DEAR DR. ROACH: I am a healthy man in my late 40s. I was married for 18 years to my first sexual partner. Since my divorce three years ago, I have had two additional partners. These were casual flings. I used condoms and did not catch anything. I was happy to meet a woman who stated she is not into casual sex. I see relationship potential. The problem is she has HSV-2. She said she caught it in college and has not had an outbreak in over a decade. She even had a normal pregnancy and childbirth after contracting herpes.
I would like to begin a sexual relationship with her if I can be fairly certain I won't catch herpes. Can I rely on condoms to be safe? She said she would do daily Valtrex if I "insist." However, she thinks she knows her body enough to keep me safe. -- Anon.
ANSWER: There is no way to completely eliminate the risk of transmission of genital herpes (usually caused by HSV-2) from one sex partner to another. However, the risk is fairly small, and there are ways to reduce risk.
In two studies, the likelihood of a man acquiring genital herpes from a woman in a year of sexual activity was between 4% and 6%. Condoms reduce that risk by about a third.
About 70% of the time, transmission occurred when the person was asymptomatic. Using daily suppressive therapy with a medicine like valacyclovir (Valtrex) reduces the risk by another 50%. There is still about a 1% to 2% risk of acquiring genital herpes in a year, despite condoms and your partner taking daily valacyclovir.
I should point out that it is possible that you, yourself, may already have been exposed to genital herpes, despite having had three lifetime partners. Most people with genital herpes are not aware, having never had symptoms.
I'm glad you are having this discussion, and you need to decide whether the relationship is worth the risk.
DEAR DR. ROACH: I am a 57-year-old male in very good health. I receive a physical exam every six months, my height and weight are proportionate (5 feet, 9 inches tall weighing 168 pounds), and I work out three to five days per week. When I was 44 years old, a routine blood test detected an elevated PSA. Subsequently I was diagnosed with aggressive prostate cancer, and several doctors recommended a prostatectomy, which I underwent. Fortunately, I have been cancer free since and have little if any side effects from the surgery. At my current age I am concerned about a testosterone decline. Can testosterone supplements -- either over-the-counter or physician prescribed (if a blood test showed low T) -- put me at risk, considering my past? -- L.G.
ANSWER: This is a controversial issue, as there are not good data to guide therapy. Prostate cancer cells grow faster with testosterone, and many urologists and oncologists will not treat people with a history of prostate cancer -- especially aggressive prostate cancer -- with testosterone replacement for fear of stimulating dormant prostate cancer into a growth phase. However, there have not been studies that have given an idea of how likely this might be. Some consensus guidelines feel that testosterone replacement may be considered when there is no evidence for residual cancer after a reasonable interval (13 years is very long), and those men should have very careful follow-up, including frequent, sequential measurements of the PSA.
I don't recommend it unless the symptoms of low testosterone are at least moderately severe and confirmed by a low testosterone level. Of course, you need to discuss with your own oncologist and urologist.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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