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Herpes Transmission to an unaffected partner
Hello!
I have recently entered into a sexual and emotional relationship with a man who does not have HSV-2, however I do. We have had lengthy conversations on transmission and prevention, however he is still nervous about infection.
We have not had sexual intercourse, but we are interested to, and he has gotten female condoms for when we decide to.
Currently we have only done mutual masturbation, which includes:
His hands touching my genitals (only when an outbreak is not present).
To prevent him from being infected we have made sure during and after masturbation that he does not touch himself, steering clear of his face, my face and his own genitals. The only part of his body that touches my genitals have been his hands. After, he and I (even if I don't touch myself) immediately wash our hands with hot water and soap.
I was told by my doctor that I could still have a sexual relationship with my partner and reduce transmission, by keeping our genitals from skin to skin contact and washing our hands regularly. I continue to get tested, and have encouraged him to do so every 6 months. We continue our conversations regularly to keep his worries to a minimum however I would appreciate any more information.
Everything that I have read just states "skin to skin" as a means of transmission, however I would like to ensure or have some sort of ease that what I have relayed correct information. As long as we are vigilant in keeping his hands away from other parts of his and my body during him touching my genitals we are keeping him at a very low risk of being infected.
I await your response!
-M
I have recently entered into a sexual and emotional relationship with a man who does not have HSV-2, however I do. We have had lengthy conversations on transmission and prevention, however he is still nervous about infection.
We have not had sexual intercourse, but we are interested to, and he has gotten female condoms for when we decide to.
Currently we have only done mutual masturbation, which includes:
His hands touching my genitals (only when an outbreak is not present).
To prevent him from being infected we have made sure during and after masturbation that he does not touch himself, steering clear of his face, my face and his own genitals. The only part of his body that touches my genitals have been his hands. After, he and I (even if I don't touch myself) immediately wash our hands with hot water and soap.
I was told by my doctor that I could still have a sexual relationship with my partner and reduce transmission, by keeping our genitals from skin to skin contact and washing our hands regularly. I continue to get tested, and have encouraged him to do so every 6 months. We continue our conversations regularly to keep his worries to a minimum however I would appreciate any more information.
Everything that I have read just states "skin to skin" as a means of transmission, however I would like to ensure or have some sort of ease that what I have relayed correct information. As long as we are vigilant in keeping his hands away from other parts of his and my body during him touching my genitals we are keeping him at a very low risk of being infected.
I await your response!
-M
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'm happy to try to help. Congratulations for a responsible approach to preventing HSV-2 transmission. You ask basic but important questions about genital herpes transmission. But I'm a little worried you're being more careful than necessary.
With apology for a pretty long reply, I am using this opportunity to write a blog-like response to be saved so I can refer future similar questions to it.
Common sense precautions to prevent HSV-2 transmission are, well, common sense. But as you may have experienced yourself, genital herpes is mostly mild and pretty easy to live with. It should never be permitted to interfere with romance and rewarding sex, especially in a committed or potentially committed relationship. If your new relationship has a good chance for long term commitment, you and your partner should be willing to accept some risk of transmission -- because there is no way to reduce the risk to zero. However, it's easy to get close to zero. It is probably not practical to avoid all skin-to-skin contact without severely curtailing your sexual expression with one another, and it generally isn't necessary.
And here is a basic fact to keep in mind: HSV isn't all that easily transmitted! Among monogamous couples in which one person has genital HSV-2 and the other does not, who have vaginal sex without condoms 2-3 times per week, transmission occurs in only 5% of couples (1 in 20) every year. Even after years of regular sex, transmission never occurs in many (most?) such couples. The chance of transmission during any single episode of unprotected vaginal sex probably averages about 1 in 1,000. Of course transmission risk isn't "average" in all people, and your risk could be higher. Or it could be even lower.
The 3 basic approaches to prevent transmission are 1) avoid sex when having a symptomatic outbreak, 2) use (male) condoms consistently, and 3) take anti-HSV suppressive therapy. None of these is perfect, but when all 3 are used, transmission of HSV-2 is uncommon.
Are you currently taking suppressive therapy? If not, the first thing you should do is talk to your provider about getting onto daily treatment with valacyclovir (Valtrex) or acyclovir. (The third antiherpes drug, famciclovir [Famvir] is somewhat less effective.) It's easy, safe, and usually free of side effects -- and not all that expensive.
