Transmission risks

[nate407]

I've had hsv2 for 18 years.  I have a girlfriend of about 1 year. We've been having unprotected sex, avoiding sex during outbreaks and to our knowledge been successful at not transmitting.  A few nights ago we had sex.  Afterwards I was cleaning off my penis and noticed two red dots.  Upon closer examination it appeared that it was where the scab from healing herpes lesion had been.  My outbreaks are very mild and unless I really inspect my penis which I hadn't done unfortunately, I can have an outbreak and never really notice it  So I know transmission during outbreaks is high and transmission risk in between is relatively low so my questions are:

1.  What would the risk be in having sex toward the end/healing stage of an outbreak and

2.  If the scabs from the two lesions came off inside of my girlfriend does this present an even greater risk.  In other words is there virus attached to the scabs that if left sitting inside her would increase her chances of contracting herpes.

[Terri Warren, RN, Adult Nurse Practitioner]

This isn't Grace, this is Terri.
Shedding varies a lot from person to person.  Some people shed before an outbreak, some at the end, some more in the middle, and some a lot in between.  

We don't know how much virus it takes to infect another adult.  

This is my final post on this thread.  You are trying to nail down something that isn't that clear in the science and in your situation, has already happened, one way or another.

Terri

[nate407]

Oh and also does transmission occur even if there is only a small amount of virus present? In other words is the only way to have unprotected and not transmit is if there is zero virus present or would a small amount have less of a chance of transmitting? Not sure of the best way to ask that where it makes sense but there it is

[nate407]

Thanks Grace but I was really looking to see if anyone knew the science around viral shedding during outbreaks I would guess that toward the end of an outbreak when scabs are almost falling off on their own that there is not as much virus as when blisters are weeping.  Also I didn't know about the scab if that itself contained some virus that would become active inside.  I was also wondering when virus sheds does it stay in the skin cell and when the hosts skin cells are sloughed off during sex its transmitted or f the virus just pops out of the skin. I know none of this really matters as whats done is done but I guess in the mean time of waiting it would be nice to have some knowledge to at least assess what kind of risk the exposure was.

[Terri Warren, RN, Adult Nurse Practitioner]

Are you taking daily antiviral therapy?  Doing so would reduce the risk of transmitting to your partner by almost 50%.  Has your partner ever been tested to determine if she is actually uninfected?  If not, I suggest she do that.  You may be worrying about things that you don't need to worry about.  

Having sex when scabs are present may or may not present a greater risk for transmission.  About 70% of herpes is transmitted when no symptoms are present  so the idea that most transmission occur during outbreaks really isn't so.  When someone has an outbreak it is a time when they know they are contagious so sex during outbreaks should be avoided.  

I can't give you a number for your risk of transmission because we don't know her true status, if you've been having sex for a while, she may be making an immune response to your herpes that may offer some protection.  Just too complicated to know.  

I would suggest that she just observe carefully for any symptoms in the next couple of weeks and if she gets them, go in for evaluation right away.  
Terri