I am male; my partner is female and has herpes.  I have been able to
learn that transmission of the virus is most likely during her
outbreaks, but is still possible, via asymptomatic shedding, at other
times (2-6% of the time, they say).  The National Herpes Hotline told
me that condom use "reduces" the chances that I become infected, but
I've been unable to get any actual NUMBERS from them.  Can you find me
some?

Assuming that she is NOT undergoing an outbreak -- during which time
we'd obviously find other things to do -- what are the odds that the
virus will be transmitted during intercourse (with and without a
condom)?  What are the odds that the virus will be transmitted from
her genitals to my mouth during oral sex?  I'd like results for both
HSV-1 and HSV-2 types.

My preference is for straight-up odds (answers of the type "1 in X
per, er, incident") but, if we can't find them, transmission rates
over a period of time is fine too (answers like "Y% of partners are
infected per year").  And for the edification of future readers of
your answer, if you find male-to-female transmission rates too, please
include them.

Thanks!

Hello jepjepjep~

Here is the information you requested. I?ve focused on your particular
situation (a man with a female partner who has herpes), but have
included some information for women who are herpes-free but have male
partners with the STD. Additional information for women may easily be
found by checking out the links I?ve included.


CONDOMS

According to Herpes Diagnosis, latex ?condoms are about 50% effective
in reducing transmission between sexual partners.? (?How is Herpes
Transmitted to Others?? http://www.herpesdiagnosis.com/transmit.html)

However, a recent study, which looked only at people with HSV-2, says
that condoms are much more effective at protecting women from an
infected male partner than protecting a male from an infected female
partner. (See ?Do Condoms Prevent Genital Herpes Infection??
http://www.arcmesa.com/cont_ed/mddigest/06-28-01.html ) In fact,
condoms were concluded to offer ?no protection to susceptible men if
their female partner has HSV-2.? During this study, ?the rate of
infection per 10,000 sex acts was 8.9 and 1.5 for susceptible women
and men, respectively.?

The reason condoms are only partially effective, even with HSV-1, is
that herpes can infect an area where condoms don?t protect.  This is
why female condoms are recommended whenever a woman with herpes has
sex. (See ?Female Condom Helps Prevent Herpes Transmission,?
About.com: http://sexuality.about.com/cs/safersex/qt/femalecondstd.htm
and ?How Can I Protect Myself? section of ?Transmission Risks? at
Famvir: http://www.genitalherpes.com/info/living/partners/preventing.jsp
)

When couples refrain from having sex during outbreaks, and only one
partner has herpes, the average transmission rate is about 5 to 10%
per year for HSV-1 and 2 combined. But, Herpes Diagnosis says, ?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.?  My Dr. points out,
?Research suggests that it is possible to transmit herpes type 2 to a
partner, even when they are not experiencing an outbreak.? (?Herpes
Transmission,? http://www.mydr.com.au/default.asp?article=3473 )


DRUGS

In addition, you may like to know that a new drug, called
valaciclovir, may actually reduce the transmission rate of herpes. One
study showed that if a person with HSV-2 took the drug (500mg) daily,
the transmission of infection was reduced by 50%. The transmission
rate among couples using this drug is about 5% per year.

ORAL SEX

The stats are the same for oral sex. If you avoid giving oral sex when
outbreaks are present, your chance of developing oral herpes is 5 to
10%.


WARNING SIGNS

You will also want to make sure your girlfriend is aware of the
?warning signs? that an outbreak is coming. You will not want to have
sex if she?s experiencing these signs. Check out the ?Additional
Information section in ?Herpes and Your Sex Life,? Famvir:
http://www.genitalherpes.com/info/living/with/life.jsp )


I hope this answers your question thoroughly. However, if anything is
unclear, please don?t hesitate to request clarification before rating
the answer.

