She's only had one outbreak of genital herpes a year ago. Do I still need protection?

May 11, 2006 11:19 AM

What is the relative safety of certain sexual acts with a partner who has had one confirmed outbreak of genital herpes and no subsequent outbreaks?

I, a male, have been dating a girl for a year. I was aware that shortly before we started dating, she contracted genital herpes (from oral sex), and had one severe outbreak. Since that incident, a year and a few months have passed with many stressful circumstances and no outbreaks. We have had sex with condoms and oral sex with dental dams, but not surprisingly, we have considered moving away from both of those (especially with oral sex, since she would prefer not to use birth control). While I know you can never say never, and that herpes can reoccur at any time, I was wondering how safe I would be engaging in either or both of the aforementioned activities. I believe that shedding will continue to occur at irrelegular intervals for the rest of her life, but if she is asymptomatic, could this affect me?

posted by anonymous to health (11 comments total)

If she has it, she has it. There's no cure for it. Meds only treat the symptoms. Symptomatic or not, you can still catch it.
posted by wheat at 11:40 AM on May 11, 2006

Yes. Even if she is asymptomatic, it could still affect you. There are people who occasionally "shed" the virus without experiencing symptoms themselves.

(Of course, that's not to say you will get herpes. I really can't tell you what the odds are. But it's certainly possible.)
posted by nebulawindphone at 11:40 AM on May 11, 2006

From what I understand, condoms are of limited protection against herpes anyway.
posted by dobie at 11:52 AM on May 11, 2006

As you say, you can never say never. But I do know of one case where the lady had contracted herpes nearly 20 years ago and has yet to pass it on, and whose activities have included both condom-less intercourse and unprotected oral sex. She apparently just abstains whenever an outbreak occurs, but makes sure that all partners know about the condition and the possibilities in advance, of course. Whether this case is typical, I cannot say.

I assume you've clicked on the "herpes" tag to get to other relevant threads. If you're really worried, though, I should point out that her having had only one outbreak is not really a safety marker -- because she's only had one outbreak, she doesn't have a lot of experience in telling when an outbreak is about to happen and when precautions need to be taken.
posted by JanetLand at 12:06 PM on May 11, 2006

If you can get at an academic database (ProQuest, etc) or archives of either the New England Journal of Medicine or the Journal of Infectious Diseases, try to find:

1. Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes. Lawrence Corey, Anna Wald, Raj Patel, Stephen L Sacks, et al. The New England Journal of Medicine. Boston: Jan 1, 2004.Vol. 350, Iss. 1; pg. 11


2. Valacyclovir and Acyclovir for Suppression of Shedding of Herpes Simplex Virus in the Genital Tract. Gupta, R; Wald, A; Krantz, E; Selke, S; Warren, T; Vargas-Cortes, M; Miller, G; Corey, L
   Journal of Infectious Diseases. Vol. 190, no. 8, pp. 1374-1381. 15 Oct 2004.

Both articles are great with the latter dealing mainly with occurance of shedding, and the former article discussing transmission rates between partners. Valacyclovir is sold under the brand name Valtrex by GlaxoSmithKline.

The abstract for each article is as follows:

1. BACKGROUND
   Nucleoside analogues against herpes simplex virus (HSV) have been shown to suppress shedding of HSV type 2 (HSV-2) on genital mucosal surfaces and may prevent sexual transmission of HSV.
   METHODS
   We followed 1484 immunocompetent, heterosexual, monogamous couples: one with clinically symptomatic genital HSV-2 and one susceptible to HSV-2. The partners with HSV-2 infection were randomly assigned to receive either 500 mg of valacyclovir once daily or placebo for eight months. The susceptible partner was evaluated monthly for clinical signs and symptoms of genital herpes. Source partners were followed for recurrences of genital herpes; 89 were enrolled in a substudy of HSV-2 mucosal shedding. Both partners were counseled on safer sex and were offered condoms at each visit. The predefined primary end point was the reduction in transmission of symptomatic genital herpes.
   RESULTS
   Clinically symptomatic HSV-2 infection developed in 4 of 743 susceptible partners who were given valacyclovir, as compared with 16 of 741 who were given placebo (hazard ratio, 0.25; 95 percent confidence interval, 0.08 to 0.75; P=0.008). Overall, acquisition of HSV-2 was observed in 14 of the susceptible partners who received valacyclovir (1.9 percent), as compared with 27 (3.6 percent) who received placebo (hazard ratio, 0.52; 95 percent confidence interval, 0.27 to 0.99; P=0.04). HSV DNA was detected in samples of genital secretions on 2.9 percent of the days among the HSV-2-infected (source) partners who received valacyclovir, as compared with 10.8 percent of the days among those who received placebo (P<0 .001). the mean rates of recurrence were 0.11 per month and 0.40 per month, respectively (p0.001).br> CONCLUSIONS
   Once-daily suppressive therapy with valacyclovir significantly reduces the risk of transmission of genital herpes among heterosexual, HSV-2-discordant couples.


