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Effect of suppression on HSV2 longevity
Happy Mother’s Day to your family,
Because of the pretty tight word limits, I’m going to get right into the questions without providing my specific background.
1) Does starting Valtrex daily from the initial HSV2 infection interfere with the virus eventually burning itself out (at least in terms of regular outbreaks) years down the road?
2) Is the IGG EIA test a reliable one? I haven’t seen the EIA reference before on the site, only ELISA. What’s the difference?
3) I’ve read on this site that hand-genital/mutual masturbation is very low risk. Does this include if a HSV 2 positive person touches their penis, for example, when asymptomatically shedding, and then (within a few minutes or less) rubs their partner’s genitals quite rigorously? Could you quantify this type of risk? How low is low?
4) I also read that the first outbreak is almost always on the genitals. Are there exceptions (for example, both leg and penis)? If so, how do often do they happen? Could you also quantify this?
5) If someone is accidentally inoculated with HSV2 on the leg, for example, through genital rubbing on this area (in the absence of intercourse or genital to genital rubbing), does this mean that the genitals could in the future be affected (through the virus traveling through the nerves to the genitalia).
6) Could one expect to have fewer recurrences in the case of #5 than if someone had genital HSV2?
Thank you
Because of the pretty tight word limits, I’m going to get right into the questions without providing my specific background.
1) Does starting Valtrex daily from the initial HSV2 infection interfere with the virus eventually burning itself out (at least in terms of regular outbreaks) years down the road?
2) Is the IGG EIA test a reliable one? I haven’t seen the EIA reference before on the site, only ELISA. What’s the difference?
3) I’ve read on this site that hand-genital/mutual masturbation is very low risk. Does this include if a HSV 2 positive person touches their penis, for example, when asymptomatically shedding, and then (within a few minutes or less) rubs their partner’s genitals quite rigorously? Could you quantify this type of risk? How low is low?
4) I also read that the first outbreak is almost always on the genitals. Are there exceptions (for example, both leg and penis)? If so, how do often do they happen? Could you also quantify this?
5) If someone is accidentally inoculated with HSV2 on the leg, for example, through genital rubbing on this area (in the absence of intercourse or genital to genital rubbing), does this mean that the genitals could in the future be affected (through the virus traveling through the nerves to the genitalia).
6) Could one expect to have fewer recurrences in the case of #5 than if someone had genital HSV2?
Thank you
MEDICAL PROFESSIONAL
I doubt your thigh rash was HSV and that opinion likely would not change with a positive HSV-1 result.
No more until/unless you report your test results.
No more until/unless you report your test results.
Wow, thanks, yes, you are right, so right: it's what I needed to hear. A blood test doesn't alter reality, merely confirms it. It is what it is, irrespective of blood work. Hence, I'll make my appointment tomorrow.
One last question I hope you'll answer before I post the results: If I test positive for type 1, should I assume the leg rash was a result of it? I've never had oral cold sores and so could have been vulnerable to HSV1 through his very vigorous licking of my legs.
That's all from me until I get the results. Thanks for your encouragement.
One last question I hope you'll answer before I post the results: If I test positive for type 1, should I assume the leg rash was a result of it? I've never had oral cold sores and so could have been vulnerable to HSV1 through his very vigorous licking of my legs.
That's all from me until I get the results. Thanks for your encouragement.
MEDICAL PROFESSIONAL
This doesn't sound like herpes, and your exposure isn't one likely to have transmitted HSV even if your partner had an active infection at the time. Given the level of anxiety that I think I discern in your questions, $130 to sort out whether or not you have HSV of either type seems to me like a reasonable investment.
In any case, I have no patience with people who decline to test for fear of the result. It isn't the test that gives someone herpes (or syphilis or HIV or whatever the concern might be). And no matter how stressed you are now, can it possibly be worse than not pursuing a new romantic relationship for fear of transmission? Or worse than going ahead anyway and finding out later you transmitted herpes to your new love, when it could have been prevented? Uncertainty usually causes more anxiety than the bad news that might result; most people concerned about test results find their anxieties are reduced, not elevated, after the test result -- even when the result is positive. (And in your case, probably it will be negative anyway.)
That's the last I'll have to say until and unless you decide to get tested and would like to post the result. Just do it.
In any case, I have no patience with people who decline to test for fear of the result. It isn't the test that gives someone herpes (or syphilis or HIV or whatever the concern might be). And no matter how stressed you are now, can it possibly be worse than not pursuing a new romantic relationship for fear of transmission? Or worse than going ahead anyway and finding out later you transmitted herpes to your new love, when it could have been prevented? Uncertainty usually causes more anxiety than the bad news that might result; most people concerned about test results find their anxieties are reduced, not elevated, after the test result -- even when the result is positive. (And in your case, probably it will be negative anyway.)
That's the last I'll have to say until and unless you decide to get tested and would like to post the result. Just do it.
Thank you for your prompt response.The reason I ask all these questions is connected to a very questionable exposure around six months ago.
