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Questions about transmission probability

First of all, thank you to everyone who has posted and responded on this forum. It's been very helpful so far.

Here are the details of my situation: I'm a 44 year old (most likely peri-menopausal) woman. I contracted genital HSV-2 sometime between 8/25/09 and 8/30/09 from a man who was asymptomatic and who apparently never experienced any outbreak symptoms in his lifetime to the best of his knowledge. We engaged in both oral and vaginal sex (unprotected).

I started noticing a burning sensation on my legs and buttocks, soreness around the opening of my vagina and flu-like symptoms about 5 days after the last day we were together. A couple of blisters formed in the same area on 9/7/09 and I took a HerpeSelect blood test with tSTD.org on 9/8/09 which came back negative for both HSV-1 and HSV-2. On 9/10/09 I went to Planned Parenthood for a culture which came back positive for HSV-2, so clearly it was was recently acquired. They put me on a 7 day course of acyclovir 3 times a day. I probably would not have classified this as a very severe outbreak, so I guess in that sense, I'm lucky (yeah right!). However, I'm still not free of symptoms after about 3 weeks.

The genital symptoms cleared up except for some minor lingering pain, but I had another minor outbreak at the top back of my thighs near the crease and also between my buttocks about a week later. These seem to have cleared up in a couple days though. I've actually been rubbing toothpaste (with sodium lauryl sulfate) on these lesions and this seems to have helped clear them up relatively quickly.

At any rate, I would like to go on suppressive therapy to avoid future outbreaks but primarily to reduce the chance of passing it on. Unfortunately I would only be able to afford acyclovir at this point. Valtrex isn't an option because I was laid off last year and am currently only working a contract job with no benefits.  So...

1) Should I start taking acyclovir right away as suppressive therapy or wait to see how often I'm likely to have outbreaks without it? Will it interfere with my body's natural ability to build up antibodies against the disease if I start taking it daily right away?
2) Also since it appears I'm going to have outbreaks in a lot of areas (thighs, buttocks) and not just around my vagina, are condoms even going to be very effective during times of asymptomatic shedding?
3) How frequently will I be shedding the virus since it was recently acquired? I've read that Valtrex is more effective for controlling shedding than acyclovir. Is this true?  
4) Should I just plan on not having sex again for the next five years for fear of passing it on to someone else??

Thank you very much in advance.
22 Responses
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101028 tn?1419603004
Typically the WB is better at picking up on hsv2 than other blood tests are. If he wants to repeat his test, he should wait another month or two before doing so.

Sometimes it just isn't all clear unfortunately - what's important is knowing what you have though you might not figure out the particulars it sounds like :(

grace
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Avatar universal
Well, unfortunately my hope that maybe my culture was mis-typed fell flat. I had another HerpeSelect blood test and it came back negative (<.90) for HSV-1 and positive (3.13) for HSV-2. Yippee. :(

I just wish I knew where this came from! My partner wants to have another blood test but I'm not sure if there would be any point.

Does HSV-1 sometimes mask HSV-2 in a Western Blot test?
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101028 tn?1419603004
Just ask the next time you are there to be sure.

grace
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Avatar universal
Never mind, I was able to find it after I registered. So the bottom line for now is culture mis-typing is pretty unlikely? I remember when I spoke with the NP, she specifically said HSV-2 and not just "genital herpes".  So I'm guessing they actually typed it and she's not just assuming it's HSV-2 because of where it's located.
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Avatar universal
Thanks again.

By the way, can you link me to your response to this post?

http://www.medhelp.org/posts/Herpes/Wrongly-typed-culture/show/1030281

It sounds similar to my situation and I'd be interested in reading it. I took a look on WebMD but wasn't able to find it.
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101028 tn?1419603004
I'd wait and get another blood test at the 4 month mark. should you have a recurrence of symptoms, go and be seen within 48 hours of their appearance for a repeat lesion culture and typing.

