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HSV discordant couples&immunocompromised condition
Dear Dr, I’m a maleHSV 2. My girlfriend has RA and is taking immunosuppressant. She is negative for HSV 2.
1.hsv-2 infection tend to be more severe and recurrent more frequently in immunocompromised people. I want to know how bad will that be if my gf got infected someday? Some studies suggest that hsv 2 can cause meningitis, encephalitis, dissemination etc,. for immunocompromised people ( advanced AIDS, cancer patients, autoimmune disorder patients taking immunosuppressant drugs), are these severe hsv complications common in these patients or even with a weakened immune system, such outcomes are rare?
2.Transmission from male to female is about 5% per year with daily valtrex+condom, but since the potential lifethreatening complications for immunocompromised people, the risk is still too high for us. Plus, my initial lesion is on pubic area near the base of penis where condom cannot cover, it seems that the chance of staying discordant in the rest of our lives is very small (we are both 25). Will an underwear condom which is made of latex and covers the whole boxer area reduce the transmission risk dramatically? I’ve found such product online and is considering it seriously. The condom fails to achieve 100% protection for hsv mainly due to it can only cover the penis, if it is true, my thought is the underwear condom which covers the whole boxer area+daily meds will offer nearly 100% protection against hsv. If I’m wrong, what’s the reason the underwear condom is not as effective as it seems to be?
3.If we want to have a baby, my gf will have to exposure to my semen. The present rate of HSV virus in semen varies significantly in different studies (3%- roughly 20%), but it is for sure that the virus can exist in semen (why virus is in semen anyway) .We really don’t know how to conceive without get infected. Any comments on this?
I feel so terrible being a lifethreatening to my love. I don’t want to indirectly ‘kill’ her but it seems very possible. pls help.
1.hsv-2 infection tend to be more severe and recurrent more frequently in immunocompromised people. I want to know how bad will that be if my gf got infected someday? Some studies suggest that hsv 2 can cause meningitis, encephalitis, dissemination etc,. for immunocompromised people ( advanced AIDS, cancer patients, autoimmune disorder patients taking immunosuppressant drugs), are these severe hsv complications common in these patients or even with a weakened immune system, such outcomes are rare?
2.Transmission from male to female is about 5% per year with daily valtrex+condom, but since the potential lifethreatening complications for immunocompromised people, the risk is still too high for us. Plus, my initial lesion is on pubic area near the base of penis where condom cannot cover, it seems that the chance of staying discordant in the rest of our lives is very small (we are both 25). Will an underwear condom which is made of latex and covers the whole boxer area reduce the transmission risk dramatically? I’ve found such product online and is considering it seriously. The condom fails to achieve 100% protection for hsv mainly due to it can only cover the penis, if it is true, my thought is the underwear condom which covers the whole boxer area+daily meds will offer nearly 100% protection against hsv. If I’m wrong, what’s the reason the underwear condom is not as effective as it seems to be?
3.If we want to have a baby, my gf will have to exposure to my semen. The present rate of HSV virus in semen varies significantly in different studies (3%- roughly 20%), but it is for sure that the virus can exist in semen (why virus is in semen anyway) .We really don’t know how to conceive without get infected. Any comments on this?
I feel so terrible being a lifethreatening to my love. I don’t want to indirectly ‘kill’ her but it seems very possible. pls help.
MEDICAL PROFESSIONAL
Your closing paragraph is correct: you're asking too much. Proper responses to these questions would take an hour or more. I would advise you to find a physician knowledgeable about herpes (e.g., an infectious diseases or STD specialist) and schedule an hour or so. Or, since you're obviously adept at searching the published medical literature, just carry on your own research. But be careful in what you think you learn: some of these questions reveal that you are having trouble understanding the implications or otherwise putting what you read into context. Like many anxious persons with a computer and internet connection, it seems you are being drawn to information and interepretations that inflame your fears and missing the reassuring information that also is there.
On one hand, your desire to understand the science of HSV transmission is admirable. OTOH, the expanded information you seek really is not especially relevant. Your partner is not at anywhere near the risks you fear; the biological reasons don't matter. Don't delude yourself that you are doing this for your partner's benefit. It's obvious that your own compulsions, anxieties, and perhaps guilt over having genital herpes are driving this.
Your very last comment is "I really don’t know what to do". In my opinion, the main problem here is psychological. You might consider professional counseling to figure out why you are having such difficulty with this rather minor health problem. I suggest it out of compassion, not criticism. In any case, I won't have any more comments or advice. That's will be all for this thread. Good luck.
