The risk and prevention of HSV-1 asymptomatic shedding.

[gammonwalker]

I have some questions about my genital HSV-1 that was diagnosed a month ago! While some of them may not be able to be directly answered, could you give your best possible approximation? Thank you very much!

I am taking: Valtrex (500mg, once daily), Vitamin-C (620mg with bioflavonoids), L-Lysine (1000mg), and Zinc (50mg). The only noticeable outbreak has been along my upper-inner left thigh, slightly upon the scrotum.

1.) To what effect will these supplements would aid in inhibiting herpes: unnoticeable to extreme?

2.) Since I have genital HSV-1 is that the area of highest transfer risk? Should I be worried about asymptomatically transferring it through my mouth though I’ve never have any major outbreaks there?

3.) Is asymptomatic shedding a threat to any location on the body despite never having had a major outbreak there?

4.) Are there any methods of “washing off” shedding viral cells before a sexual encounter? Would a custom zinc based mouth-wash be effective in killing some of the cells?

5.) Before a sexual encounter if I were to take an additional dosage of Valtrex, what would be the most beneficial time frame to further inhibit transfer? A day or so? How much would be effective?

6.) Would you happen to have an accurate % of Valtrex’s reductive effects on transfer, symptomatic and asymptomatic? I’ve read that it inhibits transfer around 50%, but have seen a 95% reduction figure on Acyclovir, despite the fact they seem to be the same thing.

7.) A month ago, once I acquired genital HSV-1, I had flu symptoms. However, I recall having cold sore when I was much younger, leading me to believe I had herpes before this. Does the shift in location cause a recurrence of those flu symptoms? I was extremely stressed before the outbreak as well, did this just trigger an unusual emergence of the herpes and I’m at the same risk I was previously?

[Terri Warren, RN, Adult Nurse Practitioner]

There is no evidence that the supplements will do anything at all, but the VAltrex will certain reduce both outbreaks and viral shedding.

If you are only infected genitally, then you can only transmit from the genital area.  You say you've never had any major outbreaks orally?  If you have ANY outbreaks orally, then it means you are orally infected and can transmit to others via your mouth.

No, you can't shed from areas where you are not infected.

to number 4, no and no.

We don't really know the answer to that.  If you are taking Valtrex daily, then that is as much as you can do to reduce the shedding medically.  I would take the medicine around dinner time, I think.  Increasing the dose to 1000 mg per day may or may not help, we don't have that data for HSV 1 transmission.

The only study on transmission and herpes antiviral therapy found that it reduces transmission by 48%.  The author is Corey, 2004.  I am also an author on that paper.

How exactly were you diagnosed with genital HSV 1?  I swab test from a genital lesion?

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

I honestly don't see any reason to go to an ID clinic.  No need to retest, and no, no testing needed from the mouth without a specific symptom.  But if you do have a symptom in the mouth, then I would definitely recommend that you get that swab tested at the very first symptom presentation.  There isn't really any way, at this point, to know how long you've been infected.  By now, you likely have antibody even if you were infected just a few weeks before the swab test was done.

Terri

[gammonwalker]

Thanks for the help! Yep, I was diagnosed exactly like that! I am going to an infectious disease clinic soon. What would you recommend I do while I am there? Should I get retested for my mouth as well? I never had an IgG done as well. I'm pretty interested in knowing approximately when I was infected.