[Question #1460] Transmission Risk

47 months ago
Hello. Thank you for your help. I have a few questions regarding oral HSV1  that I hope you can answer:
1. How widespread is viral shedding? For instance if you have active HVS 1 ocular herpes, is your saliva also contagious? 
2. At what point is a healed sore virus free?  Will the virus be gone once the scab falls off naturally?
3. If you start taking VACV during prodomal stage, does it reduce shedding or does it just shorten the infection? Or both?
4. Does VACV, compared to the other treatments, have the best results for minimizing shedding?
5. With discordant couples what do you think about taking daily suppression therapy?
6.  Are there any herpes vaccines that are in trials that sound promising?
 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
1  If you have ocular herpes, yes, you could shed from the mouth as well.  They are both innervated by the trigeminal ganglia, the same nerve group.
2.  Since we know that people can shed virus even when they have no symptoms, that's a tough question to answer.  I would say that you are less infectious when new skin has replaced a lesion.
3.  Valacyclovir would both reduce viral shedding AND shorten an outbreak
4.  No.  Acyclovir taken as directed will give you same result as valacyclovir when taken as directed.
5.  I think if the uninfected person wants to reduce the chance of becoming infected by almost 50%, then suppression in the infected partner would be very useful, yes
6.  Not prophylactic vaccines, no, but there are promising treatment vaccines out there, coming forward.

Terri
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47 months ago
Thank you. A follow up, if I may.
1. I have read many different things on various sites about when kissing would be safe ( safe from the sore that just occurred) after a cold sore is healed.  Some say as soon as the scab falls off as there is "virus free" skin underneath it,  some say after 3-4 days, others say after 7 days.  What do you think?
2. If you don't start VACV in the prodomal stage, but after the sore has erupted, does it still reduce the shedding?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I think that transmission is less likely after new skin has replaced the lesion, but to say that the skin if virus free is going too far for me, considering that people do shed virus with no symptoms present.
Starting medication once the lesion has shown up will shorten the course some, but not a huge amount, like if you took it with prodrome.

Terri
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47 months ago
Thank you .   My last follow up...
1. What is the average % shedding rate for HSV1 orally and genitally?
2. Can you  estimate the % chance of a non infected person acquiring oral HSV1 from committed  partner who has it, if:
 a.  kissing when there are no symptoms, without suppression therapy?
b. kissing when there are no symptoms, with suppression therapy?
c. kissing 24-30 hours before the first noticeable symptom without suppression therapy?
3. What is the average length of time before a cold sore becomes noticeable that  the virus begins shedding and contagious? 
4. If you don't have HSV1 and get it what is the average length of time before presenting a primary episode?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
1.  HSV 1 orally sheds between 9-18% of days, depending upon the study you read
2.  We don't' have any research on HSV 1 transmission, so sorry
3.  about 12-24 hours
4.  2-10 days, approximately

Terri
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