On one hand, your desire to understand the science of HSV transmission is admirable. OTOH, the expanded information you seek really is not especially relevant. Your partner is not at anywhere near the risks you fear; the biological reasons don't matter. Don't delude yourself that you are doing this for your partner's benefit. It's obvious that your own compulsions, anxieties, and perhaps guilt over having genital herpes are driving this.
Your very last comment is "I really don’t know what to do". In my opinion, the main problem here is psychological. You might consider professional counseling to figure out why you are having such difficulty with this rather minor health problem. I suggest it out of compassion, not criticism. In any case, I won't have any more comments or advice. That's will be all for this thread. Good luck.
Dear Dr Handsfields, thanks for your prompt reply, it is very helpful indeed. Since diagnosed, I’ve being desperate and read everything online (even paid to academic papers) trying to educate myself and to make the best decision. I still have some ‘technical’ questions and want to discuss with you, hope you don’t mind.
1 The valtrex study indicates that daily valtrex 500mg can reduce overall hsv-2 acquisition by 48%, which is not ‘that’ impressive given the transmission rate without meds is already low (but I caught the virus from one single sex act which only lasted a few minutes and I was quite drunk) and the large costs of the drug. What I’m interested in is the drug can reduce symptomatic infections by 75% ( 16/741 placebo vs 4/743 valtrex). I’d like to know the mechanism behind this. It still the same virus, why the fact that the source partners taking valtrex could result in less symptomatic acquisitions despite the susceptible partners were not taking drugs?
2 Medicines for uninfected partners may not affect the risk of transmission, but will it lead to asymptomatic acquisition once infection does occur? I really don’t want my gf to catch this virus, but if it is hard to avoid, I hope it could be ‘silent’ so we don’t have much to worry about. Given my gf’s weak immune system and the possibility of taking biologics (TNF-alpha inhibitors, much aggressive to suppress immunity to my knowledge) in the future, I really doubt her infection will be asymptomatic and as mild as normal female. Any comments?
3 If it is possible that antivirals for uninfected people can lead to asymptomatic acquisitions, then is it doable that we both take valtrex while trying to conceive? Will this affects sperm, egg and fetus? I really really want to have a baby with my gf in the natural way, but her health is always my first priority, is it necessary to go for artificial insemination?
4 Could you please share your insight about why each type of hsv has its own preferred site? Why oral-hsv2 and genital-hsv1 tend to recurrent and shed less? As far as I know, hsv-2 is much more aggressive than hsv-1, why it becomes tender when it’s above the belt? I don’t know my gf’s virus status so I’m not sure if she has oral-hsv1( but pretty sure she’s clean of hsv2). Assuming she is negative for hsv-1, if she gives me oral sex, it is possible for her to get hsv-2 orally. I’m confused that on one hand, hsv-2 is stronger, on the other hand, it tend to be less harmful when it is above belt. I think I will have psychological issues to receive oral sex if I can’t make sure it’s safe for her, because even hsv-1 can cause encephalitis+hsv-2 is more aggressive+hsv-2 can cause meningitis reasonably frequent in normal people especially female(although not severe in the immunocompetent)+meningitis and encephalitis seem so close.
5 One study (‘Efficacy of the anti-VZV (anti-HSV3) vaccine in HSV1 and HSV2 recurrent herpes simplex disease’, you can google it if you are interested) claims varicella vaccine for hsv suffers could help them reduce recurrences to 0 and the mechanism for this is the increased vzv antibodies the vaccine introduces. I really wish it is true, but personally I found a lot of flaws in this study, could you share your opinions? Is it worth a shot?
6 One more question related to vaccine. I know when a person’s immune system is suppressed, vaccinations become complicated. They can’t receive live attenuated vaccines and inactivated vaccines tend to be less effective. I’m just afraid even a fairly effective vaccine or a ‘cure’ breaks through someday in the future, my gf can’t benefit from it. The reason I feel this way is the theory behind a vaccine or a cure is to educate one’s immunity to response quicker and better to hsv-2, with immunosuppressants, there is always a discount on any potential benefits.
7 Dear Dr Handsfields, I know I probably ask too much, but I will never bother you and waste your precious time if I can easily find the answers by myself. I’ve learned hsv, autoimmune disorders for two months. These are questions that I can’t figure out by myself or need an expert to reassure. My girlfriend and I have been together for 6 years and we love each other very much. If there is no herpes thing, I’m pretty sure that we will be happily married, raise children together and take care of each other in the rest of our lives. Right now, I just feel like I’m a lifethreatening to her and our future baby if we are able to have one. Since things have happened, the only thing I can do is to learn all the facts and probabilities to make the most responsible decision. (ie. 1 if the risk for her is very small and we are able to have babies, I will beg her forgiveness, love her, treat her kind with heart forever 2 if the risk for her is relatively high, I will leave her, treat her like my daughter and always be there for her when she needs any help, I will still love her forever and won’t be with anyone else, just alone). What will be your choice if you were in my situation? Intuitively I think hsv-2 is not a big issue, but my lesion is in pubic hair area so condom can’t cover+underwear condom is unrealistic+there is a risk that it may ‘kill’ her or harm our baby, I really don’t know what to do.