It is theoretically likely the female condom would be more effective than male condom, because it prevents more skin-skin contact. But consistent use of male condoms is quite effective.
As for hand-genital contact, there is no risk at all. And genital to oral HSV-2 transmission also is rare. If you aren't having an overt outbreak, I do not recommend barriers for either hand-genital contact or cunnlingus (oral-vaginal contact). And you can't transmit your genital HSV-2 to his penis by oral contact, unless you are one of the small minority who have oral as well as genital HSV-2.
Finally, assuming your own diagnosis of HSV-2 is correct, there is no need for you ever to have another test for it. It's a lifelong infection, and any changes in your own test results wouldn't mean anything. If your partner wants periodic reassurance, he could have an HSV-2 blood test from time to time. But don't overdo it. If he doesn't get symptoms that suggest genital herpes, a blood test once a year is plenty.
If you want to provide a bit more information about your genital herpes, I might be able to better judge the transmission chances. When did you catch it? How was it diagnosed? What is your outbreak frequency? What lab tests have been done and what were the results?
I hope this provides some perspective. Best wishes for a healthy and mutually rewarding relationship, and for the happiest of holidays. (Hey, I have an idea for a great mutual Christmas present! Think about it.)
Regards-- HHH, MD
With apology for a pretty long reply, I am using this opportunity to write a blog-like response to be saved so I can refer future similar questions to it.
Common sense precautions to prevent HSV-2 transmission are, well, common sense. But as you may have experienced yourself, genital herpes is mostly mild and pretty easy to live with. It should never be permitted to interfere with romance and rewarding sex, especially in a committed or potentially committed relationship. If your new relationship has a good chance for long term commitment, you and your partner should be willing to accept some risk of transmission -- because there is no way to reduce the risk to zero. However, it's easy to get close to zero. It is probably not practical to avoid all skin-to-skin contact without severely curtailing your sexual expression with one another, and it generally isn't necessary.
And here is a basic fact to keep in mind: HSV isn't all that easily transmitted! Among monogamous couples in which one person has genital HSV-2 and the other does not, who have vaginal sex without condoms 2-3 times per week, transmission occurs in only 5% of couples (1 in 20) every year. Even after years of regular sex, transmission never occurs in many (most?) such couples. The chance of transmission during any single episode of unprotected vaginal sex probably averages about 1 in 1,000. Of course transmission risk isn't "average" in all people, and your risk could be higher. Or it could be even lower.
The 3 basic approaches to prevent transmission are 1) avoid sex when having a symptomatic outbreak, 2) use (male) condoms consistently, and 3) take anti-HSV suppressive therapy. None of these is perfect, but when all 3 are used, transmission of HSV-2 is uncommon.
Are you currently taking suppressive therapy? If not, the first thing you should do is talk to your provider about getting onto daily treatment with valacyclovir (Valtrex) or acyclovir. (The third antiherpes drug, famciclovir [Famvir] is somewhat less effective.) It's easy, safe, and usually free of side effects -- and not all that expensive.
It is theoretically likely the female condom would be more effective than male condom, because it prevents more skin-skin contact. But consistent use of male condoms is quite effective.
As for hand-genital contact, there is no risk at all. And genital to oral HSV-2 transmission also is rare. If you aren't having an overt outbreak, I do not recommend barriers for either hand-genital contact or cunnlingus (oral-vaginal contact). And you can't transmit your genital HSV-2 to his penis by oral contact, unless you are one of the small minority who have oral as well as genital HSV-2.
Finally, assuming your own diagnosis of HSV-2 is correct, there is no need for you ever to have another test for it. It's a lifelong infection, and any changes in your own test results wouldn't mean anything. If your partner wants periodic reassurance, he could have an HSV-2 blood test from time to time. But don't overdo it. If he doesn't get symptoms that suggest genital herpes, a blood test once a year is plenty.
If you want to provide a bit more information about your genital herpes, I might be able to better judge the transmission chances. When did you catch it? How was it diagnosed? What is your outbreak frequency? What lab tests have been done and what were the results?
I hope this provides some perspective. Best wishes for a healthy and mutually rewarding relationship, and for the happiest of holidays. (Hey, I have an idea for a great mutual Christmas present! Think about it.)