Hooked up with a guy of unknown status (although I do know, from your site, that at least 50% of gay men are HSV2 positive, maybe even more). We kissed a little bit, I stripped down to my underwear and he stripped down to nothing. He touched my penis, I touched his. Our hands may have double dipped. Can’t remember. Let’s assume so. But not in a very deliberate or prolonged way. No penetrative sex, no oral sex. However, he did grind his penis into my legs (stimulated dry humping but with the leg) and licked my legs quite vigorously. His only contact with my penis was with his hand. I didn’t notice any lesions on his penis but it was darkish. There were no lesions on his hand.
About a week later I developed a rash on my left upper leg, the outer part. It looked like four or five insect bites. No blistering. It did ulcerate a bit and then healed a week later, leaving a brownish scar. A week after the rash, I developed terrible pain in the groin, lasting a week or so. No rash in the penis at any time, though. Two weeks after this I developed a terrible flu, lasting around three or four days. I can’t help but wonder if all of this suggests what you refer to as a “stuttering effect” characteristic of the initial infection.
I went to a clinic a few days after the rash developed and saw two different doctors (not STD specialists). Both didn’t know what could be but were not highly suspicious that it was herpetic. I even went to a STD clinic. The nurse thought it looked like bed bug bites. I know they are not, though. She, too, didn’t know what it was. She advised me to return later if the rash returns. She also suggested I do some research on your site and follow up with an EIA IGG test in 12 weeks if I was still concern about it (at a cost of $130—it’s not free here in Vancouver, BC.).
It’s now been six months and no symptoms have returned. I’ve recently started dating a girl and have been holding off on sex out of a strong concern about putting her health in jeopardy. At the same time, I’m really scared to actually have the blood test and possibly find out I’m positive for the virus. I’ve never actually had penetrative sex so how would I explain this to her. The moral/ethical dilemma is absolutely killing me. Does this additional information help out at all?
Hooked up with a guy of unknown status (although I do know, from your site, that at least 50% of gay men are HSV2 positive, maybe even more). We kissed a little bit, I stripped down to my underwear and he stripped down to nothing. He touched my penis, I touched his. Our hands may have double dipped. Can’t remember. Let’s assume so. But not in a very deliberate or prolonged way. No penetrative sex, no oral sex. However, he did grind his penis into my legs (stimulated dry humping but with the leg) and licked my legs quite vigorously. His only contact with my penis was with his hand. I didn’t notice any lesions on his penis but it was darkish. There were no lesions on his hand.
About a week later I developed a rash on my left upper leg, the outer part. It looked like four or five insect bites. No blistering. It did ulcerate a bit and then healed a week later, leaving a brownish scar. A week after the rash, I developed terrible pain in the groin, lasting a week or so. No rash in the penis at any time, though. Two weeks after this I developed a terrible flu, lasting around three or four days. I can’t help but wonder if all of this suggests what you refer to as a “stuttering effect” characteristic of the initial infection.
I went to a clinic a few days after the rash developed and saw two different doctors (not STD specialists). Both didn’t know what could be but were not highly suspicious that it was herpetic. I even went to a STD clinic. The nurse thought it looked like bed bug bites. I know they are not, though. She, too, didn’t know what it was. She advised me to return later if the rash returns. She also suggested I do some research on your site and follow up with an EIA IGG test in 12 weeks if I was still concern about it (at a cost of $130—it’s not free here in Vancouver, BC.).
It’s now been six months and no symptoms have returned. I’ve recently started dating a girl and have been holding off on sex out of a strong concern about putting her health in jeopardy. At the same time, I’m really scared to actually have the blood test and possibly find out I’m positive for the virus. I’ve never actually had penetrative sex so how would I explain this to her. The moral/ethical dilemma is absolutely killing me. Does this additional information help out at all?
MEDICAL PROFESSIONAL
Sorry, minor typo in no. 2 above: ELISA = enzyme-linked immunosorbent assay.
MEDICAL PROFESSIONAL
Welcome to the STD forum. These are good questions, and it is apparent you have done some homework by reading the forum quite a bit before asking them. Thanks. They have been asked and answered before, but some repetition never hurts.
1) The three antiherpes drugs -- valacyclovir (Valtrex), acyclovir (Zovirax and generics), and famiciclovir (Famvir) -- probably can delay development of a positive blood test in people newly infected with HSV-2. This is one reason that I generally advise patients with new genital herpes to not start suppressive therapy right away, but to use only episodic treatment for outbreaks for the first few months. Then the patient can observe and understand the recurrence pattern, unimpeded by the effect of treatment; and the blood test is potentially more useful sooner if the diagnosis is uncertain, for example if culture or PCR isn't done or is negative.
