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STDs (Expert Forum)
Transmission
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which 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.
Transmission
by anonymous409x, Oct 30, 2009 11:56AM
Hello Doctors, I have several questions I would really like to get your input on. Firstly, I am a male, I tested positive for HSV 2 approximately 18 months ago and I take valtrax only episodically. I am curious that if not taking valtrax to combat an outbreak would help your imuno reaction become more robust over time and thus if you are not concerned about spreading the virus letting outbreaks run their course would actually benefit your immune system over time?
Secondly, I hope to be entering into a relationship eventually and want to minimize the chance of spreading the virus. Aside from the once daily 500 mg of valtrax are there any other precautions available (aside from condoms)? What are your thoughts on the usefulness of taking L-Lysine as a daily supplement to combat HSV and reduce transmission? I’ve heard of creams you can put on your skin to reduce the likelyhood of STD transmission (effective for a few hours to days), are any such products coming to market that you know of? What are your thoughts on the likelihood of a vaccine becoming available in the next few years?
Would you agree that your chance of spreading the virus during the early years post contraction ( ~8 % annual chance male to female) decreases over time such that at year 5 or 10 it would be something less than an 8% annual chance? I have heard the number of outbreaks reduces with time, but what about likelihood of transmission?
Finally, my out breaks are very mild (in the form of a small red bump(s) on the abdomen within the pubic hair area) and occur 3 to 4 times a year. I never have lesions on the shaft, does this decrease likelihood of transmission? Between out breaks (and it may just be in my head) I do have periodic itching on the scrotum, inner thigh and pubic hair area. Anyway of determining if this indicates that I am actually shedding the virus, and in an amount sufficient to transmit?
Thank you in advance!
Secondly, I hope to be entering into a relationship eventually and want to minimize the chance of spreading the virus. Aside from the once daily 500 mg of valtrax are there any other precautions available (aside from condoms)? What are your thoughts on the usefulness of taking L-Lysine as a daily supplement to combat HSV and reduce transmission? I’ve heard of creams you can put on your skin to reduce the likelyhood of STD transmission (effective for a few hours to days), are any such products coming to market that you know of? What are your thoughts on the likelihood of a vaccine becoming available in the next few years?
Would you agree that your chance of spreading the virus during the early years post contraction ( ~8 % annual chance male to female) decreases over time such that at year 5 or 10 it would be something less than an 8% annual chance? I have heard the number of outbreaks reduces with time, but what about likelihood of transmission?
Finally, my out breaks are very mild (in the form of a small red bump(s) on the abdomen within the pubic hair area) and occur 3 to 4 times a year. I never have lesions on the shaft, does this decrease likelihood of transmission? Between out breaks (and it may just be in my head) I do have periodic itching on the scrotum, inner thigh and pubic hair area. Anyway of determining if this indicates that I am actually shedding the virus, and in an amount sufficient to transmit?
Thank you in advance!
Doctor's Answer
by H. Hunter Handsfield, M.D., Oct 30, 2009 12:27PM
, Oct 30, 2009 12:27PM
Welcome to the STD forum. Your questions are good ones, and you obviously are handling your herpes responsibly. Good show.
1. In genital HSV-2, over several years the frequency of overt outbreaks declines and many people eventually stop having outbreaks. There probably is also a reduction in frequency of asymptomatic shedding, but this is less well studied. It is a logical possibility that treatment might delay this natural resolution, by inhibiting the immune response to recurrent episodes. However, most experts do not believe it happens or that it has a minor effect at most. However, we simply don't know; there are no data. If it is an issue, it probably only applies to continuous suppressive therapy, not episodic.
2. The approaches to prevention are 3-fold, two of which you mention: suppressive therapy and condoms. The third is avoiding sex if and when there are symptomatic outbreaks. Lysine therapy is quackery; it has no effect on HSV recurrences or shedding. I have never heard of skin creams to prevent transmission of any STD; that also sounds bogus. Although there is research on vaccines to prevent catching HSV-2, none is on the horizon to prevent outbreaks or transmission.
3. You have done your research well. The risk of HSV-2 transmission is maximum in the first year after acquistion then declines. In monogamous heterosexual couples in which one person has HSV-2, who have unprotected sex an average of 2-3 times per week, transmission occurs in roughly 5% of coupes (1 in 20) per year. That means that even without condoms and Valtrex, with your longstanding infection, your partner might never get it.
4. Your symtoms almost certainly are not due to herpes. HSV simply doesn't cause the sort of itching you describe. (Itching is a symptom of herpes ONLY in that recurrent outbreaks sometimes itch; itching alone is not a sign of herpes.)
