[Question #6290] Herpes Transmission
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69 months ago
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Hello, I have been diagnosed with HSV-2 for about 18 years now (34yo male) with an IGG antibody above 4.00. It was particularly difficult to get diagnosed when I had the first occurrence because of the location of the lesions, they have always occurred in the pubic region above the shaft on the right side, never have they actually appeared on the penis or anywhere else in the groin region. My primary doctor wasn't convinced it was HSV and dismissed it for folliculitis until multiple outbreaks occurred with the typical symptoms: blisters>ulcers>scabs. I haven't had an outbreak in about 5-6 years until recently when I had back to back outbreaks within a week of each other which I found strange. I took valtrex that Ive had for many years just sitting there and within 2-3 days they were all cleared up. Given that this just occurred, I have a few questions that were never answered since Ive had the diagnosis and wanted your input.
1) Given the location of my lesions, does this increase/decrease the chances of transmitting the virus to someone?
2) Since I've carried the virus for so long, are my episodes of asymptomatic shedding much lower than usual? Or does it remain the same for life?
3) I once had sex when the lesions had scabbed over, I wasnt aware that I had an outbreak at the moment and used a condom, but given the location of where the lesions always appear I don't know if I was infections anyway. This was years ago and the person never acquired the disease. At that stage of the outbreak, how infectious was I?
4)I went vegan about 3 weeks ago and the outbreak occurred. Could this be the cause of the OB after so many years? Just curious
5) I've always taken Valtrex for episodes, never for suppression. How quickly after the lesions turn into scabs may I return to sexual activity given that I took treatment?
6) At what stage of the OB am I most infectious? Prodrome, blisters, ulcers or scabs?
Thank you!
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Terri Warren, RN, Nurse Practitioner
69 months ago
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1) Given the location of my lesions, does this increase/decrease the chances of transmitting the virus to someone?
It may be slightly decreased but we know that even when outbreaks are extragenital, viral shedding occurs from the shaft of the penis in men
2) Since I've carried the virus for so long, are my episodes of asymptomatic shedding much lower than usual? Or does it remain the same for life?
It is likely that you are shedding significantly less than you were when you were first infected, correct.
3)
I once had sex when the lesions had scabbed over, I wasnt aware that I
had an outbreak at the moment and used a condom, but given the location
of where the lesions always appear I don't know if I was infections
anyway. This was years ago and the person never acquired the disease. At
that stage of the outbreak, how infectious was I?
The take away message from this question is that you used a condom, which reduce transmission of virus by 96%, which is huge. Had you not used a condom, you would have likely still been somewhat contagious but probably less than if the lesions were in a blister or ulcer stagge.
4)I went vegan about 3 weeks ago and the outbreak occurred. Could this be the cause of the OB after so many years? Just curious
Hmmm, I've never been asked that before. I honestly don't have an answer for this question, sorry
5)
I've always taken Valtrex for episodes, never for suppression. How
quickly after the lesions turn into scabs may I return to sexual
activity given that I took treatment?
That question somewhat misses the point. The point is that transmission, we know now, is not about outbreaks but rather about viral shedding, the giving off of virus which can happen both with and without symptoms. You can give off millions of copies of virus even when there are zero symptoms present. So if you want to give your partners the greatest amount of protection, using suppression makes far more sense. We know that suppression reduces transmission by 48%.
6) At what stage of the OB am I most infectious? Prodrome, blisters, ulcers or scabs?
For most people, that would be blisters, but see above for additional information
Terri
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69 months ago
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Thank you for your response. I just have a few follow ups. The last I read on daily suppression therapy was that past 1 or 2 years, there isn’t much data on the efficacy of daily suppression therapy. Has more information been available? If so what information can be provided of the efficacy of daily suppression after the 2 year mark. I ask only because I’ve had it for so long.
The part about viral shedding in the shaft regardless of extragenital lesions blew my mind. I had never known about this and wish this information was available to me before as I was always very scared of passing on the virus even when using a condom because to my knowledge shedding occurred at or around the site of lesions. Thank you for this. With that said, when lesions are present, is viral shedding concentrated at the site of the outbreak or does shedding also occur elsewhere also?
Regarding new therapies, I really haven’t focused on investigating new treatment developments as I kind of gave up hope over the years and figured there wont be any more advancement after acyclovir and its variants, but do you know of any new studies/treatments/therapies that may be available or show some kind of promise? I’m curious to know.
And one last thing, is there a larger source where more detailed information on the virus can be found? Basic internet searches will only provide the same basic information or discussions by other people that aren’t as well resourced as the medical community.
Thank you for all your help.
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Terri Warren, RN, Nurse Practitioner
69 months ago
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The efficacy of suppression has not been broken down by duration of infection
When lesions are present, shedding is primarily at the site of the lesion though I don't think we can say for sure it is not other places (like the shaft of the penis)
There are several treatment vaccines being studied currently - the research is once again very active.
If you want more detailed information, I would suggest pubmed as a resource - there are original medical articles there for anyone to read.
Terri
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69 months ago
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Thank you for that information. One more question regarding probability of transmission. What is the probability of transmission of a one time occurrence with lesions present and unprotected? When I first acquired the virus and didnt know my diagnosis I had unprotected sex toward the end of one of my outbreak (tiny open ulcers that occurred after the blisters swelled down). What, in your experience, would be the transmission rate at this point? The ulcers dried up the next day.
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Terri Warren, RN, Nurse Practitioner
69 months ago
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We don't have this data I'm afraid, on transmission based on stage of lesion. I would say there was likely some risk here.
Terri
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Terri Warren, RN, Nurse Practitioner
69 months ago
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We honestly do not have that data. I can only say that we know people are definitely infectious when lesions are present - in what stage, and how infectious, we just don't know
Terri
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