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curecomingverysoon

SO Many Unanswered Questions - Discuss!

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curecomingverysoon

This post stems from a post that I made on the webMD boards which the nurses there seem unwilling/unable to answer. This stuff has been on my mind for awhile now... It staggers me the amount of unanswered questions that I/the community have. Here are a few.

- There are vaccines for shingles, chicken pox and shingles -- WHY is there no vaccine for either strain of HSV?

- Why is there no way for us to keep track of our own viral shedding?

- What will cause a false positive on an HSV blood test or Western blot?

- What specifically constitutes an "outbreak"?

- Have there been any cases where the body heals itself of the virus? Not necessarily seroconversion but enough to be officially considered "negative".

- Why does the medical profession not promote that there ARE vaccines in the pipeline to generate awareness and hope?

- The transmission study (http://jama.ama-assn.org/cgi/content/full/285/24/3100) says that it's 4% from positive female to negative male (without condoms or antivirals) in a given year but I also noticed that this is while having an average of sex 2 times per week but there was also a statistic that said that transmission with condoms is 8.9/1000 sex acts (but this certainly doesn't seem to equate to 4%?). How much is the risk raised when you're having sex 8-10 week? What if you're using both condoms and antivirals? My doctor used the words "negligible risk" when we discussed it if you're using condoms and antivirals.

- What if you are in your first year with GHSV? As I understand it people are more contagious in their first 6 months to a year of infection -- is there a study which substantiates this?

- Has there been any discussion in the medical community of simply stopping testing for HSV altogether? It seems like a nuisance virus really that spreads rapidly yet the stigma is truly appalling. Why not just stop testing and give antivirals to pregnant women as a matter of routine since the whole thing is incurable but basically harmless? The only thing that the push for testing seems to be achieving is more money for the pharma companies while creating humiliation amongst those who have it.

Thoughts?

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motorcyclemaintainance

- There are vaccines for shingles, chicken pox and shingles -- WHY is there no vaccine for either strain of HSV?

Very good question. The reason seems to be that up until very recently, the focus was on 'safe' subunit vaccines for HSV. The idea was that these massively crippled HSV viruses would stimulate an immune response but wouldn't hang around in the nerves afterwards. This hasn't worked very well so far, and has cost millions and millions of dollars in research. Perhaps such a weakened virus doesn't (and may never) provoke an adequate ongoing immune response.

However, a scientist called William Halford is developing a new vaccine that will stay in the nerves permanently, but will not cause an outbreak. This would protect you from the wild strains of the virus. I think this works on a similar principle to the Chicken Pox vaccine. Everyone who took the vaccine would then test positive for HSV-1 and 2, but without symptoms. What would that do to the stigma I wonder?

- Why is there no way for us to keep track of our own viral shedding?

There probably is some way to do this, but you'd need swabs and some kind of home lab. I have no idea whether it would be accurate either, since swabbing is a bit hit and miss, no? Probably too fiddly for home use.

- Have there been any cases where the body heals itself of the virus? Not necessarily seroconversion but enough to be officially considered "negative".

It's very likely that this has happened in some cases, but seroconversion would still be present in the blood, even if the virus was inactive forevermore. Because of this, it would be almost impossible to prove the body had "healed" itself since exposure. In theory, a scientist could swab the allegedly "healed" person for a year, and if no virus was present, there might be a case to be made. Alternatively, they may just not have shed that year for some incidental reason. Who knows....

- Why does the medical profession not promote that there ARE vaccines in the pipeline to generate awareness and hope?

Probably because there are so many diseases out there, and so many developments, that many doctors don't have the time to keep themselves updated on it all. It's a shame, especially since this is a particularly emotionally-charged condition.

- The transmission study (http://jama.ama-assn.org/cgi/content/full/285/24/3100) says that it's 4% from positive female to negative male (without condoms or antivirals) in a given year but I also noticed that this is while having an average of sex 2 times per week but there was also a statistic that said that transmission with condoms is 8.9/1000 sex acts (but this certainly doesn't seem to equate to 4%?). How much is the risk raised when you're having sex 8-10 week? What if you're using both condoms and antivirals? My doctor used the words "negligible risk" when we discussed it if you're using condoms and antivirals.

You have to wonder how useful these statistics are. Even if you do shed and infect a partner, what is the likelihood they will be symptomatic? Say we go with the 4% chance of transmission, the 25% chance that they're already infected, and then add to that the 80% likelihood that your partner will be asymptomatic anyway. The mind boggles at what tiny, tiny percentage risk you're taking as a carrier. Can someone actually work it out?

And don't forget that if they don't have sex with you, they'll continue to take a 4% risk with 25% of the partners they sleep with.

- What if you are in your first year with GHSV? As I understand it people are more contagious in their first 6 months to a year of infection -- is there a study which substantiates this?

I've wondered that too. Can't find any studies on it.

- Has there been any discussion in the medical community of simply stopping testing for HSV altogether?

Yes, I've read papers where doctors have advised that testing is stopped. And this is actually put into action: STD clinics will very, very rarely test for HSV. I think they take your view: that in most cases it is invisible, and in many others a harmless rash.

Doctors, understandably, seem quite keen not to diagnose herpes.

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motorcyclemaintainance

This specifically addresses your question about why there is a vaccine for Chicken Pox, but not HSV-1/2:

"Live virus vaccines have a long and effective history. In fact, one of the few effective vaccines against any herpes strain -- the chickenpox/shingles (herpes zoster) shot -- was developed from live virus back in the 1960s.

Since that time, doctors have gotten more skittish about injecting people with a live form of the virus, however, so the subunit approach took precedence."

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NeedToKnow

Another question...

Why don't the herpes blood test companies, like Focus Diagnostics, Inc. that makes HerpeSelect, advertise to get people to ask for the test during routine STD testing? You know, like make people more away of herpes and the tests that are available?

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motorcyclemaintainance

This is speculative. But perhaps because:

a) Most asymptomatic people probably don't want to know they have herpes, so the diagnostic test wouldn't be a particularly popular product.

B) Most STD clinics do not want to diagnose herpes, especially in asymptomatic patients. Their counseling services could be overrun by pointlessly stigmatized individuals who might otherwise have gone their whole lives in a blissful ignorance.

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NeedToKnow

Perhaps, but if people were aware of the test, then they could insist their partners get tested and make sure they got the specific test even if they didn't want to know if they have it themselves. But I know herpes is not a very popular topic in real life or on the Internet except in a herpes forum. People seem to want to not discuss it and hope for the best.

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