Some concluding comments: Your new partner might not be at especially high risk. She could be tested for HSV-2, then you'll know for sure. If she happens to be among the 20% of the population with undiagnosed HSV-2, then she won't catch it again and you'll have no worries at all. If her blood test is negative, then it would be wise for you to resume suppressive therapy with Valtrex, and of course avoid sex in event of an outbreak (but not a scrotal itch!).
Whether or not to also use condoms is perhaps the most difficult question. Many couples in your situation would decide to go with the Valtrex alone and not worry about it, knowing that treatment is available if transmission occurs. Others will want to take every possible means to prevent it. Whether that goal is worth foregoing the pleasures of unprotected sex is something only you and your partner can decide.
I hope this helps. Best wishes-- HHH, MD
1. In genital HSV-2, over several years the frequency of overt outbreaks declines and many people eventually stop having outbreaks. There probably is also a reduction in frequency of asymptomatic shedding, but this is less well studied. It is a logical possibility that treatment might delay this natural resolution, by inhibiting the immune response to recurrent episodes. However, most experts do not believe it happens or that it has a minor effect at most. However, we simply don't know; there are no data. If it is an issue, it probably only applies to continuous suppressive therapy, not episodic.
2. The approaches to prevention are 3-fold, two of which you mention: suppressive therapy and condoms. The third is avoiding sex if and when there are symptomatic outbreaks. Lysine therapy is quackery; it has no effect on HSV recurrences or shedding. I have never heard of skin creams to prevent transmission of any STD; that also sounds bogus. Although there is research on vaccines to prevent catching HSV-2, none is on the horizon to prevent outbreaks or transmission.
3. You have done your research well. The risk of HSV-2 transmission is maximum in the first year after acquistion then declines. In monogamous heterosexual couples in which one person has HSV-2, who have unprotected sex an average of 2-3 times per week, transmission occurs in roughly 5% of coupes (1 in 20) per year. That means that even without condoms and Valtrex, with your longstanding infection, your partner might never get it.
4. Your symtoms almost certainly are not due to herpes. HSV simply doesn't cause the sort of itching you describe. (Itching is a symptom of herpes ONLY in that recurrent outbreaks sometimes itch; itching alone is not a sign of herpes.)
Some concluding comments: Your new partner might not be at especially high risk. She could be tested for HSV-2, then you'll know for sure. If she happens to be among the 20% of the population with undiagnosed HSV-2, then she won't catch it again and you'll have no worries at all. If her blood test is negative, then it would be wise for you to resume suppressive therapy with Valtrex, and of course avoid sex in event of an outbreak (but not a scrotal itch!).
Whether or not to also use condoms is perhaps the most difficult question. Many couples in your situation would decide to go with the Valtrex alone and not worry about it, knowing that treatment is available if transmission occurs. Others will want to take every possible means to prevent it. Whether that goal is worth foregoing the pleasures of unprotected sex is something only you and your partner can decide.
I hope this helps. Best wishes-- HHH, MD
Post Comment
I forgot to comment on the location of your recurrent herpes. Although outbreaks can occur anywhere in the "boxer shorts" distribution, the pubic area and lower abndomen are quite unusual sites. Do you know for a fact that herpes in fact explains the outbreaks? If so, then each episode should occur in exactly the same spot, give or take an inch, and always on the same side of the body, never both sides. (Some experts say to lay a quarter over the usual site. Every outbreak will occur within the area covered by the quarter.) If you are having more scattered lesions, than folliculitis or some other superficial skin infection might be more likely than herpes.
In any case, if you itch where you have had your herpes outbreaks, obviously you should look for herpes lesions. If none are there, probably then herpes isn't the cause. Do not look for clues for times you are shedding the virus. Except for typical herpes outbreaks, there are none.
Finally, is there any health concern regarding the long-term use of valtrax for suppressive therapy?
Can you recommend references/resources (papers or publications for HSV) for new information? Most internet content is very generic and does not provide detail or insight; just the most conservative position.
Thank you for your responses, they have been very helpful.
You can trust the herpes information provided by CDC (www.cdc.gov/std), the American Social Health Association (www.ashastd.org), or the Westover Heights Clinic of Portland, OR (the clinic owned and run by Terri Warren, who moderates the MedHelp herpes forum: www.westoverheights.com). Any of these can be trusted to promptly update their websites if and when significant new information becomes available on herpes.
Thanks for the thanks. But that will have to end this thread. Take care.