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HSV Clarifications
I've been perusing the forum (posts ranging from 2005-present) in regards to HSV II information & have noticed - like others - a large amount of discrepancies. I was hoping to clear them up once & for all.
1) Dr. HHH has maintained 3 months as being conclusive for HSV II; Nurse Warren 4 months; and Dr. Hook has quoted a study extensively in the past (83% accuracy at 6 months w/ prior HSV I infection). Dr. Hook has changed his stance a bit, sometimes quoting 73-93% accurary at 3 months (among a few other varying statements).
-Is there a conclusive window period in which the 3 of you have agreed upon?
-In your experience and/or studies, what kind of difference in results can be seen from testing at 12 weeks as opposed to 16 weeks?
***Can a person without symptoms assume a 12 week Herpeselect negative result for HSV II to be conclusive?? (even WITH a prior HSV I infection).
-If 12 weeks is conclusive, why was SO much made of the results (83% accuracy at 6 months) on this site when it was a very small study and not necessarily representative of most HSV sufferers?
2) Could most women be "asymptomatic" because they are experiencing outbreaks on their cervix?
-How often does HSV II *ONLY* present itself on the cervix?
-Dr. HHH has stated that cervical outbreaks are painless. Is there NO way of women knowing if they are experiencing them on their cervix (aside from clinical examination)? Or is there a noticeable discharge, etc. that accompanies the outbreaks?
3) I've had HSV I for many years (probably since childhood). I have never had a cold sore that I can remember. What are the odds of me shedding the virus? And how often? Should I be concerned w/ fellatio if my bf is HSV I & HSV II negative?
4) Please share your opinion on the vaccines being developed by David Bloom (UoF), David Knipe (Harvard) & William Halford (SIU) as well as Antigenics & Vical? Do any of these sound promising?
I appreciate your time & detailed answers.
1) Dr. HHH has maintained 3 months as being conclusive for HSV II; Nurse Warren 4 months; and Dr. Hook has quoted a study extensively in the past (83% accuracy at 6 months w/ prior HSV I infection). Dr. Hook has changed his stance a bit, sometimes quoting 73-93% accurary at 3 months (among a few other varying statements).
-Is there a conclusive window period in which the 3 of you have agreed upon?
-In your experience and/or studies, what kind of difference in results can be seen from testing at 12 weeks as opposed to 16 weeks?
***Can a person without symptoms assume a 12 week Herpeselect negative result for HSV II to be conclusive?? (even WITH a prior HSV I infection).
-If 12 weeks is conclusive, why was SO much made of the results (83% accuracy at 6 months) on this site when it was a very small study and not necessarily representative of most HSV sufferers?
2) Could most women be "asymptomatic" because they are experiencing outbreaks on their cervix?
-How often does HSV II *ONLY* present itself on the cervix?
-Dr. HHH has stated that cervical outbreaks are painless. Is there NO way of women knowing if they are experiencing them on their cervix (aside from clinical examination)? Or is there a noticeable discharge, etc. that accompanies the outbreaks?
3) I've had HSV I for many years (probably since childhood). I have never had a cold sore that I can remember. What are the odds of me shedding the virus? And how often? Should I be concerned w/ fellatio if my bf is HSV I & HSV II negative?
4) Please share your opinion on the vaccines being developed by David Bloom (UoF), David Knipe (Harvard) & William Halford (SIU) as well as Antigenics & Vical? Do any of these sound promising?
I appreciate your time & detailed answers.
MEDICAL PROFESSIONAL
Of course single exposures sometimes result in HSV-2 transmission. That doesn't mean it isn't a rare event. People with unusual events dominate websites. You find stories from people struck by lightning (literally or figuratively), but the millions who were not struck don't post their experiences. Never, ever judge the frequency of bad outcomes by what you find on websites.
OK, exposed twice to an infected person. At the highest possible estimate of transmission potential, 1 chance in 100, the odds of catching HSV-2 might have been 2%. Add a negative HSV-2 blood test with 90% reliability. The chance you are infected calculates at 0.1 x 0.02 = 0.002, or 1 chance in 500. And this an overestimate, since the real transmission risk is a lot lower than 1%.
