It's their right. Lawsuits have been started and won by newly-diagnosed folks who were purposely not informed about their partner's STD status before sex. This should be a warning to you.
If you're looking for an endorsement to behave irresponsibly and knowingly put someone at risk, I'm afraid you won't get it from me. I hope you make the responsible choice.
This is a typical and unhelpful response because it is ideological despite the facts. I find it shocking that such rigid views are expressed by health professionals.
At no point was I claiming there is no risk. In fact I specifically said there always is a risk. When two consenting adults have sex they both consent to that risk, and accept that unknowns might occur. Unknowns include the real world fact that one of them might be carrying hpv or herpes and not be aware of it. It includes pregnancy as a possibility. There is reasonable behaviour or as Dr Hook called it 'appropriate' behaviour to limit the possibility of these outcomes, such as the use of condoms. There is unreasonable behaviour which is for example to wear a latex suit or never ever have sex. A balance needs to be found.
The risk of me passing on hsv2 when no symptoms are present and while I wear are condom and possibly even am on antiviral drugs is lower than all potential unknown risks that occur when two people have consentual sex. Yet you state with no flexibility that it is my responsibility to let the other party make an informed choice. Well, it isn't.
If I was asked I wouldn't lie. Also in most cases, if appropriate and possible I would probably state it. But the idea that hsv carriers are bad people unless they tell everybody on their first moment of intimacy seems otherworldly to me and continues the perpetual stigma that this is a terrible, dangerous, super contagious disease that can not be controlled.
We are going to have to disagree. I have no issue with that. But I'd appreciate it if you and others if your conviction also took into consideration the context in which these moral questions are asked. I am not amoral, I just like to think.