You are a wonderful testament to a responsible approach to genital herpes and its prevention, and to the ability of careful couples to avoid transmission with some common sense precautions. Congratulations. The challenge is to bring your partner to the same level of understanding. It sounds like he is frightened enough that it will be hard for you to successfully do it alone. The best approach by far would be personal counseling of him (or better, both of you as a couple) by a herpes-knowledgeable provider. You could call the American Social Health Association (www.ashastd.org) for direct advice, or for help in finding a suitable provider in your area.
Also, it would be good for your partner to be tested for HSV-2. There is at least a 25% chance he already is infected, from some prior partner--since a quarter of the population has asymptomatic HSV-2 infection. In that case, he cannot be reinfected and you need take no precautions in your sexual practices. Also, he should try to understand that having herpes isn't such a big deal; not desirable, but something people live with, without difficulty--your own experience being a good case in point.
To answer your questions: Yes. In herpes-discordant couples who have sex 2-3 times per week and avoid sex during symptoms, only about 5% of the uninfected persons acquire HSV-2 each year. So the risk obviously is very low for any particular sexual event. And for you, the risk might be even lower (see my answer below about being infected 15 years). You could reduce the risk still further if you want to take antiviral therapy to suppress shedding; and condoms indeed reduce the risk as well. Oral-genital contact also is quite safe in the absence of outbreaks; and nobody has ever been known to catch herpes by hand-genital contact.
In asymptomatic shedding research, the subjects self-collect samples (e.g., from the vagina, vulva, and anus) once a day for several weeks at a time, and the sample are tested for HSV. The early studies used culture, but recent ones use PCR, which is more sensitive (picks up more positives).
Asymptomatic shedding hasn't been well studied in people infected more than 10 years. Symptomatic outbreaks become progressively uncommmon after 8-10 years, and many people stop having known episodes. Most likely asymptomatic shedding also declines, and the odds are good that you don't have it frequently. But unfortunately there are no data to predict the likelihood in any particular infected person.
I hope this helps. Best wishes-- HHH, MD
Your approach to this is commendable. Unfortunately, your partner's reaction was typical, just read the hundreds of posts below. We have got to somehow educate the public on herpes management and having sexual relationships when one partner is infected and the other isn't. However, I think your initial assessment is valid in that I think it is fair to say, "It's OK to touch me now", etc. You know your body and you probably know when an outbreak is likely to occur even before it does. It will be interesting to see what Doc H and monkeyflower have to say. And I'm sorry about your ex, that's just sad.
Can the viral load be measured via PCR?
If so, has the viral load been measured against the viral
load present during an outbreak?
Also one would assume the viral load would increase day by day during periods of shedding until it peaked and then drop off in the case no outbreak occurred or peak during an outbreak??
Has this ever been studied?
The concept of viral load doesn't translate to a lesion specimen. In blood, for HIV, you can count the number of RNA copies (viruses) in a given volume of blood. For a swab specimen from a lesion, there are too many variables (e.g., how vigorously the lesion was rubbed or scraped) to make measurements meaningful, so PCR results, like culture, are generally interpeted merely as positive or negative, nothing more. There are some exceptions for research purposes, but not for patient counseling.
HHH, MD