Regards,
Kriswrite


RESEARCH STRATEGY:
herpes transmission condom
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&q=herpes+transmission+condom&btnG=Search

herpes transmission "oral sex"
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&q=herpes+transmission+%22oral+sex%22&btnG=Search

---

Request for Answer Clarification by jepjepjep-ga on 18 Aug 2004 07:23 PDT

Great answer, thanks!  I have two requests for clarification:

>>>
However, a recent study, which looked only at people with HSV-2, says
that condoms are much more effective at protecting women from an
infected male partner than protecting a male from an infected female
partner. (See ?Do Condoms Prevent Genital Herpes Infection??
http://www.arcmesa.com/cont_ed/mddigest/06-28-01.html ) In fact,
condoms were concluded to offer ?no protection to susceptible men if
their female partner has HSV-2.? During this study, ?the rate of
infection per 10,000 sex acts was 8.9 and 1.5 for susceptible women
and men, respectively.?
<<<

I was quite confused by this source.  If condoms are ineffective at
protecting males, wouldn't that lead to a HIGHER rate of infection for
men than for women?  I read this as four times as many women were
infected by HSV-2 men than vice-versa, which seems to contradict the
"no protection" comment.  (I suppose it could be that transmission
from women to men in general is less likely, and that condoms don't
add any protection on top of that.)

I didn't get this message from the National Herpes hotline people, but
maybe daytrader was right after all.

>>>
The stats are the same for oral sex. If you avoid giving oral sex when
outbreaks are present, your chance of developing oral herpes is 5 to
10%.
<<<

Do you have a citation for this?  I talked with the National Herpes
Hotline, and they said that the chance for genital-to-oral
transmission was very low... not sure who to believe here!

J

---

Clarification of Answer by kriswrite-ga on 18 Aug 2004 08:04 PDT

I?m happy to try to clarify :)

Initially, I had the same trouble with the
http://www.arcmesa.com/cont_ed/mddigest/06-28-01.html link. However,
if you notice, they state that ?Only 61 % of couples reported ever
using condoms during the study in spite of the encouragement to use
condoms for all sex acts.? Even those who used condoms, didn?t use
them consistently. ?The susceptible women reported condom use by their
partners for 30% of sex acts compared with a 20% use by susceptible
men."

Therefore, the conclusions about condom use came only from the couples
who did use condoms. ?Condoms were highly protective for women (HR =
0.08), but not for men (HR = 2.02, not statistically significant).?
The figure that is confusing you lumps both condom users and
non-condom users together.

As for oral herpes, there are many differing opinions, which makes
this Researcher believe it hasn?t been studied very well. As one
website concluded, it?s difficult for studies to determine whether the
herpes came from oral sex, or some other sexual activity that the same
person has participated in. Most medical websites merely claim that
you can get herpes by giving oral sex to someone who has it. (For
example, iVillage: http://www.ivillagehealth.com/experts/infectious/qas/0,,242108_128183-3,00.html
)

Or, they say something like: ?Oral-genital contact can transmit herpes
from the individual performing oral sex and from the individual
receiving oral sex?a person with genital herpes (type II) can transmit
herpes to the mouth, though this route of transmission is not as
common.? (UHS:  http://www.uhs.uga.edu/sexualhealth/oral_sex.html )

San Francisco City Clinic downplays the risk:
http://www.dph.sf.ca.us/sfcityclinic/drk/oralsex2.asp
But does state that it?s ?estimated that there is an overall maximum
3% risk of transmission over time.? Elsewhere, they say, ?Oral sex can
definitely result in herpes transmission, although with Herpes type
II, the genital kind, it is much less likely to be transmitted than
type I.? (http://www.dph.sf.ca.us/sfcityclinic/drk/stdprevention5.asp
)

Nonetheless, this is conservative, as most medical sites states that
both types of herpes may be spread through oral sex.

HIVDent states ?The high frequency of unprotected oral sex however
means that it might account for as many as 3% to 8% of sexual
transmissions, most commonly among men who have sex with men (4,5).
Other STIs, especially gonorrhoea, syphilis, and herpes are more
readily transmissible through oro-genital contact.?
(http://www.hivdent.org/oralm/oralmogcosat072001.htm )

So, the short answer is: Nobody knows for sure. The figure 5 to 10% is
only an estimate, designed to be on the ?safe side.?

