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decreasing the chance of spreading HSV virus as much as possible
Dear Doctors,
I am HSV 2 positive since 2 years ago. I have outbreaks 2 times per year which are not annoying. I don't take any medication, and everything seems to be fine with respect to my health situation. My only concern is spreading virus for instance to a new girlfriend. I know that suppressive therapy and condoms can help in reducing the chance of spreading virus. Here are my question concerning this issue:
1- Is there any way, even very expensive to reduce the risk of spreading the virus much below than what suppressive therapy can do? For example, taking higher dosage of Valtrex? At this point, I have much less concerns about possible side effects.
2- Does washing the genital area with a proper material before a sexual activity helps in reducing the risk of spreading the virus?
3- Is there any quick test which can be done on my own in order to check presence of the virus on the skin (Viral Shedding)? This help detecting those Viral Shedding with no visible sore and thus further reducing the chance of spreading the virus.
Thanks for your help in advance
I am HSV 2 positive since 2 years ago. I have outbreaks 2 times per year which are not annoying. I don't take any medication, and everything seems to be fine with respect to my health situation. My only concern is spreading virus for instance to a new girlfriend. I know that suppressive therapy and condoms can help in reducing the chance of spreading virus. Here are my question concerning this issue:
1- Is there any way, even very expensive to reduce the risk of spreading the virus much below than what suppressive therapy can do? For example, taking higher dosage of Valtrex? At this point, I have much less concerns about possible side effects.
2- Does washing the genital area with a proper material before a sexual activity helps in reducing the risk of spreading the virus?
3- Is there any quick test which can be done on my own in order to check presence of the virus on the skin (Viral Shedding)? This help detecting those Viral Shedding with no visible sore and thus further reducing the chance of spreading the virus.
Thanks for your help in advance
MEDICAL PROFESSIONAL
Welcome to the forum and thanks for your question. It's a good one -- but I'm afraid the answers aren't so easy.
Congratulations on a responsible approach to your genital herpes and protecting your partners. As you know, the three basic strategies to prevent transmission are to avoid sex during outbreaks, suppressive antiviral therapy, and consistent condom use. While none of these is anywhere near perfect by itself (and nobody should rely primarily on just recognizing symptoms), people who use all three consistently probably transmit HSV-2 to their partners very infrequently. A corollary is that infected persons also should inform their potential partners of their herpes before having sex -- which you don't mention, but your obviously responsible approach implies you do.
I'm not clear whether you are currently taking suppressive treatment-- i.e. does"I don't take any medication" refer to other drugs or to anti-HSV drugs? If you are taking valacyclovir or another anti-herpes drug, does your current outbreak frequency (twice a year) mean on treatment or before you started suppressive therapy?
Pending that information, my preliminary responses to your questions:
1) There is a school of thought that the standard suppressive dose of valacyclovir (500 mg once daily) might be on the low side, i.e. that double that dose (1 gram) would be more effective. Since the higher dose hasn't been studied for its prevention effect, there is no way to know with certainty, hence a modicum of debate among the experts. Personally, I would take the higher dose and often recommend it to my patients. Although the cost obviously is higher, it's not double; the 1 g caplets are not twice the price of 500 mg. And the side effect profile is no different -- so my attitude is "why not?".
2) To my knowledge, the effect of washing on asymptomatic shedding in the next few minutes has not been studied, but I doubt washing before sex would make any difference. Asymptomatic shedding occurs "in" the skin, not primarily on the surface. In fact, I can imagine that washing might increase detectable virus on the surface. (This would be an interesting and fairly easy research question. I'm going to suggest it to my herpes research colleagues!)
3) There is no immediate test that could apply in this situation. PCR to detect HSV DNA can be done quite rapidly, and indeed is now recommended in pregnant women with herpes, to check fo viral shedding at onset of labor. However, it's still lab based and takes an hour or more. I'm not aware that any diagnostic companies are working on immediate, point-of-care tests, but I doubt it.
So my advice is to rely on the tried and true approaches, perhaps with the higher dose of valacyclovir. Since even with no attempt at prevention at all, the average risk of HSV-2 transmission probably is in order of once for every 1,000 episodes of vaginal sex. So routinely taking these standard precautions, the odds are strong you'll never transmit your HSV-2.
I hope this helps. Best wishes-- HHH, MD
Congratulations on a responsible approach to your genital herpes and protecting your partners. As you know, the three basic strategies to prevent transmission are to avoid sex during outbreaks, suppressive antiviral therapy, and consistent condom use. While none of these is anywhere near perfect by itself (and nobody should rely primarily on just recognizing symptoms), people who use all three consistently probably transmit HSV-2 to their partners very infrequently. A corollary is that infected persons also should inform their potential partners of their herpes before having sex -- which you don't mention, but your obviously responsible approach implies you do.
I'm not clear whether you are currently taking suppressive treatment-- i.e. does"I don't take any medication" refer to other drugs or to anti-HSV drugs? If you are taking valacyclovir or another anti-herpes drug, does your current outbreak frequency (twice a year) mean on treatment or before you started suppressive therapy?