1 The valtrex study indicates that daily valtrex 500mg can reduce overall hsv-2 acquisition by 48%, which is not ‘that’ impressive given the transmission rate without meds is already low (but I caught the virus from one single sex act which only lasted a few minutes and I was quite drunk) and the large costs of the drug. What I’m interested in is the drug can reduce symptomatic infections by 75% ( 16/741 placebo vs 4/743 valtrex). I’d like to know the mechanism behind this. It still the same virus, why the fact that the source partners taking valtrex could result in less symptomatic acquisitions despite the susceptible partners were not taking drugs?
2 Medicines for uninfected partners may not affect the risk of transmission, but will it lead to asymptomatic acquisition once infection does occur? I really don’t want my gf to catch this virus, but if it is hard to avoid, I hope it could be ‘silent’ so we don’t have much to worry about. Given my gf’s weak immune system and the possibility of taking biologics (TNF-alpha inhibitors, much aggressive to suppress immunity to my knowledge) in the future, I really doubt her infection will be asymptomatic and as mild as normal female. Any comments?
3 If it is possible that antivirals for uninfected people can lead to asymptomatic acquisitions, then is it doable that we both take valtrex while trying to conceive? Will this affects sperm, egg and fetus? I really really want to have a baby with my gf in the natural way, but her health is always my first priority, is it necessary to go for artificial insemination?
4 Could you please share your insight about why each type of hsv has its own preferred site? Why oral-hsv2 and genital-hsv1 tend to recurrent and shed less? As far as I know, hsv-2 is much more aggressive than hsv-1, why it becomes tender when it’s above the belt? I don’t know my gf’s virus status so I’m not sure if she has oral-hsv1( but pretty sure she’s clean of hsv2). Assuming she is negative for hsv-1, if she gives me oral sex, it is possible for her to get hsv-2 orally. I’m confused that on one hand, hsv-2 is stronger, on the other hand, it tend to be less harmful when it is above belt. I think I will have psychological issues to receive oral sex if I can’t make sure it’s safe for her, because even hsv-1 can cause encephalitis+hsv-2 is more aggressive+hsv-2 can cause meningitis reasonably frequent in normal people especially female(although not severe in the immunocompetent)+meningitis and encephalitis seem so close.
5 One study (‘Efficacy of the anti-VZV (anti-HSV3) vaccine in HSV1 and HSV2 recurrent herpes simplex disease’, you can google it if you are interested) claims varicella vaccine for hsv suffers could help them reduce recurrences to 0 and the mechanism for this is the increased vzv antibodies the vaccine introduces. I really wish it is true, but personally I found a lot of flaws in this study, could you share your opinions? Is it worth a shot?
6 One more question related to vaccine. I know when a person’s immune system is suppressed, vaccinations become complicated. They can’t receive live attenuated vaccines and inactivated vaccines tend to be less effective. I’m just afraid even a fairly effective vaccine or a ‘cure’ breaks through someday in the future, my gf can’t benefit from it. The reason I feel this way is the theory behind a vaccine or a cure is to educate one’s immunity to response quicker and better to hsv-2, with immunosuppressants, there is always a discount on any potential benefits.
7 Dear Dr Handsfields, I know I probably ask too much, but I will never bother you and waste your precious time if I can easily find the answers by myself. I’ve learned hsv, autoimmune disorders for two months. These are questions that I can’t figure out by myself or need an expert to reassure. My girlfriend and I have been together for 6 years and we love each other very much. If there is no herpes thing, I’m pretty sure that we will be happily married, raise children together and take care of each other in the rest of our lives. Right now, I just feel like I’m a lifethreatening to her and our future baby if we are able to have one. Since things have happened, the only thing I can do is to learn all the facts and probabilities to make the most responsible decision. (ie. 1 if the risk for her is very small and we are able to have babies, I will beg her forgiveness, love her, treat her kind with heart forever 2 if the risk for her is relatively high, I will leave her, treat her like my daughter and always be there for her when she needs any help, I will still love her forever and won’t be with anyone else, just alone). What will be your choice if you were in my situation? Intuitively I think hsv-2 is not a big issue, but my lesion is in pubic hair area so condom can’t cover+underwear condom is unrealistic+there is a risk that it may ‘kill’ her or harm our baby, I really don’t know what to do.
