Antiviral Assisted Innoculation to Genital Herpes

[Curious331]

Recently I have been asking virologists if intentionally inoculating someone with HSV in the skin of their arm while on antivirals (and immune stimulants if necessary) could prevent genital herpes and provide immunity without consequence.  

The gist of their responses is that it could work.   Well, we need to know!

The only way to know is to expose one partner to the virus on their arm, for example,  while on an antiviral, and see if immunity is created without any side effects.  

I can imagine a man doing such a thing to avoid the use of condoms.  

I can also imagine a women doing such a thing to avoid genital herpes from her husband and the dangers of transmission to a newborn.  

The other way to do this is for many people to take an antiviral whenever they have unprotected sex with an unknown partner and track to see if their rate of infection is close to zero.  "The morning after pill idea"

I don't see the medical profession doing a study on this anytime soon but these ideas need to be explored and the 86 million people with herpes might be able to think this through en mass or even do a study.

[auntiejessi]

I never had a psychological fear when I was with my ex.  No one wants herpes, but if you are educated about it, and know the risks, and how to help prevent it, there is no real fear.  If there is, then that isn't the right person for you.  

There were so many other things about my partner that were bigger than herpes, and I was willing to take the chance.  We ended up not working, but if I had not been with him because of herpes, I would have missed out on one of the great loves of my life, and I don't regret the herpes at all.  He brought a lot to my life that made it better, and in some ways, makes it better today.

Aj

[Curious331]

Maybe I am gloomy but rightfully so...  I do like to solve puzzles and right now that puzzle is to safely create immunity or latency in a non genital location.   I wish I could better comprehend why you say it is not that big a deal for a negative women with an infected male.   It would seem that every time she has intercourse with him there is a psychological fear.   I think a nongenital inoculation of HSV while on Valtrex plus immune stimulation and other measures to arrest the ability of the virus to get into the peripheral nerve endings needs to be tested for safety and efficacy using the virus of the infected male. I now call this the lamb tied to a nongenital tree idea.  Strategically put the virus out there and let the immune system learn to kill it.    It has not been done before.  

[auntiejessi]

Its not cumulative.  Also, and I should have mentioned this, the fact that someone knows about it also reduces the chances of infection since they know when to avoid sex.

I'm not sure why you are invested in this for your buddy.  Its up to him and his new friend to make these decisions and figure out what will work best for them.  Its not up to you - its up to them.

Make sure when you are talking to your buddy that you are encouraging, because here you sound very gloomy about it.  That's not going to help him feel better about talking to his woman, ya know?

I don't know how else to say it - its just NOT that big of a deal.  As it stands right now, 1 in 4 have genital herpes type 2, so at some point, statistically, you will be exposed.  30-50% of all new genital herpes infections are type 1, a result of someone with it orally giving it to someone genitally from oral sex.

I see your point - I really do, and you aren't the first one who has come up with this idea.  There are just too many variables to factor in to guarantee a good outcome.

Aj

[Curious331]

According to your odds,  a 5% risk means 50% will be infected in 13 years.  A 10% risk means 50% will be infected in 7 years.   That is too high.   If I were the female I would resign myself to the fact that I will get HSV within 7-13 years with a 50:50 chance.  And that would be in my genital area.   If it were me, I would roll up my sleeve and put the infection in my arm while on valtrex and an immune booster and interferon if it made sense.   Now my HSV is where I choose it to be and the amount of infection my body is probably 5% of what it would have been.   I am latent with low chance of relapse... This is my impression.

[auntiejessi]

I appreciate your concern, but there are easier ways to go about this.  First, he can take antivirals daily, which will reduce the chances of transmitting it.

For a positive male with a negative female partner, in a long term, monogamous relationship, the transmission rates are, for the course of a year:

~ just avoiding sex during symptoms - 8-10%

~ using daily suppression OR using condoms each time - 4-5%

~ using suppression AND condoms - 2-3%

So that's a 90-98% chance, each year, that the female will NOT get it.  

He should also make sure he has type 2.  If he hasn't had a culture that was typed, he can get a type specific IgG blood test and find out what type he has.