Oh don't be using tea tree oil on the first ob and especially not using it undiluated!!!  It has a high incidence of allergic reactions which isn't something you need with the first ob. I'd stop using the TTO definitely. I love it myself but there are certainly limitations to using it.  I'd even stop using the coconut oil at this point just in case that might be causing issues too at this point.

if the bump gets worse, return to be seen.

grace
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Avatar universal
Also, as I mentioned, I've been on acyclovir 400 mg twice a day for the last 3 weeks. Will that affect my test results if I take another HerpeSelect test in the next week or so?
I don't think I've had any new outbreaks of sores, just a lot of unusual sensations down there on and off, so I never know what's what.  I've had a little more pain and noticed a bump on my labia today, but it doesn't look like a blister. It might just be irritated skin because I've been a little bonkers about applying coconut oil and/or undiluted tea tree oil every day.
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Avatar universal
I have not, and he also says he hasn't either. And yes, the timing of everything was pretty textbook. The symptoms started about a week after the last day we were together and they were all the classic symptoms of a primary infection.

It still strikes me as odd though. He's a couple years older than I am and potentially had HSV-1 for most of his life. Would shedding of HSV-1 even be very likely after many years? We did have very vigorous sex a number of times over about 5 days. Some of it was pretty rough and I think he may have caused a scrape just inside my vagina with his fingernail. When we had oral sex, could that abrasion be where the virus got in? The blisters seemed to occur around the same area. Then again the abrasion could have just been another herpes lesion. I honestly don't know. This also all assumes that PP mistyped me, and the Western Blot only showed HSV-1 (oral) when maybe he actually has both types but has just been asymptomatic for ages. I'm totally stumped on this. :(

Is it still too soon to have another blood test? I read somewhere that most people seroconvert in an average of 25 days and it's been over a month for me now.  I'd really like to know for sure if I have 1 or 2, so I have a better idea of what to expect in the future.  
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101028 tn?1419603004
had either of you had other partners recently?  I assume this is a fairly new relationship that you can pinpoint the approximate time of infection like you did in your original post?

grace
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Avatar universal
UPDATE: Now I'm utterly confused.  My partner finally got his test results back and tested positive (Western Blot) for HSV-1.  As I said above, Planned Parenthood said my culture test was positive for HSV-2. Is it possible PP typed my culture results incorrectly?

My blood test (which was apparently done too soon since it was only a little more than a week after exposure) came back negative for both types, so it's unlikely I had an old infection of either type. Whichever it is, it probably came from him.

Any feedback would be greatly appreciated. Thanks again for all your help so far.
Helpful - 0
101028 tn?1419603004
prunella was never proven to work outside of the test tube from what I recall. No standard doses ,no effectiveness in reducing ob's in humans studies, and  no shedding studies.  Not something I recommend.  You are already on suppressive therapy which as far as we know, has the odds as high in your favor as possible at this point.   Suppressive therapy reduces ob's by 70% on average and reduces shedding by about 80% on average - that's significant reductions!  

most times recurrences will be pretty obvious and in time you'll start to recognize when one is about to start. Of course sometimes your body pretty much skips all the prelims and goes straight to a rip roaring ob too. It varies.  Pretty much recurrences are going to itch and/or tingle or be painful to touch.  When you have any sort of vaginal infection going on, avoid sex too.  

It will get easier in time :)

grace
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Avatar universal
Oops, forgot to ask: Is prunella vulgaris mainly used as an episodic treatment, or can you take it all the time for suppression?
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Avatar universal
The questions just keep on coming!

I'm generally a cynical, pessimistic sort, but let's just say by some weird, unexpected twist of fate, I'm able to keep my outbreaks pretty much in check with suppressive therapy (fingers and toes crossed!). If I don't notice any obvious symptoms, how will I know when I'm shedding and when I should avoid sex? Or will I pretty much have to feel some tingle or itch or something to have any idea?

I'm worried now that every time I see the slightest blemish anywhere on my body or feel the smallest itch below the waist, I'll get all panicky and assume I'm shedding like a white Persian cat on a black velvet couch.

