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Male with genital HSV and female with asymptomatic HSV2. How to be safe?

I’m a 48-yr old male diagnosed in April of 2018 with HSV1 after presenting one or two small pimples on my penis. This was done with a blood test, not a swab, since I didn’t have symptoms when I went to see the doctor. These outbreaks have recurred in more or less the same area (below or on the head of the penis) about once a month since then. The length and severity of the outbreaks is diminshed by taking Valacyclovir, but I avoid taking it since I haven’t been sexually active, and the symptoms are merely annoying. But now, I’ve met someone...
Before engaging in any activity (still haven't), I asked my potential partner (female), about potential STDs, and disclosed my HSV1. She said her ex-husband had cold sores but she never had symptoms. I asked her to take a test, thinking if she had HSV1 as well, we’d have nothing to worry about. She told me that the tests results indicated she had HSV2 antibodies. I don’t know if it’s genital or oral, as she has never presented symptoms, but presumably got it from her ex’s oral cold sores. What does this combination (my genital HSV1 and her asymptomatic HSV2) mean in terms of practicing safer sex?

Assumptions: No sexual contact during symptoms. Mostly use condoms for vaginal or anal sex.

1. Can it be determined if her HSV2 is the actual virus she carries or just antibodies?
2. Can it be determined if she has oral or genital HSV2?
3. If I am receiving unprotected oral sex, a) can my genital HSV1 be transmitted to her, or b) can I receive HSV2 from her?
4. If yes, is the only "safe" choice to use condoms for receiving oral sex?
5. If I am giving her unprotected oral sex, a) can I give her HSV1, or b) get HSV2?
6. If yes, is a dental dam the only "safe" choice for giving her oral sex?
7. Obviously a condom will help reduce transmission during vaginal or anal sex, but by how much?
8. Do we have to worry about kissing, if neither of us has ever had symptoms (cold sores) in the mouth, but her HSV2 seems to have been acquired by an ex who did have cold sores?
9. Is mutual masturbation (hand-job and fingering) safe? Must we wash our hands right after, or can we touch our own genitals after touching the other person’s genitals without washing our hands, and still be safe?
10. Should we *both* take anti-virals (like Valacyclovir) to further minimize risk, on daily basis, or only during symptoms? Or just me daily, or only during symptoms?

Thanks for addressing all these questions. I have read three books on Herpes and none really address the details.
1 Responses
207091 tn?1337709493
COMMUNITY LEADER
Okay so first, if someone gets genital herpes from oral sex, they have genital herpes type 1. It doesn't turn into type 2. The number indicates the strain, not the location. Hsv2 is almost always genital. Statistically, I'd assume that's where it is.

So for you, you have definitely seen a reduction in your symptoms with Valtrex? What kind of blood test did you have done? What was the time frame? I ask because ghsv1 recurring like yours does is unusual. Have you ever had one of them cultured? Does Valtrex taken every day reduce the frequency?

Did both of you get IgG testing done? Make sure it was IgG testing, not IgM. IgM testing is highly unreliable. Also, see if you can find out her numbers, as well as yours. Especially with hsv2, anything under a 3.5 needs to be confirmed, as there is a good chance it's a false positive if it's below that.

Now, your questions:

Assumptions: No sexual contact during symptoms. YES.

Mostly use condoms for vaginal or anal sex. Yes, though there is room for debate on this, which I'll address below.

1. Can it be determined if her HSV2 is the actual virus she carries or just antibodies? There is no such thing as being just a carrier or having just been exposed. If she has antibodies, she has herpes, and is infectious.


2. Can it be determined if she has oral or genital HSV2?

Without symptoms, technically no, but oral hsv2 is very rare, so unless she had any oral symptoms, it's safe to assume it's a genital infection.


3. If I am receiving unprotected oral sex, a) can my genital HSV1 be transmitted to her, or b) can I receive HSV2 from her?

a) No. Herpes rarely goes from the genitals to the mouth (though the assumption about not having sexual contact during symptoms is important here), and having hsv2 offers protection against getting hsv1. The reverse is NOT true, though - having hsv1 doesn't protect you from hsv2, though it may make hsv2 more mild.

b) Oral hsv2 is rare, but avoid this if she has any symptoms.


4. If yes, is the only "safe" choice to use condoms for receiving oral sex?

See #3 - not applicable.