Pending that information, my preliminary responses to your questions:
1) There is a school of thought that the standard suppressive dose of valacyclovir (500 mg once daily) might be on the low side, i.e. that double that dose (1 gram) would be more effective. Since the higher dose hasn't been studied for its prevention effect, there is no way to know with certainty, hence a modicum of debate among the experts. Personally, I would take the higher dose and often recommend it to my patients. Although the cost obviously is higher, it's not double; the 1 g caplets are not twice the price of 500 mg. And the side effect profile is no different -- so my attitude is "why not?".
2) To my knowledge, the effect of washing on asymptomatic shedding in the next few minutes has not been studied, but I doubt washing before sex would make any difference. Asymptomatic shedding occurs "in" the skin, not primarily on the surface. In fact, I can imagine that washing might increase detectable virus on the surface. (This would be an interesting and fairly easy research question. I'm going to suggest it to my herpes research colleagues!)
3) There is no immediate test that could apply in this situation. PCR to detect HSV DNA can be done quite rapidly, and indeed is now recommended in pregnant women with herpes, to check fo viral shedding at onset of labor. However, it's still lab based and takes an hour or more. I'm not aware that any diagnostic companies are working on immediate, point-of-care tests, but I doubt it.
So my advice is to rely on the tried and true approaches, perhaps with the higher dose of valacyclovir. Since even with no attempt at prevention at all, the average risk of HSV-2 transmission probably is in order of once for every 1,000 episodes of vaginal sex. So routinely taking these standard precautions, the odds are strong you'll never transmit your HSV-2.
I hope this helps. Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
There are no data on the efficacy of acyclovir, at any dose, in preventing transmission of HSV. Only valacyclovir has been studied for this purpose and therefore, I have less confidence in acyclovir (at any dose). 800 mg twice daily might be more effective than the lower dose, but am not comfortable with such a prediction.
Thanks again for your advices. Just one more question: I decided to take acyclovir tablets. The dosage is recommended to be 400mg 2 times a day. By the double dosage you suggested in a previous post, do you mean 800mg 2 times a day?
Thanks.
Thanks.
MEDICAL PROFESSIONAL
I doubt doses higher than 1 gram would have any additional benefit. I can't comment on washing with anything, and would not be confident applying one of the anti-HSV ointments would help.
As for periodic PCR testing, don't waste your money. Recent research shows that most asymptomatic shedding occurs for periods as short as 4-6 hours, and occurrence is entirely random. A negative result even 12 hours before sex would not guarantee you were not shedding at the time.
My strong advice is to not let this make you crazy. Start taking suppressive treatment (do it continually, not only in anticipation of sexual activity) and the other common sense stuff, including discussion with your partners. Those who decide to accept the risk and proceed with a sexual relationship are extremely unlikely to catch it, and likely not seriously affected if they do. After all, most genital herpes is just like yours -- not all that severe and quite easy to deal with. While common sense prevention is, well, common sense, you really shouldn't overdo it.
As for periodic PCR testing, don't waste your money. Recent research shows that most asymptomatic shedding occurs for periods as short as 4-6 hours, and occurrence is entirely random. A negative result even 12 hours before sex would not guarantee you were not shedding at the time.
My strong advice is to not let this make you crazy. Start taking suppressive treatment (do it continually, not only in anticipation of sexual activity) and the other common sense stuff, including discussion with your partners. Those who decide to accept the risk and proceed with a sexual relationship are extremely unlikely to catch it, and likely not seriously affected if they do. After all, most genital herpes is just like yours -- not all that severe and quite easy to deal with. While common sense prevention is, well, common sense, you really shouldn't overdo it.
Dear Dr. HHH,
Thanks very much for your answer. I don't take any anti-HSV medication. I have like 2 outbreaks per year which are not really something that annoys me. It is less annoying than a flu or seasonal allergy. What makes me worried is social stigma attached to HSV, and only because of this fact, I don't want to transmit it to anybody. Even knowing that I have informed my new partner about potential risks, I still feel guilty if it gets transmitted. So, I really want to do my best!
Your answers were very informative. I just have a few more points to clarify further:
1) What about even taking higher than double dosage? I am not really concerned about side effects. I can try a high dose for a while and if I didnt notice any side effect, stick to it.
2) Can washing with anything other than water help? for instance anti-HSV cream?
3) Do you think this approach that I weekly go though PCR testing helps? I can go through burden of it, if it can be any help.
Thanks again in advance.
Thanks very much for your answer. I don't take any anti-HSV medication. I have like 2 outbreaks per year which are not really something that annoys me. It is less annoying than a flu or seasonal allergy. What makes me worried is social stigma attached to HSV, and only because of this fact, I don't want to transmit it to anybody. Even knowing that I have informed my new partner about potential risks, I still feel guilty if it gets transmitted. So, I really want to do my best!
Your answers were very informative. I just have a few more points to clarify further:
1) What about even taking higher than double dosage? I am not really concerned about side effects. I can try a high dose for a while and if I didnt notice any side effect, stick to it.
2) Can washing with anything other than water help? for instance anti-HSV cream?
3) Do you think this approach that I weekly go though PCR testing helps? I can go through burden of it, if it can be any help.
Thanks again in advance.
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.
