STDs Expert Forum
GHSV-1 Shedding
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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GHSV-1 Shedding

Hello,

I have been diagnosed with GHSV-1 almost 10 years ago. I have very infrequent breakouts (perhaps once every two years, though if I have a stressful year it's more). I rarely take medication for it and the OB's usually last about 4 days. Haven't really been in a permanent relationship but I would like to be soon but HSV (or the disclosure of it) still unnerves me after all of these years. Anyway, in knowing what to respond with when asked questions regarding asymtomatic shedding, is there a consensus as to it's frequency given my type of history? I've tried reading around and I get so many different numbers I'm not sure what to think.

Thank you in advance for your help.
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

Unfortunately, few data are available on the frequency of subclinical (asymptomatic) viral shedding with genital HSV-1.  As you have found, the frequency of symptomatic outbreaks usually is low; once every 1-2 years is typical, and many have fewer than that.  The available data on subclinical shedding are similar, i.e. it's a lot less frequent than for genital HSV-2.  As a corollary, genital to genital HSV-1 transmission seems to be rare, which supports the idea that subclinical shedding is uncommon.  (The large majority of new genital HSV-1 infections are acquried by oral sex, not vaginal or anal intercourse.)

Having said all that, I cannot give you a percentage of time that you may be asymptomatically shedding, and cannot guarantee you won't someday transmit to a partner by genital contact.  So most experts would agree that you should indeed inform potential partners of the situaiton.  But you can do that with honest confidence that the risk or transmission is low.  Also, half of all adults in the US (variable frequencies in other countries) have positive blood tests for HSV-1, whether or not they have recognized oral herpes.   So for any particular new partnership, there's a 50% chance your partner is immune to new HSV-1 infection anywhere on the body.

I hope this has been helpful.  Best wishes--  HHH, MD
6 Comments
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It has been very helpful. Thank you HHH.
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Actually one quick f/u if you don't mind, I forgot it in my question . . . Is suppressive therapy at all useful in my case?
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239123_tn?1267651214
This is also an excellent question without a clear answer.  Suppressive therapy has never been studied in genital HSV-1 infection; all research has been limited to HSV-2.  HSV-1 is less susceptible to the anti-herpes drugs than HSV-2, and for oral herpes with HSV-1, higher doses are required than for genital herpes.  Therefore, the data on GHSV-2 cannot be safely extrapolated to GHSV-1 but I suspect the standard doses used to suppress HSV-2 shedding and help prevent transmission are too low for GHSV-1.  At least double the normal dose might be required.

In other words, I cannot say that such treatment is not "at all useful".  But it's hard to know, and for all these reasons -- including the relative infrequency of subclinical shedding and apparent low rate of genital to genital HSV-1 transmission -- I generally don't prescribe suppressive treatment in patients with GHSV-1.
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I see. Thank you for such thorough answers. It's greatly appreciated HHH. Happy New Year!
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239123_tn?1267651214
Thanks for the kind words.  HNY to you too.
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