He should also read these -

http://www.medhelp.org/health_pages/STDs/What-you-need-to-know-about-genital-herpes-but-were-maybe-afraid-to-ask/show/361?cid=84

http://www.medhelp.org/user_journals/show/15788?personal_page_id=2329

www.westoverheights.com - herpes handbook

Aj

[Curious331]

thank you for your reply.   Let me try again because I have failed to be clear.   When you did not have herpes you had a former partner who did.  That is the situation my friend is in.  He has herpes and his significant other does not.  I want to protect her and try to get this herpes thing off the table by creating immunity in her so she does not get a full blown infection some day.   In your case you contracted the virus and had problems and as I recall you have outbreaks that are painful.  I am speculating that if we turned back the hands of time and tried to immunize you before contracting the virus we could have done it with a nongenital location, antivirals, and maybe a short course of interferon to "interfere" with the virus's ability to infect cells.  Maybe we would get lucky and this cocktail would have given you immunity without any latency.  No one seems to know if this would be a better situation than getting the virus the old fashion way.  I would think and hope it would allow for a far better situation.      

I would really appreciate any words of wisdom for my friend when he has to break the news to his significant other about having HSV...

[auntiejessi]

Well, I've had herpetic meningitis, and I might have had that if I got it in my arm.

And really - herpes isn't bad enough for me to take interferon for.  That's serious stuff.  I'll stick with my daily acyclovir, which keeps me mostly outbreak free.

I wasn't stuck with frustration with my former partner, who I knew had herpes.  It wasn't an issue for us, before or after I got it, and we ended the relationship for reasons that had nothing to do with herpes.  I think you are overestimating the burden this carries.  

I haven't ever been turned down by a man since, and it hasn't affected my sex life at all.

Aj

[Curious331]

You got herpes from a man and that is the problem I am trying to solve.  The best I could "offer you" in theory, is interferon, an evaluation of your immune system before hand, optimization of your immune system, antivirals and the effort to expose non genital skin to the virus.  My hope is that this cocktail will allow immunity without allowing the virus to enter your DNA or limit the # of neurons exposed.   As for risks,  I think the answer is in the rarity of serious complications.   Wouldn't you rather have outbreaks on your arm?  I think you are overstating the risk of PHN, encephalitis, and herpetic meningitis.  Ethics are resolved in the informed consent.   You were infected.  The virus reached your sensory ganglion and started replicating causing more infection until a balance of power was reached between your immune system and the virus.   If you had "my" treatment, you would have had, at worst, in theory, a fewer # of neurons infected and thus "less" burden on your immune system to contain your the virus.  At best you would be immune.  If that man were your husband (which is the market I am focused on...) then that would be a better outcome then one day getting a full blown infection.  I am trying to solve the problem of immunizing people like you who are in relationship with infected males with whom you are in a long term relationship.  That is my motivation.   That female (and male) are stuck with a chronic frustration and I want to find a solution to that, in this lifetime.

[Curious331]

Thank you for your super response. I completely agree that the problem with developing a vaccine is that the virus has a fascinating intracellular phase. That virus has to make its way to the sensory ganglia. It has to adhere to the surface of the cell, enter the cells of the sensory ganglia and then inject its DNA into the nucleus. What I do not understand is what happens upon injection of the DNA into the nucleus of the cell. I know that the DNA creates alpha, beta and, proteins which allow it to replicate itself. But, does the DNA simply float around the nucleus or do something unique have to happen for the DNA to become part of our DNA? The key to the vaccination has to be to keep the virus outside of the cell so that humoral, cell mediated responses, natural killer cells, and everything else can do their work to study the invader so as to develop immunity. One question I had was whether pretreatment with interferon can somehow alert the body in some way such that it will not permit the herpes virus to even enter the cells in the first place. But, still, if they do, maybe there is a backup opportunity to stop the viral DNA from becoming part of the cell's DNA. Perhaps that is where an antiviral might have some value. I do not know. I do not think anybody knows. The studies have not been done. That is what I am gathering from the virus experts. I am not so sure we need to do in vitro studies. There are 86 million people with herpes, and one wonders if a simple morning after study could be put together to see if that blocks or creates immunity. I completely understand that a study such as that would be difficult to make sense because the ivirus would certainly put the subject into a latent state of infection. Therefore,, hopefully there are animal studies that could be done to prove or disprove whether the latent state had occurred or not. I understand that you are saying direct inoculation while taking a viral supplement medication would not be effective, but I don't think there is any data to back that up. That is what I have found to be so shocking. There really should be data to answer that question. It is such an obvious question. It almost demands an answer. To reiterate what I think is a major point, what exactly is happening inside the nucleus of the cell when the herpes virus injects its DNA. I don't know the answer to that I think that is where the issue of latency resides. We either stop the virus, the minute it hits the body or we stop it from allowing itself to enter the cells (interferon?) or we stop it from encoding itself into the DNA. I can't find good answers to these questions.