Also, for anyone: Has anyone tried prunella vulgaris? Does it come in capsules to be taken orally or is it a topical treatment? Can you buy it at Walmart or Walgreens or do you have to order it from somewhere?
Helpful - 0
101028 tn?1419603004
1) Is it typical to have several rounds of new blisters crop up in the same outbreak?

- yes this is normal  for a newly acquired infection

2) I've had a prescription filled for 60 acyclovir tablets for suppressive therapy (two 400mg pills per day).  Should I go back up to 3 a day instead until this stops?  

-I'd up it to 400mg 3x/day for another week. The 1st ob can take several weeks to fully run its course and a 2nd round of treatment is sometimes helpful.  Your body has no protection with the 1st one so it gets a chance to run a little wild compared to recurrences.


3) Is this any indication of what's in store for me in terms of frequency and duration of outbreaks?

- only time will tell. On average it's 4-6 ob's a year without treatment for hsv2. they usually last 7-10 days without treatment with recurrences.  

4) On a totally different subject, has anyone tried virgin coconut oil as a balm for sores? I guess you're supposed to eat it too but I'm not sure I could stomach the amount you'd need to eat to get any benefit from it. (Might look into Lauricidin instead.)

- I don't recommend lauricidin for herpes.   don't buy into the unproven info on their website.

Try soaking in the bathtub with epsom salts thrown in or a packet of aveeno bath for comfort. You can also steep a tea bag and use it as a compress on lesions too to help reduce pain.  


5) What about virgin coconut oil as a personal lubricant? I wonder if that would provide any added protection since it's supposed to be naturally anti-viral. Just throwing it out there!

- never read anything on it being used that way and I have no idea if it's a set up for vaginitis or not as well as it's probably not compatible with condoms either since it's an oil.  

grace
Helpful - 0
Avatar universal
Thank you once more, Grace.

I have a couple more questions which really anyone weigh in on if they want: When will this outbreak finally end? If I recall, the first two blisters appeared on 9/7/09. Those sores have pretty much gone away.  However it seems I'm OK for a day then one or two more blisters break out in another area. Fortunately the subsequent ones have all been on "drier" areas (thighs, etc.) so they're not quite as annoying, but they're still no fun.  

1) Is it typical to have several rounds of new blisters crop up in the same outbreak?
2) I've had a prescription filled for 60 acyclovir tablets for suppressive therapy (two 400mg pills per day).  Should I go back up to 3 a day instead until this stops?  
3) Is this any indication of what's in store for me in terms of frequency and duration of outbreaks?
4) On a totally different subject, has anyone tried virgin coconut oil as a balm for sores? I guess you're supposed to eat it too but I'm not sure I could stomach the amount you'd need to eat to get any benefit from it. (Might look into Lauricidin instead.)
5) What about virgin coconut oil as a personal lubricant? I wonder if that would provide any added protection since it's supposed to be naturally anti-viral. Just throwing it out there!

Thanks again. :)
Helpful - 0
101028 tn?1419603004
I know, hard to believe that transmission risk is so low when soooooo many folks have hsv2. The problem is, most folks who have hsv2, have no idea that they are infected so that they can avoid sex with their negative partners during obvious symptoms. everyone thinks that if you have genital herpes, it's incredibly obvious due to frequently reoccurring obvious and very painful blisters that no one could miss. The reality is, most folks have very mild symptoms and/or contribute them to other reasons so they continue to have sex not knowing that the virus could be actively shedding.    Have sex during active symptoms and the risk of transmission goes up tremendously :(   One study in fact showed that just knowing that you have genital herpes, cut the risk of transmission to a partner by 1/2 !  

You have yet to ask a "stupid" or annoying question dear - all your questions are helping you learn more as well as the thousands of folks who read your post to learn more :)  Keep asking them !!!!

grace
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Avatar universal
Thanks again Grace. I truly appreciate your input.

