Genital herpes . . . Whaaa?

January 6, 2017 6:13 PM

I just recently learned that I have had genital herpes for 25 years. Color me stunned. What are the chances, after 20+ years of unprotected sex with my monogamous partner, that they have not contracted the virus from me? My partner has never had anything remotely related to a herpes sore on their genitals or other part of their body. At this point are they likely an asymptomatic carrier? Is the viral load so low during non-outbreak periods that they could have avoided the infection altogether?

My outbreaks were infrequent and very minor, so I assumed it was something related to an ingrown hair. Anywho, I've been having unprotected sex with my partner for 20 years. I don't think we've had sex during an active outbreak because the outbreaks rarely happen (decreasing the likelihood of sex/outbreak coinciding) and also because the outbreaks are slightly painful and, for me, pain is not conducive to sexiness. But I didn't realize I was trying to avoid infecting someone, so I definitely cannot be sure. It's certainly likely that we've had sex a few days after the outbreak began but before the sore had completely healed. Thanks.

posted by anonymous to Health & Fitness (9 answers total)

If you are female and your partner is male, the transmission rate is roughly 4% per year. If you're male and they're female, it's about 10% per year, though studies differ on that. I couldn't find quick information on non-heterosexual sex transmission rates.

In any case, after 20+ years, it is likely but not impossible that your partner is an asymptomatic carrier. Your partner could get tested if you're really concerned, but unless they are planning on having sex with someone else, if they're completely asymptomatic, knowing either way may not provide any benefit.

To be paranoid, are you certain that they didn't cheat on you and pass it on to you more recently?
posted by Candleman at 6:30 PM on January 6, 2017 [5 favorites]

Any of these scenarios are possible. Both of you could be asymptomatic carriers! It's very common for the virus to produce minimal symptoms or activate late in life. It's also quite possible your partner passed it to you many years ago! The only way to find out who has what is to run HSV1 and HSV2 tests for you both (I suggest ELISA).

For up to date research, check out the Westover Heights clinic (great Q&A forum!), the UW Virology Research Center and this promising vaccine maker.
posted by fritillary at 7:46 PM on January 6, 2017 [1 favorite]

On the "cheating" angle: if I understood correctly, the OP has been experiencing a symptom for 25 years that's now been identified as genital herpes. It predates the current 20-year relationship with their partner.
posted by teremala at 8:15 PM on January 6, 2017 [14 favorites]

If the transmission rate is 4% per year, then the probability of your partner NOT contracting the virus after 20 years is 44% (.96 to the 20th power.) After 25 years it goes down to 36%. So if you're female and your partner is male, it's quite possible your partner hasn't contracted the virus.

If you use the 10% figure, then the probability of not having passed on the virus is 12% after 20 years and 7% after 25 years. So if you're male and they're female it's a lot more unlikely that they haven't gotten the virus but it's certainly possible.
posted by Redstart at 9:04 PM on January 6, 2017

I believe that cold sores (oral herpes) are frequently incompatible with genital herpes -- getting the one often stops the other.

So there may also be that factor.
posted by steady-state strawberry at 6:25 AM on January 7, 2017 [1 favorite]

There are two types of herpes. If you get one type on your mouth, then the chances of getting that type on your genitals is rare, and vice versa. (There is a window of time right after infection where you can spread the same type of herpes from your own mouth to your own genitals.) However, you can have one type on your mouth and the other on your genitals. Supposedly HSVII prefers the genitals, but HSVI spreads between the two areas more readily.

If he ever gets cold sores then it's possible your infection spread to his mouth and spared his genitals.
posted by blackzinfandel at 7:37 AM on January 7, 2017

Never mind, you say he doesn't appear to have symptoms on his mouth either. Disregard that.

The only way to find out anything, if he's not symptomatic, is to get a blood test. Even then, there are false positives.
posted by blackzinfandel at 7:44 AM on January 7, 2017

Cold sores (like herpes) can be dormant for ages, and they're found in something like 90% of the population. Chances are, he's had it.

That said, as for the odds, IANY doctor.
posted by steady-state strawberry at 12:32 PM on January 7, 2017 [1 favorite]

While not a doctor or scientist, I have done a fair bit of reading about HSV transmission rates. From what I can tell, there really hasn't been very much good research on it. The figures that do exist come from only a few studies with fairly small populations. This is the best one I've seen, and it had results from only 144 couples.

There are two points that I haven't seen discussed so far that I think are relevant:

1. Some people seem to be resistant to acquiring HSV. Even when exposed to the virus, not all people become infected. Since HSV-I is present in the majority of the adult population and HSV-II is quite common as well, almost everyone has some amount of exposure. It's entirely likely that your partner has considerable resistance to the infection or that they are infected but asymptomatic. That is quite common.
2. An infected person can infect another even when they are not having an outbreak. From the study: Despite clear recognition of genital herpes in source partners, there was substantial risk for transmission; in 70% of patients, transmission appeared to result from sexual contact during periods of asymptomatic viral shedding. So even if you perfectly avoided sexual contact during outbreaks, this doesn't change the odds of transmission dramatically. See also this section on pathophysiology.

To answer your questions:

What are the chances … that they have not contracted the virus from me?

It's hard to put a precise number on it, but I think the chances that they're uninfected are in the same ballpark as the chances that they're infected but asymptomatic.

At this point are they likely an asymptomatic carrier?

Depending on their demographics, their chances of being infected could already be significant independent of their relationship with you, so the chances are quite high that they're either resistant or infected, but I don't see any way to know which of those outcomes is more likely.

Could have avoided the infection altogether?

Certainly, but again, there's not much evidence either way based on the information at hand.

HSV This can be a very stressful thing because there is a great deal of stigma associated with the infection. Sadly, this was not always the case, and seems to have become far more prevalent since the advent of maintenance therapies. The physical reality is that for most people HSV is at worst an occasional nuisance that becomes less frequent over time. For many, there are never any symptoms and they would never be aware of an infection at all except via test result. Only for pregnant women does HSV represent a potentially dangerous complication, and even that is exceedingly rare and manageable.

The real harm from HSV seems to be far more in the emotional realm, so I encourage you to consider those effects on yourself and your partner as you think about where to go from here. Many clinicians—I think appropriately—discourage testing for an infection which requires no treatment, especially if knowledge of one's status won't affect one's behavior. Before your partner gets tested, it's a worthwhile exercise to consider what you would both do with the information in either case and whether it will be more likely to cause help or harm.
posted by Cogito at 3:35 PM on January 7, 2017 [6 favorites]