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Some questions on HSV
Hello Doctors, I have read through some of the threads but I still have some questions. Again, I thank you for your time.
1. How common is it for one to have HSV-2 orally?
2. Does anti-suppressive therapy such as valacyclovir make one with an HSV-1 or HSV-2 active outbreak less contagious?
3. Once a cold sore has crusted over for someone with recurring (i.e. not initial outbreak) HSV-1 or HSV-2, how contagious are they, practically?
4. If one has either HSV-1 or HSV-2, how well does having one type prevent the acquisition of the other? i.e., does having one protect you from the other and to what extent if so?
5. Does being immunosuppressed make it easier for one who has either HSV-1 or HSV-2 to contract the other type (HSV-1 to HSV-2) or same type of HSV (HSV-1 to HSV-1)?
6. How possible practically is it to contract HSV-2 or HSV-1 by coming into contact (touching) with a lesion of another person and then touching your genitals i.e. through masterbation? I know, I have read that the virus needs to be "massaged" into the skin, but would touching a lesion and then masterbating pose a significant threat?
1. How common is it for one to have HSV-2 orally?
2. Does anti-suppressive therapy such as valacyclovir make one with an HSV-1 or HSV-2 active outbreak less contagious?
3. Once a cold sore has crusted over for someone with recurring (i.e. not initial outbreak) HSV-1 or HSV-2, how contagious are they, practically?
4. If one has either HSV-1 or HSV-2, how well does having one type prevent the acquisition of the other? i.e., does having one protect you from the other and to what extent if so?
5. Does being immunosuppressed make it easier for one who has either HSV-1 or HSV-2 to contract the other type (HSV-1 to HSV-2) or same type of HSV (HSV-1 to HSV-1)?
6. How possible practically is it to contract HSV-2 or HSV-1 by coming into contact (touching) with a lesion of another person and then touching your genitals i.e. through masterbation? I know, I have read that the virus needs to be "massaged" into the skin, but would touching a lesion and then masterbating pose a significant threat?
Follow up to last reply:
2. I have been taking 2-3 pills (1 gram) at different times throughout the day. Would that still be as effective as taking the recommended dosage?
2. I have been taking 2-3 pills (1 gram) at different times throughout the day. Would that still be as effective as taking the recommended dosage?
One last follow up, promise last one.
1. If one was immunosuppressed and already had HSV-1 (orally), would it be possible for them to contract HSV-1 again in another site (genitally), or would the immunosuppression not affect the antibody protection?
2. My prescription is for valacyclovir HCL 1 gram, 3 times daily as needed. Would you recommend just taking two pills once a day together?
1. If one was immunosuppressed and already had HSV-1 (orally), would it be possible for them to contract HSV-1 again in another site (genitally), or would the immunosuppression not affect the antibody protection?
2. My prescription is for valacyclovir HCL 1 gram, 3 times daily as needed. Would you recommend just taking two pills once a day together?
MEDICAL PROFESSIONAL
My reply above was for untreated herpes. With effective treatment, healing is facter and viral shedding (infectiousness) is briefer. If the skin is intact under a relatively loose crust, even at only 3-4 days, the transmission risk would be low.
By the way, the currently recommended treatment for recurrent oral herpes is only 2 large doses of valacyclovir (2 grams), 12 hours apart. In fact, you probably could even skip the second dose; just one 2 gram dose probably would do it.
By the way, the currently recommended treatment for recurrent oral herpes is only 2 large doses of valacyclovir (2 grams), 12 hours apart. In fact, you probably could even skip the second dose; just one 2 gram dose probably would do it.
Thank you for your as always, quick response. Just one follow up question:
Re 3. I noticed a cold sore coming on on Tuesday morning and immediately put on abreva, ice, etc. and began taking valacyclovir that night around 8 p.m. as I could not get to it earlier. Since then I have been taking valacyclovir 3 times a day (3 thursday, 3 friday). Currently, the only remnants that remain is a little "scabby" looking skin. (the lesion only weeped a little). As such, my skin is currently as intact in the cold sore process as it would be 6-7 days out if I would not have taken valacyclovir, even though this is only the third day since it began.