I guess where I'm experiencing the most confusion is here: If the rate of transmission from a HSV2 positive female to a negative male is fairly low (4% per year if all the couple does is avoid sex during outbreaks. I think I read this assumes they have sex what, 3 times a week? it would never be that frequently for me!), then why is it such a prevalent condition? 25% of the population seems like  pretty high number of people to have it, if the transmission rate is supposedly so low.

Sorry for all the questions. The only way I think I'm going to get through this is if I'm as informed about it as possible.
Helpful - 0
101028 tn?1419603004
On average it's 15% of days by culture. some studies have shown it to be as high as 40% by pcr during the first year. suppressive therapy will keep it down to a minimal amount though.

You will never, ever, ever be able to make someone have zero risk of acquiring hsv2 from you if they are negative. it's something out of your control .  You do the best you can do by taking precautions and you can't do any better than that.  we can't control everything so you do what you can with the knowledge you have and accept that. Not always easy to do but hopefully in time you get to that place too. in the grand scheme of things, genital herpes is such small potatoes compared to so many other things.  At least you can take a pill or two a day and pretty much keep it under control, can't do that for many things in life .  Can't get the risk that someone won't treat you like crap down to 1%/year like you can the risk of transmission of your herpes now can you?

grace
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Avatar universal
Thanks so much for your reply, Grace. You're an angel! :) I'm still curious about the frequency of asymptomatic shedding for a recently acquired infection. Is it going to be a nearly constant thing for the first year or so? Or does it depend on the person? The absolute very last thing I ever want to do is give this to someone else. I couldn't live with myself if I did! :(
Helpful - 0
101028 tn?1419603004
You had a hsv2+ culture. It's not unusual to show up in the pattern you've described. No reason to doubt it.  

1) Should I start taking acyclovir right away as suppressive therapy or wait to see how often I'm likely to have outbreaks without it? Will it interfere with my body's natural ability to build up antibodies against the disease if I start taking it daily right away?

- oh yes indeed start it!  Why have more ob's than you have to?  It doesn't interfere with the body making protective antibodies - that started from the moment you were infected. All herpes antivirals do is disrupt the viral replication process so that the virus sheds less and causes less ob's - it still reactivates for your body to have to deal with.  

2) Also since it appears I'm going to have outbreaks in a lot of areas (thighs, buttocks) and not just around my vagina, are condoms even going to be very effective during times of asymptomatic shedding?

- only time will tell how often you'll have ob's and where. this is the first ob so it's typically a humdinger like this :(  when you shed the virus, you shed from the area of the lesions as well as from the anogenital area. In between obvious lesions, the skin on your thighs and buttocks is too thick for the virus to penetrate to the surface so you only shed from the anogenital area then. suppressive therapy will reduce shedding significantly and along with condoms a male partner has on average a 1% risk/year of contracting hsv2 from you.  

3) How frequently will I be shedding the virus since it was recently acquired? I've read that Valtrex is more effective for controlling shedding than acyclovir. Is this true?  

- they both work just fine. if you read valtrex's prescribing info you'll see that it had to compare itself to acyclovir to prove that it works just as well!

4) Should I just plan on not having sex again for the next five years for fear of passing it on to someone else??

- heck no!!!  

The herpes handbook at www.westoverheights.com is a free resource with lots of good info in it. there is also a wonderful patient counseling video there too to watch if you didn't get the valtrex packet at the clinic with it in.  

keep asking questions as you have them :)

grace
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Avatar universal
They told me the culture indicated I was positive for HSV-2. I don't know enough about either to know if they can distinguish between zoster and HSV-2 in a culture test though. I would assume they can. Also, being that sex was involved and I also had genital lesions, and genital herpes also shows up on the thighs and buttocks, I'm afraid it's probably what they say it is. :(
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Avatar universal
Hi,

Sorry to say, but would it be possible to have Zoster instead of Herpes Type 2. The fact that it reappears and that you have it on other parts of the body made me think of this.
Of what I know about acyclovir,  you  may take it, but herpeses never die. They stay with us for the rest of our lives and they may reappear. The same happens with the Zoster.

Take care
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