5. If I am giving her unprotected oral sex, a) can I give her HSV1, or b) get HSV2?

See #3
6. If yes, is a dental dam the only "safe" choice for giving her oral sex?

See #3


7. Obviously a condom will help reduce transmission during vaginal or anal sex, but by how much?

So we don't have transmission studies for ghsv1 like we do for ghsv2. We do know shedding rates, though.

Shedding rates: (and you can find all this in the herpes handbook - https://westoverheights.com/herpes/the-updated-herpes-handbook/)

HSV 2 genital 15-30% of days evaluated

HSV 1 genital 3-5% of days evaluated
  
HSV 1 oral 25% of days evaluated

HSV 2 oral 1% of days evaluated

Ghsv2 transmission rates, female to male, over the course of a year, assuming sex 2-3x a week:

We also know that ghsv1 generally results in far fewer outbreaks than ghsv2, and many people never get another outbreak after their first. That, combined with the lower shedding rates, means lower transmission.

So for transmission rates. We don't know the exact transmission rates for ghsv1, but here are the rates for ghsv2, and if your math is better than mine, maybe you can extrapolate some figures.

Ghsv2 transmission, female to male, over the course of a year, assuming vaginal sex 2-3 times a week (we don't have studies on anal sex):

Only avoiding sex during an outbreak - 4-5%

Adding condoms OR daily suppression - 2-3%

Adding condoms AND daily suppression - 1-2%


8. Do we have to worry about kissing, if neither of us has ever had symptoms (cold sores) in the mouth, but her HSV2 seems to have been acquired by an ex who did have cold sores?

Her hsv2 wasn't acquired by an ex who had cold sores. It was acquired by someone who had hsv2 and didn't know it, perhaps that same guy, I don't know. I explained above that oral hsv1 doesn't turn into ghsv2, it would be ghsv1.

It's possible you also have oral hsv1, or maybe not. Your blood test only tells you what type you have, not where. You can worry about oral hsv1, or you can assume that you have it, and she might have it - the IgG blood test misses 30% of hsv1 infections, and not deprive yourself of kissing your partner. Over half the adult population has hsv1 orally.


9. Is mutual masturbation (hand-job and fingering) safe? Must we wash our hands right after, or can we touch our own genitals after touching the other person’s genitals without washing our hands, and still be safe?
10. Should we *both* take anti-virals (like Valacyclovir) to further minimize risk, on daily basis, or only during symptoms? Or just me daily, or only during symptoms?

Mutual masturbation is always safe. You don't need to wash your hands. You are not walking bio-hazards. The only times ways you can spread genital herpes are by direct skin to skin genital to genital contact, like unclothed grinding, rubbing, penetration, etc.

It's up to you all to decide, together, what prevention methods work best for you, and what you are both comfortable with.

Before making any decisions, I'd get copies of your tests, and I'd get one of your lesions cultured. That's where I'd start.

3 Comments
Thank you for taking the time to answer my questions so thoroughly. It is immensely appreciated. Thank you.

As a follow up, just to clarify, would you mind spelling out the answer to question #5 (you reference #3’s answer, but I’m having trouble untangling the directionality and specific risk cases from one to the other scenario).

Beyond that, the next step is getting the actual test results and getting my lesions cultured. Got it. Thanks again for your dedication and giving me the most comprehensive and sensible answers I’ve gotten so far--there is so much random and contradictory or insufficient information out there, so I want to express my gratitude fully.
Sure. :)

So herpes very rarely goes from the genitals to the mouth. Unless she has an hsv2 outbreak on her genitals, there is little chance you'd ever get that orally. Hsv2 just doesn't prefer the oral area. It does happen, but it's considered very rare, so just avoiding giving her oral if she has any genital symptoms is sufficient.

If you have oral hsv1 - which is as yet undermined - you can give her oral sex. Even assuming you have hsv1 orally, she already has hsv2, which offers her significant protection against getting hsv1 after (I'm assuming her tests were negative for hsv1, and she should check on that because some docs don't give those results because so many have it, and they consider it not a big deal).

So basically, for both of you, in the absence of symptoms, oral sex is fine, giving or receiving. Really, it's just a good sex code for anyone to not have sexual activity while you have symptoms. Even fungal infections like yeast or jock itch can be transmitted with sexual activity.

Does that help? I hope so, but if you need further clarification, let me know. :)

If you could get copies of all your test results, that would be really helpful, too.

Oh and you're welcome. I'm happy to help.
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