As an aside, UHC recommends using a female condom when giving oral sex
to a woman with herpes:
http://www.uhs.uga.edu/sexualhealth/STI/herpes.html


I hope this helps!
Kriswrite

Super, thanks!

I can't cite it, but I remember a study that threw out the number of
10% risk of infection per year for +/- married couples abstaining
during outbreaks.  So 5 years of marriage by that theory is a 50%.

The truth is that the Herpes virus is extraordinarily complex.  The
virus is somewhat different in everybody and it may also change over
time.  Many people will carry the virus and show no symptoms.  Men are
less prone to outbreaks than women, and the outbreaks tend to be more
bothersome for women.

Since Herpes is spread from skin-to-skin contact and not bodily fluids
like HIV, condoms offer limited protection.  imho, condoms are not
worth it for you.

What is very important is that your partner learn to recognize that
"tingle" that comes 1-2 days before an outbreak.  She is contagious at
this point, even though there is no sore or blister yet.  Again, this
is *very important*

Many people can control their outbreaks with Valtrex or Famvir (brand
names).  Valtrex is older and cheaper than Famvir.

Daytrader, thanks for the comments... but there are two problems with
what you've said.  I'm not sure where you get your information from,
but I'm going to refute some of it here for the sake of other readers
who might get confused by your authoritative-sounding comment.

>>>
10% risk of infection per year for +/- married couples abstaining
during outbreaks.  So 5 years of marriage by that theory is a 50%.
<<<

A bit off on your statistics -- 10% risk a year gives about 40% chance
of infection over five, by my calculation.  (90% chance of NOT getting
each year = 90^5/100^5 ~= 59%.)  Not sure where you get this 10%/year
figure from, however, so it's hard to know if those couples were using
condoms or not, hard to know which type of herpes (HSV-1 or -2), etc. 
Do you have a citation?

>>>
Since Herpes is spread from skin-to-skin contact and not bodily fluids
like HIV, condoms offer limited protection.  imho, condoms are not
worth it for you.
<<<

True, the virus passes from skin-to-skin contact -- but the virus
can't make it past most unbroken skin, and CAN make it through mucuous
membranes like the mouth or genitals.  So condoms are recommended by
pretty much everyone.  See
http://www.ashastd.org/hrc/educate.html#get.

Hi Jeb.  Condoms don't work well because they don't cover all of you. 
The part that isn't covered can rub against a sore or just some
shedded cells.  That's all it takes.

Here's something to think about:  You may already have been infected
and not know it.  Men are more likely to be asymptomatic carriers. 
You could use a condom for the rest of your life and never know if it
is wasted effort or not.

A core issue here is the level of commitment that you have with your
partner.  Are you prepared to spend the rest of your life with her? 
If you are mentally prepared for that commitment and she is also,
herpes can be no big deal.  However, if you don't see yourself
spending your future with this woman, it can and will drive you crazy.
 Even if you break up with her now, there is a slim chance that you
could be H+ now, and carry it until you die without ever knowing.  In
that unlikely but possible scenario, the breakup would have been for
nothing.

Now may be a good time for you both to decide to live happily ever
after.  Best wishes.

I just saw your comment.  That number came from an article in a
medical journal that I read in the Univ of S Florida library in Tampa
in 1997.  I wish I cite it better.  And I am no statistician, so
whatever 10%/yr comes out to...

The truth is that there are so many intervening variables that trying
to put a number on your scenario is impossible.

"True, the virus passes from skin-to-skin contact -- but the virus
can't make it past most unbroken skin, and CAN make it through mucuous
membranes like the mouth or genitals.  So condoms are recommended by
pretty much everyone. "

"Experts" are scared to deviate from the "all condoms all the time"
stance.  You are a rare exception to this rule.  But it is still a
pretty good rule.
The problem is that condoms don't cover "all of you" by any means.  If
you rub the uncovered part against a blister, you can get infected.