[Question #7303] GHSV-1

7 months ago
I have a few questions about genital hsv-1. I understand a lot of the facts about it but I was wondering if the same ideas apply to an infection that is newer (say less than 1 year).

1. I know that studies are lacking but what does shedding look like in the first year? I’ve heard it is around 12.3%, which is much higher than older infections. Does this mean that transmission in the first year is comparable to that of a typical GHSV-2 infection because shedding is so similar?

2. I know that male to female transmission is higher (2x) than female to male, but would you still state that transmission from an infected male to an uninfected female is rare?

3. I have seen that people quote a study from Anna Wald that only 25% of people with GHSV1 shed virus asymptotically. Does that suggest that 75% of people with GHSV1 don’t asymptomatically shed? 

4. I have heard Dr. Hook say that not all contact with asymptomatic shedding would lead to infection in terms of transmitting HSV-1 to a partner. However, I didn’t know if that was true about a genital infection. I saw that the virus must be “worked in” or there must be friction. I feel like this occurs during most if not all acts of sexual intercourse especially if an infected male is having sex with an I infected female. If a male is shedding is it still not guaranteed infection will be transmitted during sex? 

5. It has been nearly 4 months since my diagnosis and I have yet to have another outbreak. I know this is not long enough to truly see how my body reacts to the virus, however, I’m unsure when it is safe to have unprotected sex/when transmission through intercourse is truly “rare”. I would prefer not to go on antivirals until I know the course of the infection/to let my immune system lower shedding naturally. 

I know this infection is truly benign and unlikely to be passed on via intercourse in the long run but I am just curious to know if it applies to the first few months as well. I have been very anxious since my first outb
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
1.  Your statistic is about right, but this does not compare to a new genital HSV 2 infection which can be shed on up to 42% of days. 
2.  Transmission via intercoure of HSV 1 is indeed uncommon though it has certainly been documented in the scientific literature.
3.  I am not aware of the study that you are quoting - could you give me the source of the original paper?  We know that people who have frequently recurring oral HSV 1 shed on about 25% of days - could that be what you are referring to?
4.  It is true that not all episode of shedding, symptomatic or asymptomatic, result in transmission, absolutely.  That is true of both oral and genital infection.  There are a number of immune factors involved in transmission - both of the part of the infected person and the uninfected person.  Also, it is necessary for a certain volume of virus to be present for transmission to occur.  Transmission is never certain.
5.  If you have been infected only 4 months (vs. being diaganosed 4 months ago), then your shedding rate is still around 6-7% and care should definitely be taken to avoid transmission to a sex partner.  You could take daily antivirals or be sure your partner is using condoms or both.

Terri
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6 months ago
Hi Terri! 

Thanks for the response. You have no idea how useful this forum has been for me and I’m sure countless others.

1. If shedding right now is 6-7% are antivirals truly necessary to prevent transmission? Like I said earlier I’d like to see how my body handles the virus naturally during the first year to see I can expect more outbreaks.

2. I have not seen the article personally. I have seen others quote it but never seen you quote or address it so I was just wondering if you’d ever heard of that. Given your experience though, is it possible this may be the case and some people just don’t shed HSV-1 genitally as it is outside of its preferred location?

3. To reassure future partners within the first 4–6 months of infection, is it safe to tell them that even this early on transmission to them would be rare? 

4. Seeing the work being done by Dr. Jerome and Fred Hutch, is it too optimistic to say that this could be a cure that could come to fruition within the next 10 years? If not at Fred Hutch, could you see the research at Sanofi in Cambridge also being promising? 

Thanks again!


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
1. If shedding right now is 6-7% are antivirals truly necessary to prevent transmission? Like I said earlier I’d like to see how my body handles the virus naturally during the first year to see I can expect more outbreaks.

That really has to be your call.  You are involving someone else in this, so you need to consider them in your decision, not just yourself, right?  That makes your decision a bit more complicated, I know

2. I have not seen the article personally. I have seen others quote it but never seen you quote or address it so I was just wondering if you’d ever heard of that. Given your experience though, is it possible this may be the case and some people just don’t shed HSV-1 genitally as it is outside of its preferred location?

I really don't understand what articled you are referring to now.  But I'm sure there are probably people who have HSV 1 genitally that don't shed.  The problem is,  how would you know if it  is you? 

3. To reassure future partners within the first 4–6 months of infection, is it safe to tell them that even this early on transmission to them would be rare?
I think you could say that transmission to a partner is uncommon, yes, for HSV 1 genital infection.

4. Seeing the work being done by Dr. Jerome and Fred Hutch, is it too optimistic to say that this could be a cure that could come to fruition within the next 10 years? If not at Fred Hutch, could you see the research at Sanofi in Cambridge also being promising?

I'm not positive about 10 years, but that seems close, for sure, for the work of Dr. Jerome.  I guess we'll have to see how well gene editing is accepted and what ethical concerns will need to be resolved as a population.

Terri


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6 months ago
Thanks Terri. Like many people I got very bad information from the NP. They even told me HSV was in the blood and shows up as both oral and genital. 

In terms of dating negative partners, is there a possibility of going through my life and never passing it on? My current partner knows my HSV-1 status and doesn’t care but I’d like to keep her from catching it.

I understand most people say that this will have little to no impact on my life going forward and from what I’ve read and what you have told me this is probably true. However, I have still been quite anxious. Any advice that would allow me to move on from this?

I’ve heard some people say their doctors tell them not to let this affect their sex life at all and as long as there are no symptoms and their partner knows the risk is almost negligible. Is avoiding sex during outbreaks truly enough and I can then lead a normal sex life? 

Thanks again Terri! I know this is my last post so thanks so much for all your help.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
I'm so sorry you got bad information - that's terrible.
Yes, you may never pass this on to a partner, absolutely!  It's quite normal to feel anxious about this diagnosis at first.  Our research shows that the vast majority of people will go back to normal baseline functioning psychologically within about 6 months after a diagnosis.  They are never going to LIKE it, but they get used to it.  I suggest that you give this time to sink in, try not to push yourself too much to feel normal - that takes time, and I hope you give it to yourself.
Avoiding sex during outbreaks disregards the concept of asymptomatic viral shedding.  It is true that you will shed far less than someone with HSV 2, but you will still shed.  I know you would like to hear from me that you don't need to worry at all about HSV 1, but that's scientifically a bit dishonest.  I don't think you have to worry a lot, but I think you still need to pay attention to this, be aware of symptoms and consider carefully disclosing to partners who are uninfected with HSV 1.  This isn't just a moral or ethical issue - it is a legal issue as well so just think it through carefully.  The risk of transmisssion is truly low but there are other factors involved here, like trust.  What if you don't disclose right away and a year later, have to disclose for some reason?  It's complicated, I know.  You are pursuing the truth and accurate answers - I think you're going to do just fine.

Terri
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