female protecting spread of herpes to male

[Siri]

I'm a female who just discovered I have HSV 2 via a blood test. I had one outbreak nine years ago and I wanted to make sure what it was. I've had no other discernible symptoms. My boyfriend of course wants to know what this means to him. We haven't had sex yet, but this is a potential long term monogomous relationship. 1)Do we always have to use a condom? Of course we want to have children so at some point we'd need to NOT use a condom. For married couples, what is your best advise?
2) How effective are suppressive drugs re: lowering risk of transmission?
3) What are his risks in performing oral sex on me? Me on him after his penis has been around my genitals? Does HSV 2 ever transmitt to the mouth?
4) What are the best ways and what are the best percentage chances of not transmitting the disease?
5) Since I have no outbreaks, how can I know if the virus is active and shedding?

Any help is great!

[H. Hunter Handsfield, M.D.]

In my opinion, the risk of HSV transmission should never be the main determinant of what people do sexually.  Most genital HSV-2 infections are asymptomatic or cause very mild symptoms.  So if your partner gets infected, the odds are it will be mild, perhaps so mild he doesn't even know when it happens.  And if he does get symptoms, effective treatment is available.  So assuming you and he are both planning on a permanent, committed relationship--and there is no risk of infecting other people--than my advice is to not worry very much about whether or not he gets infected.

After 9 years and with no symptomatic recurrences, the odds are good that you don't shed virus all that often.  But there are no readily available tests to know for sure how often that happens.

The first priority is for your boyfriend to be tested for HSV-2 infection.  Since 25% of the population is infected, there is a fair chance he already has it.  In that case, you have no worries; he is immune to getting reinfected from you.

Assuming he is susceptible (i.e., negative HSV-2 blood test) and you decide together to try to avoid infecting him, you have three options:  avoid sex when you have symtoms (presumably not a problem since you're not having outbreaks); condoms; and antiviral therapy for you.

Now to your specific questions:

1) Always "have to use" condoms?  No; see above.  Even if you decide to use condoms most of the time, you can leave them out for the few mid-cycle days when you are trying to conceive.

2) Effectiveness of antiviral therapy?  The short answer is "good, but not perfect".  The only research study showed a 50% reduction in transmission on valacyclovir (Valtrex) vs placebo.  There were aspects of the study design that probably minimized the effectiveness, so the actual protection may be higher.  But some risk of transmission persists.  (I prescribe a higher dose than was used in the study, 1.0 gram per day instead of 0.5 gram; I suspect it would work better.)

3) The risk he would get oral HSV-2 infection by cunnilingus is low, but not zero.  But if it happens, he won't get recurrent oral outbreaks, which are rare with HSV-2.   There is no risk to you whatsoever from performing oral sex (or any other sex) on him; you cannot reinfect yourself with the virus you already are carrying.

4) See above.  Many couples go through their entire sexual lives without transmitting HSV-2.  Your chances are pretty good.

5) You can't know for sure.  But we do know that after 8-10 years, recurrent outbreaks and probably asymptomatic shedding are less frequent than in the first couple of years after infection.

Good luck--  HHH, MD  

[Unlucky man]

I understand that Type II seldom occur orally and even if it does, recurrence is rare. In addition, once antibody is produced it gives protection to the host when s/he comes into contact with the same type of virus in other parts of the host's body. Since it is impossible to completely protect the sexual partner of an infected person from sex contacts, would you agree that it could be a "blessing in disguise" if a person is infected with type II orally, since s/he can be protected from having Type II genital herpes, which is most feared by people generally.

Thank you.

[confused33]

I have read numerous posts on this same type of question--transmission of gential herpes/herpes through oral sex and am wondering if you can provide a bit of clarification, rather than a generalization. If her boyfriend is performing oral sex on her and comes in contact with her gential herpes, will he then become infected in his facial/oral region, or will the virus enter through the oral region and then travel to the gential region, thus causing his infection in the genital region and not the oral/facial region.

[monkeyflower]

While you wait for the Dr's reply, I thought I'd share my own experience. I have herpes, and when I found out (also by blood test), my husband decided to just assume he had it as well. Although we do use condoms with other partners, we've never taken any precautions with each other at all, because neither of us think of herpes as a big deal. Consider your own experience - if you've only had one outbreak in nine years, it hasn't exactly been the tragedy many in our society try to make it seem. Yes, he might have more frequent outbreaks if he contracts it, but still it's treatable.

In any case, I think the risk of transmission from woman to man, without using condoms and just avoiding sex during outbreaks, is around 4%/year. With condoms and suppressive therapy, I think it's somewhere around 1 - 2%/year. However, there are periods of asymptomatic shedding, so you could literally be contagious at any time. Still, the risks are pretty small. This is a decision only the two of you can make, though.

As for oral, it's pretty uncommon to get HSV2 orally since it really doesn't like the mouth area. I think if he has HSV1 orally (most do) it might offer some protection, but even if he did contract HSV2 orally, he'd probably only have one outbreak and no more. There are no issues from you giving him oral, unless of course you have HSV1 orally and he doesn't. If you're worried, you can use dental dams or Saran Wrap with lots of lube between it and your vulva, and a condom for oral on him.

Read back a bit on the forum for some great info from Dr. Handsfield, and definitely check out the link at the top of the page. Also, check www.cdc.gov/std, www.westoverheights.com, and www.ashastd.org. The more both of you know, the better I think you'll feel :-)