[Question #4101] Question #4071 follow-up - Herpes simplex 1 & 2 / Hep A & E

30 months ago
Dr. Hook,

Thankyou again for all your very helpful responses before. I understand fully you say no repetitive questions, however this is something I forget to cover so is additional question, rather than re-covering the same ground.

I asked before if any conditions/medication a person has (examples listed again below) could increase their risk of contracting STDs - however I realised I didn't ask about HSV 1 / HSV2 / oral herpes? As I understand that HSV 1 / HSV 2 are not necessarily considered STDs.

So my follow-up questions are:

1. Am I right in assuming there are also no conditions/medication a person can have that materially increases their risk of contracting HSV 1 / HSV2 / oral herpes, through non-sexual transmission?  (i.e. no direct sexual contact)

2. And I would be right this also is the same for Hep A / Hep E? As I understand these are not necessarily considered STDs

3. HPV is considered an STD so presumably has been covered under your previous advice? (sorry if this last one is a repetitive question from before)

This would be for my family with various medical conditions living with my ex-girlfriend for 3 months, and sharing razors/toothbrush/towels/household objects/non-sexual massage, as mentioned in #4071. (Examples of conditions from #4071 listed again below). Thank you very much again Dr.

Immune thrombocytopenic purpura (ITP)
High-dose long term oral steroid use for Bronchiectasis/COPD/asthma/bronchitis
Von Willebrand / other blood clotting disorders
Varicose veins 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome back, but sorry you found it necessary. I would strongly suggest you carefully re-read your other thread and Dr. Hook's replies. The answers to these questions are obvious, if not directly addressed, in that discussion.

NO medical conditions or drugs affect susceptibility to ANY STD. Other medical conditions sometimes can make STDs more prominent or increase risk of complications. For example, people on immune suppressing drugs or with advanced AIDS or other immune deficiencies can have more frequent or more prolonged herpes outbreaks, and they are at increased risk of genital HPV leading to cancer. However, NOTHING is known to have any effect on risk of CATCHING any STD.

You apparently misunderstand something you read about HSV1, HSV2, and sexual transmission. HSV2 is almost always an STD. It is only caught by sex, usually vaginal or anal intercourse. HSV1 usually is not sexually transmitted, although sometimes can be (e.g. genital herpes from a partner who has non-sexually acquired oral herpes).

So the answer to all three of your question is yes, your understanding is correct: There is no increased risk of any of those infections because of immune suppressive medical conditions or drugs. This includes the specific medical conditions you have listed.

30 months ago
Great thank you Dr Handsfield that is so helpful. Just one more question (sorry if this is again repetitive) - I’m right in assuming Syphillis is included in the STDs you mention above?

So I’m right in assuming there is no condition/medication a person has that would increase materially their risk of contracting Syphillis, via blood borne/non-sexual routes? I.e. transmission routes as mentioned in the above post (when living together and sharing razors/toothbrush/towels/non-sexual massage/other household objects, over a 3 month period)

Thankyou again Dr 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Huh? It's as if you're questioning whether I would have remembered that syphilis is an STD. You're on your own for that question.

As Dr. Hook made clear in your first thread, it is theoretically possible syphilis could be transmitted in the ways you mention. He also told you that any such risk is exceedingly small, low enough so that testing or precautions against transmission are not required or recommended. But if the common sense, science based replies you have had don't settle it for you, you are free to have a blood test. If you do, it will be negative.

30 months ago
Thank you again Dr Handsfield - you are very right, my last follow-up reply was repetitive/unnecessary, apologies. 

My last final questions instead are covering new ground, so I hope you can help me just with these last queries:

1. I also read about HTLV-1 & HTLV-2, my previous belief was these were rare diseases. However reading articles from CDC (https://wwwnc.cdc.gov/eid/article/15/7/08-0796_article) and EU health authority (https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/geographical-distribution-areas-high-prevalence-HTLV1.pdf) - these are saying HTLV is much more common than I had thought.

Also my ex-girlfriend was not from the US/Europe, and was very promiscuous with previous partners from many different countries. However would I be right that the risk of transmission to my family of HTLV 1&2 through sharing razors/toothbrush/towels/household objects/non-sexual massage, is at least as low or lower than HBV/HCV, i.e. so Dr. Hook's advice in last response #4071 would be unchanged? And that per your comments above on transmission for STDs, no medical condition/medication would impact the risk of HTLV transmission?
I was googling it to save having to ask you, I found this response (from a long time ago) where you stated you didn't actively keep up to date on HTLV literature (https://www.medhelp.org/posts/STDs/HTLV-1-and-2/show/246144). But I would I be right that given your extensive expertise as an epidemiologist, you have current knowledge in this field, and are thus fully able to give expert advice? (I see more recently you have given more detailed responses on HTLV)

2. At the same time I was googling your previous advice, I came across reference to the XMRV virus. Am I correct that the risks through any non-sexual/household transmission methods for XMRV (as mentioned in question 1 on HTLV) would be at least as low or lower than HBV/HCV, so Dr. Hook's response would be unchanged? And that no medical condition/medication has impact on transmission risk?

Sorry I tried googling XMRV as well but apart from a spate of news articles/studies around 2010, I was not able to see anything more current.

Many thanks once again Dr.

30 months ago
Also meant to say - the CDC study linked in my above reply appeared to suggest HTLV was being easily/regularly transmitted from people from high prevalence areas/nationalities, to people they were living with from low prevalence areas. I.e due to this high transmission rate, even people originally from low prevalence areas were at risk of HTLV.

So if you could give information on this and and answer my final questions #1 & #2 above, that would be so very appreciated Dr.
Thank you so very much again.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Follow-up questions/comments are intended for clarification or follow-up on the original question. Entirely new questions must be asked anew. Thanks for your understanding. 

I will say that there are few data on transmission of HTLV. Sexual transmission is assumed, but not well proved. To my knowledge, few data are available on nonsexual transmission risks, and neither I nor Dr. Hook can answer the questions you ask. So think twice before re-asking on this forum.