2. Background.
   Valacyclovir exhibits better oral absorption and higher, more prolonged serum concentrations
   than oral acyclovir. The efficacy of valacyclovir and acyclovir on genital herpes simplex virus (HSV) shedding was
   assessed in a double-blind, 3-period crossover trial.
   Methods.
   Sixty-nine immunocompetent participants with genital HSV-2 received oral valacyclovir, acyclovir,
   and matching placebo in random order for 7-week periods. Participants provided daily genital mucosal swabs for
   HSV detection by viral culture and polymerase chain reaction (PCR).
   Results.
   HSV was detected at least once in 62 (90%) participants by culture and in 68 (98%) by PCR. During
   placebo, the total HSV shedding rate was 15.4% of days by culture (PCR, 40.2%); the subclinical shedding rate
   was 6.6% by culture (PCR, 27.1%). Both antivirals were associated with lower HSV shedding by culture (relative
   risk [RR], 0.03 [95% confidence interval {CI}, 0.01–0.07] for valacyclovir and RR, 0.05 [95% CI, 0.03–0.10] for
   acyclovir) and PCR (RR, 0.18 [95% CI, 0.12–0.26] for valacyclovir and RR, 0.20 [95% CI, 0.15–0.28] for acyclovir),
   compared with placebo. No significant differences in frequency and quantity of HSV were detected by PCR between
   the valacyclovir and acyclovir arms.
   Conclusions.
   Although the suppression of viral replication is not complete, valacyclovir and acyclovir are
   highly effective in suppressing the frequency and quantity of genital HSV shedding.
   

Good luck with whatever decision you make.
posted by SemiSophos at 1:02 PM on May 11, 2006

Abstinence is the only absolute preventative. Non-symptomatic transmission is a significant factor in the spread of herpes. Barrier methods provide a significant but not absolute protection. Viral suppressive therapy (i.e. Valtrex) will reduce her chances of spreading the virus to you. But a significant possibility of your contracting it will remain. What does "significant" mean, exactly? That's going to be very, very hard to provide any kind of precise answer to that. I'll give you the best I found, this

...couples in whom one partner has genital herpes and the other does not, it appears the average rate of transmission is about 5 to 10% per year when the couples simply refrain from intercourse during outbreaks. But this average obscures two important factors: 1) The risk to uninfected women is roughly three times greater than the risk to men, and 2) the risk of acquiring herpes type 2 is higher in those who have not previously been infected with herpes type 1.

Valtrex claims I think an average 50% reduction in transmission. So you could maybe think about a 3-5% chance per year. But like all these kinds of statistics, the sheer number of variables really makes a specific percentage useless for the individual case. But perhaps as a ballpark it will help you consider your decision.
posted by nanojath at 1:15 PM on May 11, 2006

And who knows, you may already have it but just don't know it. From what I've read, like 75% of the population has it but a much smaller percentage actually has outbreaks.
posted by drstein at 7:02 PM on May 11, 2006

From what I've read, like 75% of the population has it but a much smaller percentage actually has outbreaks.

While 75% of the population could easily have oral herpes, far, far fewer have genital. Most of what I've seen has pegged 20% of adults 35 and older with genital, and I keep seeing things along the lines of "only 2% [or similarly miniscule number] of those with genital herpes know they have it."
posted by SemiSophos at 7:23 PM on May 11, 2006

You want the herpes stats for who's got it? I'm just going to average out the male/female, black/white variables (though, they apparently make a difference) -- at age 25-29, ~20% are HSV-2 positive; at 30 and above it hovers around 30%. Also, 20% of your "oral herpes" infections are caused by the genital strain and vice versa.

You want to not contract this virus? Then yes, you are going to need to continue with protection. This infection does not get resolved and she will be shedding virus for the rest of her life; even if she is not currently experiencing an outbreak, she could still be shedding. Acyclovir might work as a prophalytic, but then she may also be carrying an acyclovir resistant strain.
posted by The Bishop of Turkey at 8:56 PM on May 11, 2006

drstein, I think you might be thinking of HPV (genital warts), not herpes.
posted by jesourie at 9:31 PM on May 11, 2006

The questioner is pretty clear about knowing the chance of infection is greater than zero. The question is: how much greater?
posted by scarabic at 8:46 PM on May 19, 2006