What can I safely do with a partner?

[Sashaoralex]

I believe I contacted genital herpes 24 years ago from a man who I had intercourse with and had herpes.  Between then and now I was married and had unprotected sex with my now x-husband for 12 years. I was very careful not to have sex with him if I thought I had an outbreak or thought one was coming. I did take aclivar (sp) starting a week before each vacation to make sure I did not have outbreaks when we had plenty of play time. He did not contract herpes during our marriage. After our divorce I was tested for all STD except herpes because I assumed I had herpes. I tested negative for everything. I still have outbreaks maybe once a year, but they are usually accompanied by a major stressful event such as moving, death in the family, etc.

I am contemplating having a sexual encounter with someone that I am getting to know. I will be honest and open about my herpes. I am now taking Valtrex and would like to be able to tell him what we could safely do with little or no risk of him contracting herpes from me.

Specifically, 1) could we have intercourse with or without a condom and be at low risk of transmission? 2) what are the risks of him performing oral sex on me? 3) I am assuming all hand contact is safe, correct? 4) What are the risks of me performing oral sex on him, if he thinks he is free of STDs? 5) Anything that I forgot to ask?

aka Sasha

[Terri Warren, RN, Adult Nurse Practitioner]

Specifically, 1) could we have intercourse with or without a condom and be at low risk of transmission?

Yes, the risk of transmission is low.  With daily therapy alone, the risk of transmission is probably about 2% per year, having sex twice per week.  If you add condoms, the risk goes down even further.
2) what are the risks of him performing oral sex on me?
If you only have genital herpes, the risk is zero.
3) I am assuming all hand contact is safe, correct?
Correct
4) What are the risks of me performing oral sex on him, if he thinks he is free of STDs?
There is a slight risk of him acquiring HSV 2 orally from giving you oral sex.  Has he ever in his life had a cold sore?  If yes, then it would look just like a cold sore and probably recur very infrequently.
5) Anything that I forgot to ask?
I think you need a reference for him when you tell him.  Have a book for him to take home.  You can also let him watch the patient counseling DVD on our website, westoverheights.com, there is also a booklet you can download from the website for free.

I hope it goes well!  Keep us posted.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

Around 5%

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

The doctor who told you to be on daily suppression is the correct one.  There are no known long term side effects with this class of medication.  You might want to print out the January 2004 article that was in JAMA showing that valacylovir 500 mg once daily reduces the risk of transmission to a partner by 48%.  This is very disconcerting to me that you are getting this information.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

Your herpes is likely not completely dormant.  Most people who get herpes get it from asymptomatic viral shedding, giving off the virus when there are no symptoms present.  From time to time, and less the longer you have the infection, you will be giving off virus when you have no symptoms.  You should be looking for the symptoms that you describe above.  If your partner knows the risks and you are on daily therapy, the choice is truly his.  If he gets herpes from you, he does.  Has he actually been tested to determine that he is negative for HSV 2?  If he has not been tested, I strongly suggest that he be tested.  

I hope you get more into the book and find it helpful.  Let me know if you have other questions.

Terri

[lou7979]

Hi Terri, I was curious if there was a statistical percentage for males, in terms of the risk of transmission of HSV-2 to a female (assuming daily therapy alone, having sex twice per week).  I know you wrote for females its about 2% per year.  What is the percentage that has been studied for males? Thank you.

[lou7979]

Thanks, both of you cleared that up for me.  And yes, it makes more sense that females would be more receptive with intercourse.

Terri, just one last thing in regards to that topic.  Is there a statistic just for males, in terms of the risk of transmisison of HSV-2 to a female (assuming daily therapy alone, having sex twice per week).  I know you wrote for females its about 2% per year.  What is the percentage that has been studied for males? Thanks again.

[Terri Warren, RN, Adult Nurse Practitioner]

Females are more likely to contract all STDs than males, yes, because they are receptive with intercourse.

Terri

[talik]

im not a doctor or anything but i would think that females can contract it easier considering we are internal and have a for lack of a better word " better breeding ground" for std's.

i hope some one else answers but that is just my opinion. there should be some more solid statistics on the internet some where.

[lou7979]

Terri, in your first response on this forum, you wrote that the risk of transmission for HSV-2 from an infected partner to an uninfected partner is low.  With daily therapy alone, the risk of transmission is probably about 2% per year, having sex twice per week.  If you add condoms, the risk goes down even further.

Now, your response was given to a female who was infected with HSV-2.  But what about in the case of a male who is infected with HSV-2 and is worried about transmitting the virus to a female.  With daily therapy alone, is the risk of transmission still around about 2% per year?  Or is it higher considering he's a male who's infected?  Thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

you're most welcome.

Terri

[life goes on]

Thank you for your response.  I will go over this with my partner and doctor soon.

Best wishes to you

[life goes on]

Hello Terri,

I recently called my gyn Doctor Farzan Shirazi (NY area) to refill my "Valaciclovir" (HVS2 positive) prescription.  He refused he said I didn't need to be on medication since I don't recall having outbreaks.  He advice me to wash before intercourse!  He stated that there are side effects with "Valaciclovir" and can hurt me in the long run. There are side effects with all medications.  He's share an office with his son and claims they have the same policy and doesn't see  why Michael Shirazi would refill my prescription.  But that I should come see he or his son with my partner.

Michael Shirazi is my doctors son and I originally met with him for my HSV2 screening, and when my result came back positive he gave me a prescription for Valtrex if I were to get in a relationship.  His site claims he’s STD expert.  Michael informed me with Valtrex and condoms lower the risk of transmission.  I worry that his father is giving his patient inaccurate information.

http://www.stdtestingny.com/

I'm currently in a relationship and I am just beginning to get comfortable with HVS2 and possible transmission.  I've done my research and in order to protect my partner I should be on suppressants and condoms.  I may not have experienced any lesions, but what about asymptomatic shedding?   I believe he is not qualified in this area.  Is this doctor correct?

This has me stressed!

Thank you!  

[Terri Warren, RN, Adult Nurse Practitioner]

thanks and Happy New Years to you!
Terri

[life goes on]

My partner has tested negative for HSV2, but postive for HSV1.  I will discuss your reponse with my partner and see if he has any questions.

Thank you for the response.

Happy New Year!

[life goes on]

Since my diagnoses I've learned there are other symptoms like redness, itching, and numbness that go unnoticed as HSV2 symptoms.  Redness and numbness I have not seen.  Just vagina itch!  

In the last year I have had three yeast infections.  I've experience many yeast infection due to hormone changes from birth control pills (since I was 19). My aunt has the same problem, but is STD free.  Yaz birth controls seem to work the best and on them I have had only one episode(in the last 6months).  I have myself examined anytime I feel funny down below.  Each time I have been diagnosed with a yeast infection.

My partner and I have recently been sexually active.  We’ve only been intimate twice and both time he started off with using a condom and well he later took it off and went raw.  He is circumcised and wash his genital soon after with warm to hot water. I  want to protect my partner.  But he can’t seem to have the self control to wear condoms. The risk seems very low, but I don’t want to infect him.  

My question is about asymptomatic shedding.  According to my doctor my HSV2 is dormant(latent).  What does that me exactly?  Is there always shedding?  What signs should I be looking for?

Thank you,

V

PS I recently bought your book and well its sound great and easy to read, but I am only on the first chapter and I am anxious for answers.