Transmission during outbreak probability and other questions

[tiffanymar09]

Hello,
I wanted to ask a few questions regarding information I have read on here.

If one were taking Valtrex 1g for 6 months and had unprotected sex during a symptomatic breakout (2 very tiny ulcerations near the pubic hair region noticed afterwards) what would be the risk that the uninfected male would catch it from the infected female? This is GSHV 2.  Not sure if those skin areas touched between the two.  I have never experienced outbreaks  on the inner labia, opening, etc..I also have HSV1 which rarely recurs.

How often does GHSV recur? Can it recur within days between outbreaks or is it usually longer. Would one ulcer show, then days later another, etc..Its hard for me to tell when I have o/b because it is nothing like the HSV outbreaks I have on my face at all.

I have read different things on here regarding the transmission rates and wanted some clarification. Is it:
1/1000 risk per act if a lesion IS present (I have seen a few different things on here where its 1/1000 WITH a lesion and 1/1000 without  a lseion..just clarifying )
-Is that risk lowered if the infected partner has been taking Valtrex?

I was curious where those statistics/numbers come from as well-just like to read.

Thanks!

[Edward W Hook, MD]

Our time/space for answering questions is limited. This will need to be the final answer to this thread.

Your interpretation is correct.  If he becomes infected you may not know BUT, the important fact is that this further reduces that already low risk for infection by half.  When this is combined with other measures such as avoiding sex when you have outbreaks, his risk for infection is low.

Yes, in all probability and while it was not studied, your risk of infecting him is lower becasue you are takng 1000 rather than 500 mg.

Finally, should you have an outbreak while on valtrex it should be briefer and have less virus present than if your were not taking the medication.  

Take care.  EWH

[tiffanymar09]

Thank you! I do have another question:

From reading the Valtrex study, it seems as though since I am on Valtrex, he has a 75% reduced risk of getting symptomatic infection IF he becomes infected, and a 50% reduced risk of asymptomatic infection. Is that being interpreted correctly?  I am on 1000mg-possibly even a better chance? So most likely if he IS to become infected we won't know?

Is my viral load/shedding during an OB going to be lower because I am on the Valtrex?

Im trying to stay positive that he is going to be ok! This is really stressful :(

[Edward W Hook, MD]

Many questions and limited time/space.  Brief answers will follow.

1.  **With this comment are you saying recurrences are rare, OR, transmission during an outbreak while on Valtrex is rare?**

I gave you the figure for recurrences above- average 3 per year.  I also provided data on transmission frequency following exposure-it is rather rare.

2. "  I know the studies show that people who take the meds and avoid having sex during outbreaks have low rates of transmission-but would it be feasible that they had sex at times they didn't know of outbreaks occurring?"

You are correct that some transmission occurs because some people mis-identify their outbreaks as something other than HSV.  Nonetheless, transmission following lesion exposure is low.

3. "Also, what % of people have the full blown GH outbreak? I am assuming not many since most people don't know they have it. "

You keep asking different versions of the same question.  It is hard to know how many people mis-identify outbreaks and how many do not have them but have become infected.  We do know that mis-identification will be common.  that however should not be the case your you - you know you have the infection and know what your outbreaks tend to be like.

4. "Is it positive that the ulcers were tiny and way up high? I am not sure he even came in contact with them. The last thing-is that how do you know what IS and what ISNT a part of GHV? I find myself looking at anything. Would a nick looking thing the size of a pinhead (or smaller) be herpetic? "

these are "what if" questions that cannot be answered. As I said above, if you have had outbreaks in the past and recognized them, you will be likely to see them if and when recurrences occur.

Time for this to end.  You may as A FEW final follow-up questions but again, answers will be limited.  EWH

[tiffanymar09]

Thank you, this is definitely helpful!

There are no data from these studies as to how likely it is for transmission to occur if a recurrence has occurred while on suppressive therapy (they are rare).   **With this comment are you saying recurrences are rare, OR, transmission during an outbreak while on Valtrex is rare?**


In thinking "out of the box too" I know a lot of people have atypical outbreaks and probably are having sex (while on Valtrex) while they have outbreaks and just don't realize they are having one. Is this a likely contributing thing to the 1:1000 exposures risk?  I know the studies show that people who take the meds and avoid having sex during outbreaks have low rates of transmission-but would it be feasible that they had sex at times they didn't know of outbreaks occuring?

Also, what % of people have the full blown GH outbreak? I am assuming not many since most people don't know they have it.

Is it positive that the ulcers were tiny and way up high? I am not sure he even came in contact with them. The last thing-is that how do you know what IS and what ISNT a part of GHV? I find myself looking at anything. Would a nick looking thing the size of a pinhead (or smaller) be herpetic?

I am sorry for all the questions. I am so afraid of infecting my partner-the anxiety over this may be too much. I have been a mess since I noticed those little ulcerations this morning and worried he will catch it. :(

[Edward W Hook, MD]

Welcome to the Forum.  I will try to address your questions although some of the questions you ask do not have scientific data to base an answer on and thus will be answered based on expert opinion which I have generated through both years of experience, reading (and writing) the scientific literature on the subject and discussions with other experts.  

We estimate that the risk for infection if one is exposed to a partner with a herpetic lesion is about 1 infection per 1000 estimates and that in the absence of a lesion, the risk is lower, about 1 in 10,000 exposures.  These are estimates.

Scientific studies show that the use of regular use of valacyclovir for suppression of HSV reduces the risk of transmission by at least half.  There are no data from these studies as to how likely it is for transmission to occur if a recurrence has occurred while on suppressive therapy (they are rare).

In addition to suppressive valacyclovir therapy, the risk for transmission can also be reduced, in an additive fashion by correct and consistent condom use.  

Finally, regarding recurrence rates, studies show that following acquisition of infection, persons with HSV-2 have an average of slightly more than 3 recurrences per year and that the rate of recurrence tends to decline slowly, over a period of years.  Of course for any one person the frequency of recurrence can be quite variable with some persons never having recurrences (rather uncommon- less than 10% of persons who acquire HSV) and some have more than the average 3 recurrences per year.

I hope this information is helpful to you.  EWH