I understand your question is a little different, though. It is theoretically possible that long-term suppressive antiviral therapy could actually prolong the period of symptomatic herpes outbreaks. In other words, it could be that someone who takes Valtrex for, say, 5 years, might continue to have outbreaks another 5 years after stopping the drug; but that recurrences would have stopped earlier without treatment. This isn't proved, but it's another reason to use suppressive treatment only for very good reasons: to protect an uninfected partner from transmission and to control symptomatic outbreaks if they are fairly frequent and severe.
Note that I'm speaking here only of symptomatic outbreaks. Asymptomatic shedding of the virus probably continues indefinitely in people with HSV-2, i.e. for life. It is unlikely that antiviral therapy makes any difference in this. In other words, when it comes to asymptomatic viral shedding, HSV-2 never "burns itself out".
2) EIA = enzyme immunoassay. ELISA = enzyme-linked immunoassay. In other words, ELISA is a type of EIA. (All ELISAs are EIAs, but not all EIAs are ELISAs.) But the abbreviations are often used interchangeably, and for HSV testing they are the same thing.
3) Nobody can put a number to the exceedingly low risk of the scenario you describe. Could it be possible that such contact could result in transmission? Maybe. All I can say is that in 30+ years in the STD business, in a clinic that sees around 15,000 patient visits every year, I have never seen or heard of a patient with genital herpes who had not had insertive intercourse. See the reply to no. 4 as well.
4) HSV probably doesn't infect people by merely coming into contact with the genital skin. Usually it has to be massaged into the exposed tissues. And generally it takes lots of virus for infection to "take". For these reasons, the initial herpes outbreak is usually limited to those body parts that receive the maximum friction during sex: the penis head and shaft in men, the vaginal opening and labia minor in women, the anus in people who have had anal sex with an infected male partner. There undoubtedly are exceptions, but they are uncommon.
5) If an initial infection really occurred on a leg, I would not expect that person to ever have genital outbreaks. It could happen, but unlikely.
6) I have no way of predicting whether someone with a non-genital initial HSV-2 infection would have any different outbreak frequency.
While I understand and appreciate your desire to ask a relatively succinct question, my replies might have been more helpful if you had given at least a brief description of your situation. Do you have confirmed genital herpes? Due to HSV-2? Based on what evidence or tests?
Regards-- HHH, MD
1) The three antiherpes drugs -- valacyclovir (Valtrex), acyclovir (Zovirax and generics), and famiciclovir (Famvir) -- probably can delay development of a positive blood test in people newly infected with HSV-2. This is one reason that I generally advise patients with new genital herpes to not start suppressive therapy right away, but to use only episodic treatment for outbreaks for the first few months. Then the patient can observe and understand the recurrence pattern, unimpeded by the effect of treatment; and the blood test is potentially more useful sooner if the diagnosis is uncertain, for example if culture or PCR isn't done or is negative.
I understand your question is a little different, though. It is theoretically possible that long-term suppressive antiviral therapy could actually prolong the period of symptomatic herpes outbreaks. In other words, it could be that someone who takes Valtrex for, say, 5 years, might continue to have outbreaks another 5 years after stopping the drug; but that recurrences would have stopped earlier without treatment. This isn't proved, but it's another reason to use suppressive treatment only for very good reasons: to protect an uninfected partner from transmission and to control symptomatic outbreaks if they are fairly frequent and severe.
Note that I'm speaking here only of symptomatic outbreaks. Asymptomatic shedding of the virus probably continues indefinitely in people with HSV-2, i.e. for life. It is unlikely that antiviral therapy makes any difference in this. In other words, when it comes to asymptomatic viral shedding, HSV-2 never "burns itself out".
2) EIA = enzyme immunoassay. ELISA = enzyme-linked immunoassay. In other words, ELISA is a type of EIA. (All ELISAs are EIAs, but not all EIAs are ELISAs.) But the abbreviations are often used interchangeably, and for HSV testing they are the same thing.
3) Nobody can put a number to the exceedingly low risk of the scenario you describe. Could it be possible that such contact could result in transmission? Maybe. All I can say is that in 30+ years in the STD business, in a clinic that sees around 15,000 patient visits every year, I have never seen or heard of a patient with genital herpes who had not had insertive intercourse. See the reply to no. 4 as well.
4) HSV probably doesn't infect people by merely coming into contact with the genital skin. Usually it has to be massaged into the exposed tissues. And generally it takes lots of virus for infection to "take". For these reasons, the initial herpes outbreak is usually limited to those body parts that receive the maximum friction during sex: the penis head and shaft in men, the vaginal opening and labia minor in women, the anus in people who have had anal sex with an infected male partner. There undoubtedly are exceptions, but they are uncommon.
5) If an initial infection really occurred on a leg, I would not expect that person to ever have genital outbreaks. It could happen, but unlikely.
6) I have no way of predicting whether someone with a non-genital initial HSV-2 infection would have any different outbreak frequency.
While I understand and appreciate your desire to ask a relatively succinct question, my replies might have been more helpful if you had given at least a brief description of your situation. Do you have confirmed genital herpes? Due to HSV-2? Based on what evidence or tests?
Regards-- HHH, MD
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.
