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Clarification of transmission
I'm recently divorced and dating again - with HSV-2 - acquired 9 years ago. . I've only had two recurrences in my life and make efforts to eat well and now take Valtrex 500 mg everyday (following the evidence from the study that this reduces transmission). The recurrences were very mild and in the exact spot where the initial outbreak was located (labia majora).
A few questions:
I told my partner about my status (that I have HSV) he was wonderful about it. We decided to have sex without protection and to abstain during any symptoms. I take 1 gram of Valtrex now to reduce transmission further - some data suggest this is better vs. 500mg.
1) Since I have not had a recurrence in so long - could I just be missing them all together and be shedding?
2) Do the recurrences always re-appear near the original site of infection (in my case, the labia majora )
3) Sometimes, I don't lubricate that much and we have had "dry" sex which left some chaffing - irritation of the inside of my labia - any concerns that this could pass along the virus? I noticed some friction/tears - painful but likely due to poor lubrication. How risky is this? Are these lesions that I'm overlooking (no prodrome - just feels like a burn).
4) Is it possible that I just have "mild" case of HSV-2. I took lots of Valtrex after my first episode and understand that possibly determines/reduces the "amount of virus" left to reactivate.
5) How likely is it that I have had lesions/virus internally (on the cervix, inside the vagina) and missed them?
6) Any risks to long term use of Valtrex and the kidneys/liver?
7) Does birthcontrol (use of hormones) increase risk of recurrence? I've been off of it for 6 years and going back on (i'm 38).
Thank you very much -
A few questions:
I told my partner about my status (that I have HSV) he was wonderful about it. We decided to have sex without protection and to abstain during any symptoms. I take 1 gram of Valtrex now to reduce transmission further - some data suggest this is better vs. 500mg.
1) Since I have not had a recurrence in so long - could I just be missing them all together and be shedding?
2) Do the recurrences always re-appear near the original site of infection (in my case, the labia majora )
3) Sometimes, I don't lubricate that much and we have had "dry" sex which left some chaffing - irritation of the inside of my labia - any concerns that this could pass along the virus? I noticed some friction/tears - painful but likely due to poor lubrication. How risky is this? Are these lesions that I'm overlooking (no prodrome - just feels like a burn).
4) Is it possible that I just have "mild" case of HSV-2. I took lots of Valtrex after my first episode and understand that possibly determines/reduces the "amount of virus" left to reactivate.
5) How likely is it that I have had lesions/virus internally (on the cervix, inside the vagina) and missed them?
6) Any risks to long term use of Valtrex and the kidneys/liver?
7) Does birthcontrol (use of hormones) increase risk of recurrence? I've been off of it for 6 years and going back on (i'm 38).
Thank you very much -
Thank you - as always, your feedback is very helpful. I'd like to read the data you referenced on long term viral shedding - was it a publication?
MEDICAL PROFESSIONAL
Welcome back to the forum. I'm glad you have found an understanding partner, to complement your own sober attitude toward your herpes, as we discussed a few months ago.
You don't mention one important aspect of all this, your partner's HSV-2 status. Even if he has no history of genital herpes, remember that 20% of adult North Americans have HSV-2. If he is one of them, he is immune to a new HSV-2 infection and there would be little or no risk of transmission. He should consider testing so you know whether he is susceptible or not. (Not that I wish him a positive result, but it certainly would be convenient!)
To your questions:
1) Very recently (since your last thread) research results have become available on long-term viral shedding. Unfortunately, the results are not what you would hope: asymptomatic shedding of HSV-2 continues in most infected persons 10+ years after their initial HSV-2 infections, including people with few or no symptoms of recurrent herpes.
2) Symptomatic recurrent outbreaks do not necessarily occur at the site of the initial infection. Recurrent episodes can occur anywhere from waist to upper thighs. (Think of the parts of the body covered by men's boxer shorts -- that's where recurrent HSV-2 episodes are possible.) However, regardless of where the symptomatic outbreaks occur, most people have asymptomatic genital shedding; for women, that means the vagina, cervix, etc. You cannot assume there is no potential for transmisssion just because there are no symptomatic outbreaks or because they occur on, say, the buttocks or lower back.
