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Q. I contracted genital herpes due to HSV-2 in college some 30 years ago. Now as a female of 54 I have unfortunately given it to my dating partner of one year. He is very concerned about several things:
 
1. We think I gave it to him because after four years of my being on the acyclovir twice a day, my new doctor told me to quit taking it and just take it in the event of an outbreak….a month later he contracted it from me and had a herpes outbreak at the base of his penis.
2. Do we always have to use condoms or can we re-infect each other and cause outbreaks?
3. How about oral sex? Can we never have oral sex without the worry of transmitting it to one another? Our concern is what if we do not know if an outbreak is going to show up say, in a couple of days, on one of our mouths?
 
Thank you so very much!

A. 1. The use of medication to prevent transmission of genital herpes to an uninfected partner works well (reduction of transmission by about 50% or more)…. But the medication must be taken every day. If it is stopped and used only instead to shorten outbreaks (“episodic therapy”), the protective effect goes away. Although you may have given him genital herpes, it is possible that he was asymptomatically infected before he met you or even while you were having sex with him a while ago, and only now has he become symptomatic and had his first outbreak.
 
2. Once you are both infected with the same type of the virus (HSV-2 presumably in your situation), there is no need to use condoms or any other protection from herpes transmission since you cannot give someone “more” herpes infection.
 
3. If you are both infected with genital HSV-2 it is very unlikely that you can acquire HSV-1  genitally from someone else's mouth during oral sex.  Also, it is difficult to acquire HSV-2 in your mouth from someone else's genital area that is infected with HSV-2.

Gary A. Richwald, MD, MPH

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