Dr. Hook is exactly right about absence of symptoms being very reassuring. People tend to make too much of asymptomatic infection, as you seem to be doing. You don't say it, but I gather you have had a sex partner with HSV-2 and are worried you are infected despite a negative blood test. But the research shows that when people know they are at risk for HSV-2, over 60% have symptoms if they get infected. Most likely it's even higher among persons who are especially concerned and body-aware, as you likely are. So let's assume an 80% chance you would have had symptoms. Integrate that assumption into the calculation above and you 20% of 1 in 500 (0.002 x 0.2), or 1 chance in 2,500. That's probably the maximum chance you have HSV-2. Now factor in 1% transmission risk for each episode of unprotected vaginal sex and you're at 1 chance in a quarter million. And since it's a new reltionship, you probably will use a condom, 90% efficacy. Now we're at 1 chance in 2.5 million. Even without condoms and assuming the relationship goes a year, the chance of transmission would be somewhere around 1 in 25,000. As a living human being, your risk of dying in that year (from an accident or horrible illness) is at least 1 in 2,500 -- 10 times higher than the chance you would transmit HSV-2 to your partner.
In other words, I suggest you just drop this entire line of reasoning and stop worrying about it. You were exposed to a partner with HSV-2. You didn't catch it. You should never mention it to future sex partners. You might bring up your known HSV-1 infection, h but for the reasons already discussed, it can be in the context of very low risk, not worth any worry.
That will end this thread. Take care-- HHH, MD
OK, exposed twice to an infected person. At the highest possible estimate of transmission potential, 1 chance in 100, the odds of catching HSV-2 might have been 2%. Add a negative HSV-2 blood test with 90% reliability. The chance you are infected calculates at 0.1 x 0.02 = 0.002, or 1 chance in 500. And this an overestimate, since the real transmission risk is a lot lower than 1%.
Dr. Hook is exactly right about absence of symptoms being very reassuring. People tend to make too much of asymptomatic infection, as you seem to be doing. You don't say it, but I gather you have had a sex partner with HSV-2 and are worried you are infected despite a negative blood test. But the research shows that when people know they are at risk for HSV-2, over 60% have symptoms if they get infected. Most likely it's even higher among persons who are especially concerned and body-aware, as you likely are. So let's assume an 80% chance you would have had symptoms. Integrate that assumption into the calculation above and you 20% of 1 in 500 (0.002 x 0.2), or 1 chance in 2,500. That's probably the maximum chance you have HSV-2. Now factor in 1% transmission risk for each episode of unprotected vaginal sex and you're at 1 chance in a quarter million. And since it's a new reltionship, you probably will use a condom, 90% efficacy. Now we're at 1 chance in 2.5 million. Even without condoms and assuming the relationship goes a year, the chance of transmission would be somewhere around 1 in 25,000. As a living human being, your risk of dying in that year (from an accident or horrible illness) is at least 1 in 2,500 -- 10 times higher than the chance you would transmit HSV-2 to your partner.
In other words, I suggest you just drop this entire line of reasoning and stop worrying about it. You were exposed to a partner with HSV-2. You didn't catch it. You should never mention it to future sex partners. You might bring up your known HSV-1 infection, h but for the reasons already discussed, it can be in the context of very low risk, not worth any worry.
That will end this thread. Take care-- HHH, MD
MEDICAL PROFESSIONAL
Welcome to the forum. There really aren't any significant discrepancies, at least not reflected in your questions -- just mild differences of expression between me and Dr. Hook, and probably within some of our own comments. And these differences in turn are largely due to lack of definite data. And the available science is pretty complex as well. I'm afraid my responses below won't completely resolve the issues for you. But I'll give it a shot.
1) Time to HSV-2 seroconversion: If there is any difference between 3 months and 4 months, it is small. This comes down to the uncertainties that always accompany statistics and probability with small number. The data just aren't very precise. If you understand a bit of math, you'll remember the notion of an asymptotic curve: the farther a rising graph line extends to the right, the slower it rises -- steadily approaching but never reaching 100%. The curve for HSV-2 seroconversion is quite flat by 10 weeks and rises only a bit through 16 weeks. As for the 83% value at 6 months, that's from a single small study and the margin of error was very broad -- the true value could be as low as 60% or as high as 99%. Further, these studies were done with a single test, the Focus/Quest HerpeSelect. There are now 7 or 8 type-specific HSV-2 antibody results on the market, none of which have been studies as much as HerpeSelect. But when all is said and done, the weight of evidence supports the estimate that around 90% of newly infected people will have positive HSV-2 antibody tests at 3-4 months.