Regards-- HHH, MD
MEDICAL PROFESSIONAL
The HSV blood tests are good but not perfect, and there may be a possibility you don't actually have HSV-2, especially in view of your infrequent outbreaks and if the result was not strongly positive. Not to raise your hopes -- probably you have it -- but If you'd like to explore this further, try to find the numerical values of your HSV-1 and HSV-2 results and, if available, the name of the test that and/or what lab performed it. Also, let me know a bit more about the two outbreaks you had (symptoms, location, etc) and whether you can recall any previous outbreaks before your positive blood test.
You have learned a couple of urban myths about herpes. First, there is no such thing as a blood test showing exposure without infection. A positive test means a person is infected. Second, staying healthy, exercising, and avoiding stress of course are good things. But they have no effect on frequency or severity of HSV outbreaks or the likelihood of asymptomatic viral shedding that can result in transmission.
HSV can be acquired at the base of the penis or pubic area, but much less commonly than the head or lower shaft. Infection with HSV often requires the virus be massaged into the exposed tissues, so initial herpes usually involves sites of maximum friction during sex. The base of the penis not only gets less friction, but the skin is thicker and less susceptible than the head or lower shaft. In addition, viral shedding by infected women may be most common at the cervix, in the vagina, or vaginal opening, less likely from labia major or other tissues likely to be contacted above the range of the condom. These facts probably explain the high degree of protection by male condoms, plus the simple fact that less penile skin surface is exposed.
You have learned a couple of urban myths about herpes. First, there is no such thing as a blood test showing exposure without infection. A positive test means a person is infected. Second, staying healthy, exercising, and avoiding stress of course are good things. But they have no effect on frequency or severity of HSV outbreaks or the likelihood of asymptomatic viral shedding that can result in transmission.
HSV can be acquired at the base of the penis or pubic area, but much less commonly than the head or lower shaft. Infection with HSV often requires the virus be massaged into the exposed tissues, so initial herpes usually involves sites of maximum friction during sex. The base of the penis not only gets less friction, but the skin is thicker and less susceptible than the head or lower shaft. In addition, viral shedding by infected women may be most common at the cervix, in the vagina, or vaginal opening, less likely from labia major or other tissues likely to be contacted above the range of the condom. These facts probably explain the high degree of protection by male condoms, plus the simple fact that less penile skin surface is exposed.
Hi Dr. Handsfield,
Thank you so much for giving me and hopefully my partner a better understanding! I have spoken to my doctor about getting on Valtrex, and will start in the New Year.
I was given the unfortunate new by my ex boyfriend in May 2008 to get tested. I was given a blood test for all STD's and HIV/AIDS and came back negative for all (including HSV-1) except for HSV-2 "genital herpes." My doctor had told me that while I may not have had an outbreak yet, I have come in contact with it, which is why my blood test came back positive.
At that time, I hadn't noticed any outbreaks, however, after reading about other peoples first outbreaks and talking to friends who have confided about having HSV-1, I figured out what to expect, a tingling sensation prior to the actual outbreak.
Since 2008 I have had only 2 outbreaks which were in 2009. I have tried to keep all my stress to a minimum and keep healthy with exercise as I know stress and an unhealthy lifestyle can lead to a poor immune system which can make you susceptible to outbreaks.
The only other question I have for you is:
Since this is a skin to skin transmission, how is a male condom enough prevention? Could the area around the actual shaft of the penis become infected?
Thanks again and happy holiday to you and yours!
-Melissa
Thank you so much for giving me and hopefully my partner a better understanding! I have spoken to my doctor about getting on Valtrex, and will start in the New Year.
I was given the unfortunate new by my ex boyfriend in May 2008 to get tested. I was given a blood test for all STD's and HIV/AIDS and came back negative for all (including HSV-1) except for HSV-2 "genital herpes." My doctor had told me that while I may not have had an outbreak yet, I have come in contact with it, which is why my blood test came back positive.
At that time, I hadn't noticed any outbreaks, however, after reading about other peoples first outbreaks and talking to friends who have confided about having HSV-1, I figured out what to expect, a tingling sensation prior to the actual outbreak.
Since 2008 I have had only 2 outbreaks which were in 2009. I have tried to keep all my stress to a minimum and keep healthy with exercise as I know stress and an unhealthy lifestyle can lead to a poor immune system which can make you susceptible to outbreaks.
The only other question I have for you is:
Since this is a skin to skin transmission, how is a male condom enough prevention? Could the area around the actual shaft of the penis become infected?
Thanks again and happy holiday to you and yours!
-Melissa
MEDICAL PROFESSIONAL
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Thank you so much for such a straight forward and informative response!
You are reading content posted in the STDs Forum
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