MEDICAL PROFESSIONAL
Welcome to the forum.
I reviewed your discussion with Terri on the herpes forum and agree with all she advised. Directly to your questions:
1) While it is true that certain immunosuppressive drugs, including methotrexate, in theory might result in increased frequency or severity of herpes recurrences, in fact this is uncommon. It depends in part on the dose of drug; with methotrexate, this probably occurs only with the very large doses used for chemotherapy for certain cancers. The doses for ongoing conditions like rheaumatoid arthritis, psoriasis, etc are not known to actually have these effects. I can't say it will never happen, but it is exceedingly rare. Also, even in people with profound immunosuppression, like advanced AIDS or terminal cancer, serious HSV complications are rare and easily treated.
I can speak to this in personal as well as professional terms. A family member with whom I am very close has been on methotrexate and now is on other immunosuppressive drugs, and also has an HSV infection. I have never had, and still do not have, any concern for any serious herpes problem -- either from the HSV infection she already has, or in the event of future exposure to the other virus type.
2) For the same reasons, I disagree with your conclusion about sexual practices and the risk of HSV-2 transmission to your girlfriend. Her actual susceptibility to HSV probably is minimally elevated due to methotrexate treatment; as noted above, the main risk is for more severe outcomes, not a higher chance your partner will be infected.
The other thing for you to consider is that since you and your partner are obviously on high alert for symptoms if she were to be infected, you will instantly know she is likely to have been infected before symptoms are severe. At that early stage, treatment with valacylcovir or other anti-HSV drugs will be very effective in preventing severe symptoms or complications. Also, as Terri informed you, there is no significant risk of transmission of HSV-2 by semen if and when you decide to conceive a child.
For all those reasons, many couples in your situation would take no precautions at all, and few if any would go beyond suppressive treatment plus condoms. The extreme measures you are taking are unwarranted, and they can't be good for the romance and sexual satisfaction that loving couples deserve and need.
My final advice is that the main decider should be your partner, not you. How does she feel about all this? If she is willing to take whatever small risk would remain if you dropped all the sillier strategies, then you should not dictate otherwise. (I've never heard of an "underwear condom", but it sounds quite unpleasant!)
I hope this has provided some perspective and that my comments are useful. Best wishes-- HHH, MD
I reviewed your discussion with Terri on the herpes forum and agree with all she advised. Directly to your questions:
1) While it is true that certain immunosuppressive drugs, including methotrexate, in theory might result in increased frequency or severity of herpes recurrences, in fact this is uncommon. It depends in part on the dose of drug; with methotrexate, this probably occurs only with the very large doses used for chemotherapy for certain cancers. The doses for ongoing conditions like rheaumatoid arthritis, psoriasis, etc are not known to actually have these effects. I can't say it will never happen, but it is exceedingly rare. Also, even in people with profound immunosuppression, like advanced AIDS or terminal cancer, serious HSV complications are rare and easily treated.
I can speak to this in personal as well as professional terms. A family member with whom I am very close has been on methotrexate and now is on other immunosuppressive drugs, and also has an HSV infection. I have never had, and still do not have, any concern for any serious herpes problem -- either from the HSV infection she already has, or in the event of future exposure to the other virus type.
2) For the same reasons, I disagree with your conclusion about sexual practices and the risk of HSV-2 transmission to your girlfriend. Her actual susceptibility to HSV probably is minimally elevated due to methotrexate treatment; as noted above, the main risk is for more severe outcomes, not a higher chance your partner will be infected.
The other thing for you to consider is that since you and your partner are obviously on high alert for symptoms if she were to be infected, you will instantly know she is likely to have been infected before symptoms are severe. At that early stage, treatment with valacylcovir or other anti-HSV drugs will be very effective in preventing severe symptoms or complications. Also, as Terri informed you, there is no significant risk of transmission of HSV-2 by semen if and when you decide to conceive a child.
For all those reasons, many couples in your situation would take no precautions at all, and few if any would go beyond suppressive treatment plus condoms. The extreme measures you are taking are unwarranted, and they can't be good for the romance and sexual satisfaction that loving couples deserve and need.
My final advice is that the main decider should be your partner, not you. How does she feel about all this? If she is willing to take whatever small risk would remain if you dropped all the sillier strategies, then you should not dictate otherwise. (I've never heard of an "underwear condom", but it sounds quite unpleasant!)
I hope this has provided some perspective and that my comments are useful. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