[Dallasfan]

I made some general comments about direct tissue innoculation as you implied in your original post. Ajs comments are essentially correct. The problem with developing a vaccine to Herpes is that the virus has a prolonged intracellular phase which explains its latentcy phase. Host response to Herpes involves the entire immune system to include humoral, cell mediated responses to include interferon induction and the interplay of Natural killer cell and cytotoxic T cells in conjunction with host macrophages. Part of the problem with humoral antibodies produced by Herpes is that there are also surface protein cytokine stimulating proteins taht both induce and suppress the antibody response. Developing a vaccine would envole testing all of these factors invitro first then progess to futher studies. Direct innoculation while taking transscriptionase enzyme inhibitors would not predictably circumvent the questions. Many of these studies are ongoing. Developing a vaccine is complex and not as simple as you imply. Hopefully some day we may have a vaccine. But knowing the nature of the Herpes virus., I doubt it would be as effective as we would want.  I still say direct innoculation while take a viral suppessant medication would not be effective.

[auntiejessi]

What do you mean by valtrex and acyclovir causing a latent infection?  Even without meds, herpes already has periods of latency - its the nature of the virus.

The meds can perhaps extend that period, but it doesn't cause a permanent latency, as people on any antiviral will still shed the virus, just at a lower rate, perhaps.

I agree that lots of things have risks, but you have to weigh the benefits vs risks, and a lot of times, the risks aren't all that clear.  I got herpes from a man who had relatively few symptoms and very little pain.  I have had very frequent outbreaks and mine are painful.    Obviously, I wasn't infected in the arm, which would change the site of my outbreaks entirely, but even so, with PHN, herpetic meningitis and encephalitis, etc., being possible, I'd say this is unethical.

Aj

[Curious331]

DallasFan: The HIV fear is without merit. Lets stay focused on the issue.  Science can control the innoculum.  The "person" who is willing to do this is at risk from the partner for a lifetime.   Why not take that risk off the table.  The unknown information that must become known is whether or not valtrex or acyclovir pretreatment can STOP the infection in the first place and allow immunity.   I learned today from one virologist that he thought valtrex and acyclovir would cause a "latent" infection.  If so, this is a matter of the lesser of evils.  Risk of infection vs Controlled latent infection or if we are lucky,  Immunity with No infection.   Knowledge is knowing the extent of our ignorance.    Post herpetic neuralgia would be in the informed consent as would other hypotheticals.  We can't say NO to this idea because of a hypothetical risk.  Lasik eye surgery can blind you.  But people do it every day.  So I agree we need to list the potential risks and weigh against the benefit of zero risk of genital herpes.   thank you for responding.

[auntiejessi]

Oh I'd say in theory it could work, but I think its a bad idea.

First, you can never predict how a person is going to respond to any virus.  Some people can get what's called post-herpetic neuralgia, which is painful.  

Its also not easy to inoculate someone on thick skin, like the skin found on the arms.

Transmission rates are probably lower than most people think, and with daily antiviral therapy, its even lower.

Aj

[Dallasfan]

Bad idea from many points of view. Injecting biological material from one person to the next is of course a high rsik for transmitting HIV. The idea is unethical. The immunulogical response would not be predictable for several reasons. There is already a vaccine available to ypoung women for HPV that is recommended. Developing a viccine for Herpes is more complex. Even if one could immunize against Herpes, condom use is still recommended as a prevention for other STDs .