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Herpes questions

Hi doc,

26,  female hsv free dating male who was diagnosed with hsv2 4.5 igg and equivocal for hsv1 1.1 (interesting the doctor said he was negative, but numbers suggestive positive, should he get retested, you think he could be negative for hsv 1?)  We had protected intercourse on two occasions prior to his results coming back- I wanted to abstain as I was worried he may have herpes even though he said he never had symptoms. Indeed I was correct. Initially I had a ton of anxiety and did not want to be with him. Since the diagnosis we only had intercourse 1 other time. He wore boxer briefs and used a condom. No skin to skin contact from what we can tell. After having read up on the std, I feel that we may be able to continue if we are cautious. Questions:

1.Skin to skin contact. I know someone who has herpes and they say it is not passed skin to skin, but through sexual fluids. If I touch his genitals or get semen on my finger or if his semen gets on my stomach, am I at risk? I have read that it IS passed by skin touching skin. I go to the electrolysis for my bikini. I know it puts me more at risk because I sometimes get ingrown hairs and scarring from the procedure. But, if we use a condom and his skin around doesn’t touch me, will I be ok? This sounds silly, but if he wears boxer briefs that cover his genitals, thigh,  plus a condom, will that add extra protection?
2. Valtrex: He has not gone on valtrex yet. He does not have health insurance at the time being- is there a discount website where he can buy valtrex? How much should he take a day if he doesn’t have outbreaks but wants to lower transmission. Will it lower risk of hsv1 and 2? How many days does it take to start working ?
3. If he doesn’t have breakouts, or obvious ones, do you think he has a low viral load? Will transmission risk reduce over time? Also, he is a smoker, do you think that will affect asymtomatic shedding?
7 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Well, my starting point is that you seem more concerned about herpes than necessary.  (Sex with boxer shorts??  That won't reduce the risk over concoms alone, and sounds rather unappealing on the face of it....)

If the long term prospects for this relationship are poor or unknown and you're likely to be dating other persons in the future, you definitely should do your best within reason to avoid infection.  But herpes is too trivial in most cases, and life too short, for it to interfere with the potential for a committed romantic and sexual relationship.  In that case, you still might want to take precautions, but not go to extremes.
  
Among monogamous couples in which only one partner has HSV-2, who have unprotected vaginal sex an average of 2-3 times per week, the average transmission rate is 5% (1 in 20 couples) per year.  So the risk is very low for each episode of sex, assuming no sex when the infected person has symptoms.  Your actual risk could be higher or lower than this, however.  Transmissions tend to be more frequent early in relationships than later (maybe passion overridding caution in presence of mild symptoms?) and when the infected person's infection is recent.  But it's lower in couples in which there has been disclosure, as in your case.

1.  As I already implied, I agree the boxer shorts "sounds silly".  Obviouly you already know the basics of transmission; you're just taking it too far (as with the boxer shorts).  The 3 key elements are no sex when the infected person is having symptoms of an outbreak; condoms at other times; and antiviral therapy, usually with valacyclovir (Valtrex).  Once you're doing those things, the other details of skin contact etc don't add any further safety.  Don't do things that so dramatically impact sexual spontaneity and enjoyment.  Condoms is plenty.  And don't worry about electrolysis etc.

2. The usual dose of valacyclovir is 500-1000 mg once daily.  Personally, I prefer the higher dose, but he should follow the advice of a personal health care provider who prescribes it.  It probably is effective in suppressing viral shedding more or less immediately with the first dose, certainly within 3-4 days.  As to HSV-1, most likely your partner doesn't have HSV-1 and it wouldn't matter much if he did.  If you're going to worry about HSV-1, you have to exclude 50-60% of all potential lifetime partners from consideration.

3. The frequency of asymptomatic shedding is the same in people with or without symptomatic outbreaks and, in those with outbreaks, regardless of their frequency.  Smoking makes no known difference.

I hope this helps.  Please don't let herpes rule your sex life as much as it seems to be doing.  Best wishes--  HHH, MD
Helpful - 3
239123 tn?1267647614
MEDICAL PROFESSIONAL
I did respond to your semen question; re-read answer no. 1 ("Once you're doing those things...").  Most likely there is little or no asymptomatic shedding from the scrotum or thighs.

Herpes is not so easy to transmit. Re-read my description of statistics in monogmous couples.  If it's 1 in 20 per year with no protection, adding condoms plus valacyclovir probably brings it down to near zero, without worrying about semen on the skin and certainly without worrying about contact with scrotum and thighs.  Even in a casual, non-permanent relationship, boxer shorts (and latex gloves??) are just going too far.  The juice isn't worth the squeeze.

That will be my last comment on it.  Cheers.
Helpful - 1
Avatar universal
Dear Dr. Hansfield,

Thank you for the thorough response.

Yes, I am concerned for reasons which you pointed out: I am not sure the longetivty of this relationship. I like my partner enough to see where it goes, but I do not know if this is a forever thing, thus, I want to prevent infection.

The reason why I thought boxer shorts would help because I have read that the virus can be present on scrotum/testicles/thigh. That area does come in contact with me when we have sex.

The one thing you did not respond to was the risk of his semen on my skin? I'm assuming that handjobs both ways are not risky even if our hands come in contact with our genitals?

Ok, those are the last of my questions! Thank you so much
Helpful - 0
Avatar universal
Since you are recommending 1,000 mg of Valtrex daily for suppression, would you have a recommendation for an equivalent dose of acyclovir? And can you give your reasoning for recommending the higher dose? Great succinct and comprehensive explanation, BTW.
Helpful - 0
Avatar universal
Thanks:)
Helpful - 0
Avatar universal
A related discussion, couples w/hsv1 was started.
Helpful - 0
Avatar universal
A related discussion, herpes shedding on the thigh was started.
Helpful - 0

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