How to reduce transmission

[Canucks117]

I have had gential herpes for around 5 months now. I got it off a one time exposure, and the emotional effects were pretty bad, but I've finally accepted the fact I now have it. My main fear and concern is to avoid passing it on to future partners. This is what I already know, first is to tell all partners about my condition. Second is never to have sex when you feel the first signs to 7 days after the lesions have healed. My next question is about condoms. I have the outbreaks on my scrotum, because I always use condoms. Does this mean that condoms are not effective for me preventing transmission to a partner because the site is on my scrotum? My next question is on medication. How effective is the medication for reducing assympomatic viral shedding? I heard it is only 50%. Does this mean with medication alone there is only a 50% chance my partner won't get infected? Finally, how often does viral shedding occur with no symptoms after the first year? I notice alot of strange sensations in the site of where my outbreaks occur, but I notice no outbreaks at all. When I do have an outbreak, I only see like 1 or 2 small blisters. Does this mean my outbreaks will always be less sevre? Thank you for your response.

[Edward W Hook, MD]

Your concern and question are gratifying.  You are doing the right things and should feel good about it.  To recap and address your questions:

1.  Prevention.  there are several elements to successful prevention.  These include disclosure to partners, avoidance of sex during outbreaks, condoms, and chronic suppressive therapy with antiviral medications.  Each component has been studied individually and found to significantly reduce the risk of transmission.  By doing all of them, the risk becomes very low but not zero (how low cannot be said).
2.  Condoms which do no cover the lesions will not prevent transmission.
3.  Chronic suppressive therapy. In the study which proved that chronic suppressive therapy reduced transmission about 50% also showed that in couples in which one person had herpes and the other did not, without therapy transmission occurred at a rate of about 6% per year.  this with suppression alone the rate falls to about 3% and still lower when you add the other things you plan to do.
4. Asymptomatic viral shedding in the first year occurs at about 12% of the time.  (Remember however, the virus is actually not very transmissible and most exposures do not lead to transmission).
5.  the sensations you notice without outbreak may be what is called a "prodrome" which may indicate viral activity even without lesions.
6.  The pattern of outbreaks tends to be pretty consistent. I suspect this is your pattern.

Finally, I suspect you might benefit form a direct conversation about the disease and transmission.  The American Social Health Association (ASHA) has both a web site and a hotline which are great sources of additional information.  I encourage you to check them out. (Disclosure- Dr. Handsfield and I are both on the Board of Directors of ASHA)

[Canucks117]

Thanks for reply. So after the first year, doesn't asympomatic shedding go down to like 5%? Also with regards to the condom question, even though I'd still wear it, and would have sex durning an outbreak, does it provide any protection when I don't have an outbreak? Like if I were to shed through the shaft of my penis, even though the infection is still on my scrotum? Thanks again for the reply.

[Edward W Hook, MD]

After the first year the shedding rate does decrease somewhat but it is still closer to 10% than 5%.

Regarding the condom.  Asymptomatic shedding is just that, shedding without an outbreak.  Condoms do protect.  If your lesions were predominanatly n the scrotum then your shedding will be there as well.  If not covered by the condom, tranmission could occur although most tranmission in men is from penile, not scrotal sources.   eWH

[Canucks117]

I should change that last comment, I meant I wouldn't have sex durning an outbreak.

[Edward W Hook, MD]

I thought that was the case and framed my response accordingly.  EWH

[Canucks117]

I hate to post again, but just two more short questions. Aaymptomatic shedding is just like any other outbreak, but no noticeable symptoms, it doesn't occur like every other day, only a few times a year, like a regular outbreak? Finally, even though I have my outbreaks always on my scrotum, not on my actual penis, a condom will still be helpful protecting future partners from contracting herpes from me?

Thanks for your reply, and this will be my final post.

[Edward W Hook, MD]

Asymptomatic shedding occurs rather frequently.  Recent studies have estimated that this is as much as 10% of the time.  At that time virus is present and can (but usually is not) be tranmitted.

If the scrotal lesion (a very unusual place for HSV by the way, is your diagnosis culture proven?) is present it could be a source of transmission.  At the same time becasue of differences in both the sort of skin present and the sort of contact that would occur with a scrotal vs a penile lesion, I would suspect that there would be less risk of transmission.
EWH

[Canucks117]

Yes I had both a blood test and a culture that came back positive for HSV 2. The doctor figured because I was wearing a condom, that is the reason why it is on my scrotum. It is on the left side, maybe an inch away from the lower shaft of my penis. I've had about 3 outbreaks so far, including the primary one since I contracted it which was about 4 and half months ago. The second outbreak was barely noticeable, it was only one small blister. The third was about 2-3 small blisters that caused lesions. I contracted it from a one time encounter, although I'm not entirely convinced the person whom I was with wasn't having symptoms. They have denied it, but from what I remember in the encounter she complained of pain, so she was probably having an outbreak at the time but did not know it.

[Edward W Hook, MD]

thanks for the clarification. EWH