My question is, if my skin is as healed as it would be after 7 days of non-suppresive surgery, am I as contagious (less contagious) as I normally would be after 7 days of natural healing, or am I still as contagious as I normally would be at day 3 of natural healing.
In essence, is contagiousness accounted for based on overall time or the condition of the skin itself? Note, I have also not picked at the skin.
Re 3. I noticed a cold sore coming on on Tuesday morning and immediately put on abreva, ice, etc. and began taking valacyclovir that night around 8 p.m. as I could not get to it earlier. Since then I have been taking valacyclovir 3 times a day (3 thursday, 3 friday). Currently, the only remnants that remain is a little "scabby" looking skin. (the lesion only weeped a little). As such, my skin is currently as intact in the cold sore process as it would be 6-7 days out if I would not have taken valacyclovir, even though this is only the third day since it began.
My question is, if my skin is as healed as it would be after 7 days of non-suppresive surgery, am I as contagious (less contagious) as I normally would be after 7 days of natural healing, or am I still as contagious as I normally would be at day 3 of natural healing.
In essence, is contagiousness accounted for based on overall time or the condition of the skin itself? Note, I have also not picked at the skin.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your succinct, straightforward questions.
1) Among people with genital HSV-2, a few percent have oral HSV-2 as well. Isolated oral HSV-2 is rare; almost all recurrent oral herpes is HSV-1.
2) If an outbreak occurs despite suppressive treatment, it is probably just as transmissible as in someone not taking valacyclovir.
3) This is hard to answer. Time since onset of the lesion probably is a more reliable indicator. Early in crusting -- e.g., only a couple of days after onset, or if the crust is still moist or with raw tissue underneath, infectivity may be quite high. It would be a lower after that, e.g. a dry scab with just some redness underneath. Any lesion under 7 days in duration should be considered highly infectious, and it is always safest to avoid contact until any crusts have dried and fallen away on their own -- usually 10+ days after onset.
4,5) Having HSV-1 appears to slightly reduce the chance of catching HSV-2. But I stress "slightly"; people with HSV-1 should not assume they won't get HSV-2 if exposed. There are no data on HSV-2 protection against HSV-1; probably any protection is modest. To my knowledge there are no data about the effect of immunosuppression, but logic suggests little effect: since cross protection is weak to start, being immunosuppressed shouldn't make much difference.
6) I cannot say that such contact would be zero risk, but certainly it would be very low -- a lot less than direct genital contact with an infected partner.
Happy holidays-- HHH, MD
1) Among people with genital HSV-2, a few percent have oral HSV-2 as well. Isolated oral HSV-2 is rare; almost all recurrent oral herpes is HSV-1.
2) If an outbreak occurs despite suppressive treatment, it is probably just as transmissible as in someone not taking valacyclovir.
3) This is hard to answer. Time since onset of the lesion probably is a more reliable indicator. Early in crusting -- e.g., only a couple of days after onset, or if the crust is still moist or with raw tissue underneath, infectivity may be quite high. It would be a lower after that, e.g. a dry scab with just some redness underneath. Any lesion under 7 days in duration should be considered highly infectious, and it is always safest to avoid contact until any crusts have dried and fallen away on their own -- usually 10+ days after onset.
4,5) Having HSV-1 appears to slightly reduce the chance of catching HSV-2. But I stress "slightly"; people with HSV-1 should not assume they won't get HSV-2 if exposed. There are no data on HSV-2 protection against HSV-1; probably any protection is modest. To my knowledge there are no data about the effect of immunosuppression, but logic suggests little effect: since cross protection is weak to start, being immunosuppressed shouldn't make much difference.
6) I cannot say that such contact would be zero risk, but certainly it would be very low -- a lot less than direct genital contact with an infected partner.
Happy holidays-- 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.
