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Roja

Shedding and Transmission: Numbers

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Roja

Hi everyone, 

I just wanted to share this article I have just found about shedding and transmission for HSV-2. 

https://www.medscape.org/viewarticle/472427_2

Have a look at the numbers of transmission in the studies! They were quite low actually!! 

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Jill71

Its asking me to sign in.   Sounds interesting though!

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Constant Diplomat

Yeah I'd have liked to read these lower stats too. Can you copy and paste?

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Roja

Here you go: 

"This randomized, placebo-controlled trial involved the study of nearly 1500 immunocompetent, heterosexual, monogamous couples who were serologically discordant for HSV-2 infection. HSV-2-seropositive partners were randomized in a 1:1 ratio to receive valacyclovir 500 mg once daily or matching placebo.[19]Condoms were provided free of charge to all participants in the trial throughout the study, and all couples received counseling about the effective use of condoms. HSV-2-seronegative, susceptible partners were evaluated monthly for 8 months for clinical and laboratory evidence of HSV-2 infection. New infections were diagnosed on the basis of isolation of HSV-2 from culture or HSV-2 seroconversion. Of 1498 couples at 96 centers worldwide, 1159 completed the study. During the study period, a total of 41 HSV-2 infections occurred among susceptible partners: 20 were clinically symptomatic and 21 were diagnosed on the basis of HSV-2 seroconversion only ( Table 3 ).

Of the 20 symptomatic infections, 16 occurred among the 741 partners of placebo recipients (2.2%) and 4 occurred among the 743 partners of valacyclovir recipients (0.5%) (relative risk, 0.25; 95% CI, 0.08-0.74; P = .01) (Figure 2). The time to development of symptomatic first episodes of genital herpes was significantly longer among the partners of valacyclovir recipients than among the partners of placebo recipients. In all 41 cases of HSV-2 acquisition that were evaluated, HSV-2 had been acquired by 27 of the susceptible partners of placebo recipients (3.6%) compared with 14 of the susceptible partners of valacyclovir recipients (1.9%) (hazard ratio , 0.52; 95% CI, 0.27-0.99; P = .04) (Figure 2).

Consistent with the findings of other studies of HSV-2 transmission, more female partners than male partners of placebo-treated patients acquired HSV-2 infection (7.4% vs 1.8%).[19] No evidence of a significant difference in treatment effect of valacyclovir was seen between susceptible female or male partners. There were several significant factors that influenced the effectiveness of the medication, however. Valacyclovir-treated persons who had genital herpes for less than 2 years were nearly 3 times more likely to transmit than those who had genital herpes for more than 2 years. Similarly, those who were in a monogamous relationship of less than 2.5 years' duration were also 3 times more likely to transmit infection. Interestingly, past HSV-1 infection was not a factor in protecting against the acquisition of HSV-2.

Condom use data were collected during the course of the trial.[19] Couples were classified, on a monthly basis, as those who never used condoms, sometimes used condoms (1% to 90% of sexual contacts), and nearly always used condoms (> 90% of sexual contacts). In the study population as a whole, frequent condom use was found to reduce the acquisition rate of genital herpes infections. Of interest, the effect of valacyclovir was similar among all frequencies of condom use. While the numbers were small, there was no evidence of transmission among couples who used condoms very frequently (> 90%) and also received valacyclovir (Figure 3); the study was not powered, however, to confirm that utilization of both modalities was 100% effective."

 

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