What's the worst case?

[DeMar]

Hi all,

SO it's been a rollercoaster few months. I'll skip the details but feel free to ask if it's relevant.
I am male, have HSV2, and my partner, female, doesn't. She thought she had, had terrible comparable symptoms etc, but has had another test and is now negative. Although more terrified than ever.
Years ago, she had something happen which damaged her pituitary nerve and is now immuno compromised. Because of this her doctors have told her that if we are together she will more than likely catch hsv2 and that her symptoms will be extreme and she'll have more outbreaks.
SO I have 2 questions. I'm trying to educate myself and get as full an understanding as much as possible.

1. I listened to a podcast about managing HSV2 in a relationship and the expert said some figures, which if I understood correctly was that:
Non symptomatic HSV2 man to Non HSV2 woman:

10% chance of transmission over a year (does that mean sex every day?).
Reduced by 90% if condom is worn (so would that be 90% from 10% so basically 1%? (excuse my maths if wrong))

Further reduced by 50% with antivirals (so a final figure of a 0.5% chance of passing it on if I use a condom and antivirals)

Is that all correct? Has anyone see or have reference to those figures?

2. Worse case scenario:
What are the worst symptoms? How painful is it? What is the most frequent any one has had?

I do want to see a sexual health specialist together if we get that far, as well as an immunilogical expert (whatever they are called).

Thanks. And I appreciate any sharing of stories.
 

[Ebelskiver]

Unfortunately, the worst case scenario can be quite bad. Especially among the immunocompromised. Unrelenting, painful outbreaks. Severe prodromal symptoms, ambiguous constitutional symptoms, not to mention distress, anxiety, and depression. You should try to avoid transmission at all costs. 
 

You are right that transmission from infected male to uninfected female whilst using precautions such as abstinence during prodromes and outbreaks, condoms and antivirals is around 1% per year. Assuming sex twice per week. 
 

Male viral shedding occurs along the penile shaft, for the most part, and this area is well-covered by condoms. However, if you are someone who gets outbreaks on the scrotum, anus, or buttocks, shedding will occur from there as well. 
 

Women are much more likely to get HSV because of our anatomy but are much more capable of transmitting because viral shedding occurs all over the vulva and perineum. Luckily for you, condoms are very effective at preventing male to female transmission. Use of a cock ring to keep the condom from riding up would add further protection. Some couples have the male wear boxers as well to further reduce the skin to skin contact necessary for transmission. 
 

I don’t believe infection is a foregone conclusion. I think with proper precautions you can protect your partner. 
 

Good luck. 

[DeMar]

Thanks Ebelskiver. I've never had any outbreaks and don't know how old my infection is. Somewhere between 1 and 30 years ago. This virus, and all the uncertainty is emotionally exhausting. Thanks for the cockring tip. Anything I can do that helps is good.

[DeMar]

Hi Ebelskiver, I'm just following up on this as I digest your advice.
Re the 1% chance of transmission. Another factor in my case is I have not knowingly had an outbreak ever. And I know for certain I have never had lesions. I heard a Terri Warren interview where she said the only indicator of shedding frequency is outbreak frequency. SO I would take that to imply my shedding frequency would be a lot lower than 1%... But how much lower?
I know there are no concrete answers, but what are your thoughts?