[Question #1687] Antivirals

66 months ago
As I understand it, genital HSV1 does not shed frequently when compared to oral HSV1 or genital HSV2, and recurrent outbreaks are much less frequent. Therefore, antivirals are generally not indicated.  I have only had one noticeable, minor outbreak with which it was swabbed and cultured and resulted in  a HSV1 genital diagnosis.  But I am very concerned about inoculating him with the virus so I wanted to start suppressive antiviral therapy.  However, this article has me concerned about it: https://liveherpesvaccine.com/2016/06/11/the-downside-of-daily-antiviral-therapy/  If you think suppressive antiviral therapy is appropriate do you prefer one antiviral over another.  Additionally, if this were true, would i be more likely to autoinnoculate elsewhere on my body?  What do you think is the most promising new therapy/cure/vaccine, and an estimate as to when they may become available?  Your thoughts on CRISPR? 
Terri Warren, RN, Nurse Practitioner
66 months ago
Has your partner actually tested negative on the IgG test?  Just so you know, the test misses about 30% of infections (compared to the gold standard western blot), so even if he did test negative, he could be infected and the test is not picking up the infection.
How long ago were you diagnosed?  Do you believe that you were infected close to the date of diagnosis? 
It is true that if you start daily antiviral therapy early in the infection, antibody development may well be delayed.  We have seen a patient who was diagnosed by swab test nine months prior to her IgG testing (which was negative ) and started on antiviral therapy immediately as her first outbreak was quite severe and she wanted to be on daily therapy.  The IgG test remained negative but for legal purposes, she needed to document her infection and subsequent seroconversion.  We pulled her off of suppression and within 2 months she had fully seroconverted (gone from negative antibody test to positive antibody test).  While she was on suppression, the medicine took the place of her immune response, when she came off, her immune response was fully functional.  I don't think being on daily antiviral therapy will somehow increase the likelihood of autoinoculation, no. 
I think the therapeutic vaccines will be quite useful (though they are not being tested on people with HSV 1 at this time).
The CRISPR issue is so new - cutting DNA can I'm sure be very helpful in some cases, but as I understand the herpes trials, they are not even in animals yet, much less humans, and one must keep in mind the dangers of cutting other human DNA.  In summary, I don't know really enough to comment yet