3) Basically, you are asking whether irritation or trauma from sex can increase HSV-2 transmission potential by people who happen to have asymptomatic shedding at the same time. It makes sense that might happen, but there are no data. I cannot judge how much higher the risk might be, if at all.
4) See no. 1. Frequency of asymptomatic shedding is unrelated to severity of the initial infection or recurrent outbreaks.
5) Quite possible. Some infected persons with asymptomatic shedding undoubtedly have internal lesions that cannot be felt or easily seen.
6) Valacylovir is extremely safe. There have been no reports of serious adverse effects from long term treatment.
7) To my knowledge, hormonal contraception does not make any difference. If there is a slight increase in shedding rate, it is minor.
Having said all that, despite the recent research results, other data show that HSV-2 transmission risk declines with time. Specifically, in monogamous couples in which one has HSV-2 and the other does not, transmission is less common when the infected person has had it a long time. So although some risk of transmission undoubtedly persists, my guess is that the risk in your situation is relativley low -- and is further reduced by taking valacyclovir. (By the way, I agree with the higher dose you are taking. I always prescribe 1 g daily rather than the officially recommended 500 mg.)
Bottom line: Probably overall low transmission risk, but definitely not zero. I do recommend that your partner be tested.
I hope this helps. Best wishes-- HHH, MD
You don't mention one important aspect of all this, your partner's HSV-2 status. Even if he has no history of genital herpes, remember that 20% of adult North Americans have HSV-2. If he is one of them, he is immune to a new HSV-2 infection and there would be little or no risk of transmission. He should consider testing so you know whether he is susceptible or not. (Not that I wish him a positive result, but it certainly would be convenient!)
To your questions:
1) Very recently (since your last thread) research results have become available on long-term viral shedding. Unfortunately, the results are not what you would hope: asymptomatic shedding of HSV-2 continues in most infected persons 10+ years after their initial HSV-2 infections, including people with few or no symptoms of recurrent herpes.
2) Symptomatic recurrent outbreaks do not necessarily occur at the site of the initial infection. Recurrent episodes can occur anywhere from waist to upper thighs. (Think of the parts of the body covered by men's boxer shorts -- that's where recurrent HSV-2 episodes are possible.) However, regardless of where the symptomatic outbreaks occur, most people have asymptomatic genital shedding; for women, that means the vagina, cervix, etc. You cannot assume there is no potential for transmisssion just because there are no symptomatic outbreaks or because they occur on, say, the buttocks or lower back.
3) Basically, you are asking whether irritation or trauma from sex can increase HSV-2 transmission potential by people who happen to have asymptomatic shedding at the same time. It makes sense that might happen, but there are no data. I cannot judge how much higher the risk might be, if at all.
4) See no. 1. Frequency of asymptomatic shedding is unrelated to severity of the initial infection or recurrent outbreaks.
5) Quite possible. Some infected persons with asymptomatic shedding undoubtedly have internal lesions that cannot be felt or easily seen.
6) Valacylovir is extremely safe. There have been no reports of serious adverse effects from long term treatment.
7) To my knowledge, hormonal contraception does not make any difference. If there is a slight increase in shedding rate, it is minor.
Having said all that, despite the recent research results, other data show that HSV-2 transmission risk declines with time. Specifically, in monogamous couples in which one has HSV-2 and the other does not, transmission is less common when the infected person has had it a long time. So although some risk of transmission undoubtedly persists, my guess is that the risk in your situation is relativley low -- and is further reduced by taking valacyclovir. (By the way, I agree with the higher dose you are taking. I always prescribe 1 g daily rather than the officially recommended 500 mg.)
Bottom line: Probably overall low transmission risk, but definitely not zero. I do recommend that your partner be tested.
I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
