STDs Expert Forum
asymptomatic 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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asymptomatic shedding

i'm a female with genital herpes for the past 15 years. i have never given the virus to a partner. i was in a 4-year relationship with my last boyfriend. we had normal, unprotected sex, but were very careful about avoiding sex during outbreaks and prodrome, and he never caught it. (i myself got the virus from an ex-boyfriend who had an active sore at the time of transmission, but had unprotected sex with him for two years prior to that and was fine during that time.)

i recently dated a man for a couple of months. we hit it off instantly and really liked each other. i told him i had herpes and at first he seemed okay with it. i told him i was very careful: i avoid sex during OBs and am on anti-viral therapy. we had sex 3 times with a condom, and then he started to worry. i believe he spoke to friends who told him he could catch herpes from skin on skin contact, even when using a condom. it completely freaked him out. the last couple of times we were together, it was pretty much dry humping with underwear on, and that even worried him as he thought he could get the virus from the sweat on my thighs. he would not touch my genital area with any part of his body, including hands, and certainly not mouth. he admits that he's overreacting but the fear of acquiring herpes is too much for him. he really likes me and has struggled with this, but we agreed to break it off a few days ago because it was not a healthy way to go thru a relationship.

during this ordeal, i tried to be reassuring by telling him that herpes can be pretty manageable in a relationship if we're careful and honest with each other. i am fairly certain that i could avoid passing it on to him, but i hesitate to say things like "don't worry about touching me there" or "it's okay to go down on me now" because i feel that all the information on the internet and from his friends would contradict this and i would be seen as unreliable. i don't know how to approach this and be reassuring with a potential next partner.

my questions:

given my years of experience with the virus and and the precautions i take -- avoiding sex during OBs, anti-viral therapy, and most likely consistent condom use (though if i ever hope to procreate, i hope to find someone who can forego the condom for a few sessions:) --

-  is it fair for me to tell a partner that the chance of him getting herpes from me is extremely low if we're careful?

- when i'm not having an outbreak, is it fair to tell someone that it's okay to touch my genital (hands or mouth) without worry.

and, just curious:

- how did researchers come to find out about asymptomatic shedding. did they actually test patients for a year to see if they shed in the absence of symptoms? (were these people who had recently acquired the virus or all types?) or did they rely on testimonials from people who did not know how they got the virus? and in regards to my situation, how much shedding would i be doing after 15 years with the virus?

thanks.
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You are a wonderful testament to a responsible approach to genital herpes and its prevention, and to the ability of careful couples to avoid transmission with some common sense precautions.  Congratulations.  The challenge is to bring your partner to the same level of understanding.  It sounds like he is frightened enough that it will be hard for you to successfully do it alone.  The best approach by far would be personal counseling of him (or better, both of you as a couple) by a herpes-knowledgeable provider.  You could call the American Social Health Association (www.ashastd.org) for direct advice, or for help in finding a suitable provider in your area.

Also, it would be good for your partner to be tested for HSV-2.  There is at least a 25% chance he already is infected, from some prior partner--since a quarter of the population has asymptomatic HSV-2 infection.  In that case, he cannot be reinfected and you need take no precautions in your sexual practices.  Also, he should try to understand that having herpes isn't such a big deal; not desirable, but something people live with, without difficulty--your own experience being a good case in point.

To answer your questions:  Yes.  In herpes-discordant couples who have sex 2-3 times per week and avoid sex during symptoms, only about 5% of the uninfected persons acquire HSV-2 each year.  So the risk obviously is very low for any particular sexual event.  And for you, the risk might be even lower (see my answer below about being infected 15 years).  You could reduce the risk still further if you want to take antiviral therapy to suppress shedding; and condoms indeed reduce the risk as well.  Oral-genital contact also is quite safe in the absence of outbreaks; and nobody has ever been known to catch herpes by hand-genital contact.

In  asymptomatic shedding research, the subjects self-collect samples (e.g., from the vagina, vulva, and anus) once a day for several weeks at a time, and the sample are tested for HSV.  The early studies used culture, but recent ones use PCR, which is more sensitive (picks up more positives).

Asymptomatic shedding hasn't been well studied in people infected more than 10 years.  Symptomatic outbreaks become progressively uncommmon after 8-10 years, and many people stop having known episodes.  Most likely asymptomatic shedding also declines, and the odds are good that you don't have it frequently.  But unfortunately there are no data to predict the likelihood in any particular infected person.

I hope this helps.  Best wishes--  HHH, MD
4 Comments
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Avatar_n_tn
Your approach to this is commendable.  Unfortunately, your partner's reaction was typical, just read the hundreds of posts below.  We have got to somehow educate the public on herpes management and having sexual relationships when one partner is infected and the other isn't.  However, I think your initial assessment is valid in that I think it is fair to say, "It's OK to touch me now", etc.  You know your body and you probably know when an outbreak is likely to occur even before it does.  It will be interesting to see what Doc H and monkeyflower have to say.  And I'm sorry about your ex, that's just sad.
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Avatar_m_tn
Can the viral load be measured via PCR?

If so, has the viral load been measured against the viral
load present during an outbreak?

Also one would assume the viral load would increase day by day during periods of shedding until it peaked and then drop off in the case no outbreak occurred or peak during an outbreak??

Has this ever been studied?
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239123_tn?1267651214
The concept of viral load doesn't translate to a lesion specimen.  In blood, for HIV, you can count the number of RNA copies (viruses) in a given volume of blood.  For a swab specimen from a lesion, there are too many variables (e.g., how vigorously the lesion was rubbed or scraped) to make measurements meaningful, so PCR results, like culture, are generally interpeted merely as positive or negative, nothing more.  There are some exceptions for research purposes, but not for patient counseling.

HHH, MD
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