The second part of this question is test interpretation, which should never be done in a vacuum. On this forum, and whenever a blood test is done by a wise clinician, the interpretation depends on the whole picture -- the combination of exposure history, likelihood of infection in the partner, symptoms, etc, in addition to test result. A negative test with 90% reliability often translates into 100% reassurance, or sometimes only 50:50 reassurance. It differs on a case by case basis; one size doesn't fit all.
2) Asymptomatic because the cervix is the only infected site? Absolutely yes; that probably happens quite a bit. But to my knowledge there are no data to say what proportion of HSV-2 infected women have infection of, or limited to, the cervix. A few such women may have changes in vaginal discharge with herpes reactivation of the cervix, but probably most do not.
3) HSV-1 viral shedding in oral herpes: The latest research shows that people with oral HSV-1 have the virus detectable an average of 8-10% of days, but it varied between 0 and 30%. Most of those times, the virus was present in very small amounts that might not be transmissible; and some shedding episodes lasted only a few hours. Only 18 people with oral herpes were studied, so once again wide margins of error. Here is a link to the research paper itself, if you want to delve into it: http://www.ncbi.nlm.nih.gov/pubmed/18783315
My standard advice to people positive for HSV-1 without symptoms is that they probably will never transmit it to another person, as long as you avoid kissing and performing oral sex whenever they obvious cold sores. But the stress is on "probably"; there are no guarantees and in theory you could transmit the infection almost any time.
4) HSV vaccines: Don't hold your breath. I'm not familiar with the authors you cite, but a quick look on line indicates they do sophisticated virological work of the type that in theory could lead to a vaccine, but I see nothing to indicate an actual vaccine has been developed or is close to human research. I don't anticipate an effective HSV vaccine for at least 10 years, maybe never.
This response has taken a lot of energy, as I hope you appreciate -- and the forum really isn't an appropriate venue for sophisticated scientific discussion. I can take a brief follow-up comment or two, but for more detailed information you should plan on continuing your own research. In any case, I hope this helps.
Regards-- HHH, MD
1) Time to HSV-2 seroconversion: If there is any difference between 3 months and 4 months, it is small. This comes down to the uncertainties that always accompany statistics and probability with small number. The data just aren't very precise. If you understand a bit of math, you'll remember the notion of an asymptotic curve: the farther a rising graph line extends to the right, the slower it rises -- steadily approaching but never reaching 100%. The curve for HSV-2 seroconversion is quite flat by 10 weeks and rises only a bit through 16 weeks. As for the 83% value at 6 months, that's from a single small study and the margin of error was very broad -- the true value could be as low as 60% or as high as 99%. Further, these studies were done with a single test, the Focus/Quest HerpeSelect. There are now 7 or 8 type-specific HSV-2 antibody results on the market, none of which have been studies as much as HerpeSelect. But when all is said and done, the weight of evidence supports the estimate that around 90% of newly infected people will have positive HSV-2 antibody tests at 3-4 months.
The second part of this question is test interpretation, which should never be done in a vacuum. On this forum, and whenever a blood test is done by a wise clinician, the interpretation depends on the whole picture -- the combination of exposure history, likelihood of infection in the partner, symptoms, etc, in addition to test result. A negative test with 90% reliability often translates into 100% reassurance, or sometimes only 50:50 reassurance. It differs on a case by case basis; one size doesn't fit all.
2) Asymptomatic because the cervix is the only infected site? Absolutely yes; that probably happens quite a bit. But to my knowledge there are no data to say what proportion of HSV-2 infected women have infection of, or limited to, the cervix. A few such women may have changes in vaginal discharge with herpes reactivation of the cervix, but probably most do not.
3) HSV-1 viral shedding in oral herpes: The latest research shows that people with oral HSV-1 have the virus detectable an average of 8-10% of days, but it varied between 0 and 30%. Most of those times, the virus was present in very small amounts that might not be transmissible; and some shedding episodes lasted only a few hours. Only 18 people with oral herpes were studied, so once again wide margins of error. Here is a link to the research paper itself, if you want to delve into it: http://www.ncbi.nlm.nih.gov/pubmed/18783315
My standard advice to people positive for HSV-1 without symptoms is that they probably will never transmit it to another person, as long as you avoid kissing and performing oral sex whenever they obvious cold sores. But the stress is on "probably"; there are no guarantees and in theory you could transmit the infection almost any time.
4) HSV vaccines: Don't hold your breath. I'm not familiar with the authors you cite, but a quick look on line indicates they do sophisticated virological work of the type that in theory could lead to a vaccine, but I see nothing to indicate an actual vaccine has been developed or is close to human research. I don't anticipate an effective HSV vaccine for at least 10 years, maybe never.
