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JHenry

Asymptomatic shedding (mostly)

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JHenry

After 30+ years of GHSV2, you’d think I’d be out of questions—however, research changes answers and I tend to forget over time.  Below are a few questions I would appreciate solid data driven responses and in LAYMANS terms please.   Most are related to asymptomatic situations.

A. I have it hanging on a memory hook via asymptomatic shedding, the probability  of transmitting HSV2 was .0025 or 1/4 of a percent provided the infected person was using Valacyclovir for supression.  Can anyone confirm if this is correct?  

Is there an accurate and easy way to tell a partner, what the average chance of asymptomatic transmission is, both on and not on a suppressive therapy?    What would those chances be?  

B. While acknowledging asymptomatic shedding can occur anywhere in the “trunk” area.  If my partner and I sleep naked, making contact, but not in  “mucosal areas”, is there risk in transmission, given there is no active occurrence and/or open cuts, etc. on our bodies?  

C. Last question about asymptomatic transmission:  I understand HSV is a “skin to skin” type of transmission.  If I am with my partner and have been touching myself, and with that same hand, touch my partner in a mucosal area, can I transmit the virus to my partner?  Is this likely and/or probable is this?   In years gone by I had thought of “skin to skin” as the actual direct contact of my skin to an area on my partners body, not from me,  to my hand, to my partner.  Sorry to be so dicey, just trying to comprehensively understand.

D. I read recently something about a person with oral HSV1 has “protection” against developing GHSV1.  Is this true?  I don’t believe I’ve ever heard it before.  

Thanks everyone for your input,  remember—please keep it in layman’s terms.   WilsonInAu, I value your opinion, please feel free to respond.

Henry.

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WilsoInAus

Hey @JHenry I'll have a crack.

There are numerous studies on the transmission rates of HSV-2 to seronegative partners. These are typically done with monogamous couples and explore condom usage and antiviral use. In theory all transmissions relate to asymptomatic shedding as clearly all participants are well aware of their status and to stay clear of outbreaks. 

A) The general summary of the findings maybe expressed as follows:

Male to Female annual chance of transmission, about 100 episodes of sexual activity:

No antivirals or condoms used: 8%. This means for 100 couples where the male is positive and females negative, we expect 8 females to become infected in the year. The longer the infection, potentially the lower the rate of transmission.

Antivirals used: 4%. This is potentially a 'poor' case in the sense that there was probably pretty patchy use of acyclovir. Very regular daily use of valtrex (or twice daily of acyclovir) may result in an even better reduction in odds.

Antivirals and condoms: 2%. This probably also includes patchy condom use. Terri Warren holds the view that condoms used correctly on an infected male reduces the transmission rate by up to 90%.

Here is one study that provides an example that is quite consistent with the above: https://www.nejm.org/doi/full/10.1056/NEJMoa035144

B) Without sex you are talking a negligible chance of transmission, no issues with sleeping naked.

C) The virus transfers via anything very poorly. The infection chances are dramatically lower than above, its a theoretical possibility only. No more than 10% of the chance of vaginal sex transmission as discussed above.

D) Yes when you have one type as an established infection, you have strong immunity to further infection in another location. There is no documented case of it occurring.

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JHenry

First off, thank you Wilson, just couldn’t do it without you.

A) In question A, Help me extrapolate this into a conversation for telling a potential partner.  If my partner and I had sex 100x in a year, and I am on Valacyclovir, what are the odds I would transmit the virus to her?  Can that be expressed as a percentage of risk?    That is what I’m trying to drill this down to.

B) Regarding B, I am assuming that cuddling (spooning) naked is essentially a “no-risk” option?

C) I’m interpreting your response to C to say while things can and do happen, it’s highly unlikely and improbable to spread my GHSV2, via my hand, to a partner by touching a mucosal area of there’s with that same hand of mine?  

D) D sounds pretty self-explanatory.   If you have oral HSV1, it’s never been documented to be re-infected with that same virus in another (in this case genital) area. 

Thanks Wilson, you are my “go-to” guy.

Henry.

1 hour ago, WilsoInAus said:

Hey @JHenry I'll have a crack.

There are numerous studies on the transmission rates of HSV-2 to seronegative partners. These are typically done with monogamous couples and explore condom usage and antiviral use. In theory all transmissions relate to asymptomatic shedding as clearly all participants are well aware of their status and to stay clear of outbreaks. 

A) The general summary of the findings maybe expressed as follows:

Male to Female annual chance of transmission, about 100 episodes of sexual activity:

No antivirals or condoms used: 8%. This means for 100 couples where the male is positive and females negative, we expect 8 females to become infected in the year. The longer the infection, potentially the lower the rate of transmission.

Antivirals used: 4%. This is potentially a 'poor' case in the sense that there was probably pretty patchy use of acyclovir. Very regular daily use of valtrex (or twice daily of acyclovir) may result in an even better reduction in odds.

Antivirals and condoms: 2%. This probably also includes patchy condom use. Terri Warren holds the view that condoms used correctly on an infected male reduces the transmission rate by up to 90%.

Here is one study that provides an example that is quite consistent with the above: https://www.nejm.org/doi/full/10.1056/NEJMoa035144

B) Without sex you are talking a negligible chance of transmission, no issues with sleeping naked.

C) The virus transfers via anything very poorly. The infection chances are dramatically lower than above, its a theoretical possibility only. No more than 10% of the chance of vaginal sex transmission as discussed above.

D) Yes when you have one type as an established infection, you have strong immunity to further infection in another location. There is no documented case of it occurring.

First off, thank you Wilson, just couldn’t do it without you.

A) In question A, Help me extrapolate this into a conversation for telling a potential partner.  If my partner and I had sex 100x in a year, and I am on Valacyclovir, what are the odds I would transmit the virus to her?  Can that be expressed as a percentage of risk?    That is what I’m trying to drill this down to.

B) Regarding B, I am assuming that cuddling (spooning) naked is essentially a “no-risk” option?

C) I’m interpreting your response to C to say while things can and do happen, it’s highly unlikely and improbable to spread my GHSV2, via my hand, to a partner by touching a mucosal area of there’s with that same hand of mine?  

D) D sounds pretty self-explanatory.   If you have oral HSV1, it’s never been documented to be re-infected with that same virus in another (in this case genital) area. 

Thanks Wilson, you are my “go-to” guy.

Henry.

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