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Risk assessment for herpes
I recently was with a new partner. We didn't have intercourse, but we were naked in bed together. At one point I placed my fingers in her vagina, and (don't read if you're squeamish) she put the fingers in her mouth. We kissed more, and at some point (I don't remember the exact order) she had my penis in her mouth for about 5 seconds. To make matters worse, during kissing my lip got a little smashed against her tooth and developed a small cut. Great, huh?
She later told me she had learned a couple months ago from a routine test that she had been previously exposed to HSV2, from an event she thinks happened two years ago. She said she has never had an outbreak.
I didn't freak out in person, but inside I am. I've started a post-exposure prophylactic course with Valtrex. But can you tell me anything about where you think I stand in terms of risk? I was tested two months ago during a physical and was negative for all STDs, including HSV1 & 2, after a dry spell of about a year without sex.
Last, if she and I do continue together and are sexual, how do we manage a safe-as-possible sex life?
Many thanks.
She later told me she had learned a couple months ago from a routine test that she had been previously exposed to HSV2, from an event she thinks happened two years ago. She said she has never had an outbreak.
I didn't freak out in person, but inside I am. I've started a post-exposure prophylactic course with Valtrex. But can you tell me anything about where you think I stand in terms of risk? I was tested two months ago during a physical and was negative for all STDs, including HSV1 & 2, after a dry spell of about a year without sex.
Last, if she and I do continue together and are sexual, how do we manage a safe-as-possible sex life?
Many thanks.
MEDICAL PROFESSIONAL
You need say nothing to future partners. If everyone told all partners about every potential exposure, real or assumed, nobody would ever have sex wtihout saying "I was exposed to XXX". For example, we have all been exposed to HPV and at any point in time, at least a quarter of us are infected. And probably 80% of sexually active persons have been sexually exposed to people with HSV-2, without their knowledge. So what's the point? Of course if you ever have a confirmed infection, that's another story.
MEDICAL PROFESSIONAL
Oh, and by the way: although your partner's "exposed" terminology isn't exactly right, she did tell you about it. That's a hard thing for people with genital herpes to do; it implies responsibility and caring. From that persepective, she sounds like a good catch!
MEDICAL PROFESSIONAL
Welcome to the forum. Bottom line: even if your partner is infected, there was no risk whatever of herpes from this exposure. The explanation follows.
First, let's be clear on one thing: there is no test that shows a person has been only "exposed" to HSV-2, and using that term tends to inappropriately minimize the situation. If your partner's test is positive, then she is infected with HSV-2, which can be transmitted to partners. She should explain to future partners that she has HSV-2 and they may be at risk. That said, the tests aren't perfect; there are many discussions on this forum involving persons with low-positive HSV-2 test results that are false. If you would like, ask your partner the exact test done (brand name and/or lab where it was done) and the numerical result of both her HSV-1 and HSV-2 results. Maybe it will turn out she doesn't have it after all.
Now, assuming she indeed is infecte with HSV-2: unprotected genital or anal intercourse is by far the dominant mode of transmission. The virus is rarely if ever transmitted by hand-genital contact. And it is rare that persons with HSV-2 have oral infections; usually it is genital only. Therefore, it is rarely if ever transmitted by oral sex, i.e. from the oral to genital partner. Or by kissing. And even with unprotected intercourse, the average transmission risk probably is roughly once for every 1,000 exposures; many long-term couples in which one person has HSV-2 have regular unprotected sex for years without transmission of the virus.
So your risk is zero for practical purposes. You should not be taking Valtrex. And post-exposure treatment doesn't prevent infection anyway. The only way that would work would be to have taken the drug before exposure; even an hour later is too late to prevent infection. All it would do is delay the first outbreak. Please stop taking it.
There are 3 basic methods to prevent HSV-2 transmisison: consistent condom use; avoiding sex when the infected person is having an outbreak; and treatment of the infected person with valacyclovir or related drugs. When couples use all 3 methods, transmission is rare. I'll also say that if a relationship is potentially a committed one, herpes should never be permitted to stand in the way. It's just not that important a problem. But let's hold off on further discussion of this aspect until and unless you can confirm your partner's HSV-2 status, as suggested above.
I hope this helps. Best wishes-- HHH, MD
First, let's be clear on one thing: there is no test that shows a person has been only "exposed" to HSV-2, and using that term tends to inappropriately minimize the situation. If your partner's test is positive, then she is infected with HSV-2, which can be transmitted to partners. She should explain to future partners that she has HSV-2 and they may be at risk. That said, the tests aren't perfect; there are many discussions on this forum involving persons with low-positive HSV-2 test results that are false. If you would like, ask your partner the exact test done (brand name and/or lab where it was done) and the numerical result of both her HSV-1 and HSV-2 results. Maybe it will turn out she doesn't have it after all.
Now, assuming she indeed is infecte with HSV-2: unprotected genital or anal intercourse is by far the dominant mode of transmission. The virus is rarely if ever transmitted by hand-genital contact. And it is rare that persons with HSV-2 have oral infections; usually it is genital only. Therefore, it is rarely if ever transmitted by oral sex, i.e. from the oral to genital partner. Or by kissing. And even with unprotected intercourse, the average transmission risk probably is roughly once for every 1,000 exposures; many long-term couples in which one person has HSV-2 have regular unprotected sex for years without transmission of the virus.
So your risk is zero for practical purposes. You should not be taking Valtrex. And post-exposure treatment doesn't prevent infection anyway. The only way that would work would be to have taken the drug before exposure; even an hour later is too late to prevent infection. All it would do is delay the first outbreak. Please stop taking it.
There are 3 basic methods to prevent HSV-2 transmisison: consistent condom use; avoiding sex when the infected person is having an outbreak; and treatment of the infected person with valacyclovir or related drugs. When couples use all 3 methods, transmission is rare. I'll also say that if a relationship is potentially a committed one, herpes should never be permitted to stand in the way. It's just not that important a problem. But let's hold off on further discussion of this aspect until and unless you can confirm your partner's HSV-2 status, as suggested above.
I hope this helps. Best wishes-- HHH, MD
Hi doctor. The woman I've been discussing told me yesterday that she she has oral HSV 2, not genital, based on what her physician now says was probably a herpes outbreak on her cheek that the physician at the time diagnosed as shingles. All my nerves had calmed down and now I'm freaking out again. We have kissed and certainly our faces have been in lots of skin on skin contact. Can you reassess for me the risks involved? I haven't had any symptoms, and she doesn't appear to have ever had an outbreak while we've been together. But crap. I'm scared. She has taken a follow up test but hasn't received the results yet.
MEDICAL PROFESSIONAL
Glad to have helped. That's why we're here. Take care.
Thanks a million, doctor. You've really helped, and the subsequent discussion she and I had actually brought us closer, not further apart.
Thanks very much for the reply and information Dr. Handsfield.
I think she's pretty cool, too. But if, for whatever reason, she and I don't wind up together, what information do I owe the next woman I may be intimate with, especially if it's before the typical three-month window for sufficient antibody development?
As you might have guessed from my initial post, I'm re-entering the dating world after a long time away and am fumbling my way forward.
I think she's pretty cool, too. But if, for whatever reason, she and I don't wind up together, what information do I owe the next woman I may be intimate with, especially if it's before the typical three-month window for sufficient antibody development?
As you might have guessed from my initial post, I'm re-entering the dating world after a long time away and am fumbling my way forward.
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.