This response has taken a lot of energy, as I hope you appreciate -- and the forum really isn't an appropriate venue for sophisticated scientific discussion. I can take a brief follow-up comment or two, but for more detailed information you should plan on continuing your own research. In any case, I hope this helps.
Regards-- HHH, MD
awesome discussion - bookmarked it for future partners who worry too much about asymptomatic infection as well as odds of infection - thanks!
grace
grace
MEDICAL PROFESSIONAL
I have no comment and neither the time nor the interest to look at past threads. Most likely I just was trying to reassure the users in ways that would be most helpful to them. What is "quite a large discrepancy, in [your] mind" doesn't matter to most forum readers. Every response on this forum is meant to be read strictly in the context of the question asked. Please read my replies to your own questions, concentrate on them, understand them, believe them, and move on. I have neither the time nor the energy to debate them, or to work any harder than I have to convince you that you should forget herpes and move on with your life.
This thread is over.
This thread is over.
Thank you for taking the time to respond in detail.
I just have one final clarification. I don't mean to nit-pick; however, since HSV is lifelong & contagious, I'm sure the majority of potentially infected people want to be confident that, w/ a negative 3-4 month result, they will not infect others.
-In some posts, you list 6 months as a possibility for HSV II to become positive (http://www.medhelp.org/posts/STDs/HSV1-vs-HSV2/show/544216) but, in others, you state that it NEVER takes 6 months (http://www.medhelp.org/posts/STDs/Help-with-HSV/show/408005).
Please clarify the discrepancy? I don't mean to split hairs or question your expertise; it's just quite a large discrepancy, in my mind.
I'll leave you alone after this, I promise. Thank you again & best wishes to you.
I just have one final clarification. I don't mean to nit-pick; however, since HSV is lifelong & contagious, I'm sure the majority of potentially infected people want to be confident that, w/ a negative 3-4 month result, they will not infect others.
-In some posts, you list 6 months as a possibility for HSV II to become positive (http://www.medhelp.org/posts/STDs/HSV1-vs-HSV2/show/544216) but, in others, you state that it NEVER takes 6 months (http://www.medhelp.org/posts/STDs/Help-with-HSV/show/408005).
Please clarify the discrepancy? I don't mean to split hairs or question your expertise; it's just quite a large discrepancy, in my mind.
I'll leave you alone after this, I promise. Thank you again & best wishes to you.
MEDICAL PROFESSIONAL
Thanks Grace -- that's exactly my intent for these occasional detailed, blog-like replies. I have bookmarked it myself.
Hope all is well with you. Take care.
Hope all is well with you. Take care.
I greatly appreciate your detailed responses; I know your time is valuable. You are very kind.
I have read that one act of sexual intercourse w/ an HSV II + person is extremely low risk (although I have seen several posters who have acquired it after one time which leaves more uncertainty, in my mind).
Say one engages in 1-2x times of unprotected sexual intercourse w/ a person + for HSV II. With the absence of symptoms & this type of exposure, is a 12 week negative Herpeselect sufficient to place reassurance that infection was escaped close to 100% (even w/ prior infection w/ HSV I)?
My concern is that "the absence of symptoms" in women could simply be that the outbreaks are occurring on the cervix. Dr. Hook has maintained the stance (as read in countless posts) "if you do not develop lesions within 4-10 days of exposure you almost certainly did not become infected." What if the lesions simply cannot be seen and/or outbreaks cannot be felt? How does this uncertainty factor into the ultimate determination?
Again, thank you so much for your time.
I have read that one act of sexual intercourse w/ an HSV II + person is extremely low risk (although I have seen several posters who have acquired it after one time which leaves more uncertainty, in my mind).
Say one engages in 1-2x times of unprotected sexual intercourse w/ a person + for HSV II. With the absence of symptoms & this type of exposure, is a 12 week negative Herpeselect sufficient to place reassurance that infection was escaped close to 100% (even w/ prior infection w/ HSV I)?
My concern is that "the absence of symptoms" in women could simply be that the outbreaks are occurring on the cervix. Dr. Hook has maintained the stance (as read in countless posts) "if you do not develop lesions within 4-10 days of exposure you almost certainly did not become infected." What if the lesions simply cannot be seen and/or outbreaks cannot be felt? How does this uncertainty factor into the ultimate determination?
Again, thank you so much for your time.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
