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Dating again with hsv2 after 20 year marriage


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I am a 54 year old male. I picked up hsv2 when I was 21. At the start my OBs were very frequent. Over the years they have diminished significantly. I now experience them 1-2 every couple years. 
I was married for 20 years and never transmitted the virus. I / we were careful and did not have much sex anyways. 
I am now in a relationship with a woman who I told about my virus prior to sex. I have been on antivirals and we use a condom every time. Well... almost .. we have slipped a couple times. My doctor says that Transmission is very low during dormant times and being on antivirals is another layer of protection. Having not really thought about it for 20 years, I am now paranoid about “shedding” and transmission. There is so much out there I don’t know what to believe other than abstinence is best (which is not an option). 
Just wondering if there are any other “old folk” Out there that can shed (no pun intended) some light on best practices and may have hard data on transmission rates. I freak out when (after a few drinks) we have skipped the condom. I worry for days. 

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On 5/31/2021 at 8:26 AM, Jtkirk44 said:

I am a 54 year old male. I picked up hsv2 when I was 21. At the start my OBs were very frequent. Over the years they have diminished significantly. I now experience them 1-2 every couple years. 
I was married for 20 years and never transmitted the virus. I / we were careful and did not have much sex anyways. 
I am now in a relationship with a woman who I told about my virus prior to sex. I have been on antivirals and we use a condom every time. Well... almost .. we have slipped a couple times. My doctor says that Transmission is very low during dormant times and being on antivirals is another layer of protection. Having not really thought about it for 20 years, I am now paranoid about “shedding” and transmission. There is so much out there I don’t know what to believe other than abstinence is best (which is not an option). 
Just wondering if there are any other “old folk” Out there that can shed (no pun intended) some light on best practices and may have hard data on transmission rates. I freak out when (after a few drinks) we have skipped the condom. I worry for days. 

Hey Jtkirk, not sure these stats help answer your questions regarding transmission rates.... hope they do.  Sounds like you are doing all the right things to prevent transmission already.....

- Condoms are one of the best ways to reduce the risk of transmission. A study from 2016 followed over 900 couples for an average of 18 months. The findings showed that condoms reduced the transmission rate with each act of intercourse from men to women by 96% and from women to men by 65%. 

-daily Valtrex has been shown to reduce genital herpes outbreaks by 70% to 80%

- and then there is this report from the Journal of American Medical Association (JAMA) regarding a study comparing the efficacy of valacyclovir vs pritelivir (not yet on the market) but it hopefully gives you an idea as to shedding rates if you are taking valtrex:

HSV Genital Shedding

Herpes simplex virus was detected in 173 of 7276 swabs (2.4%) obtained during pritelivir treatment and 392 of 7453 swabs (5.3%) obtained during valacyclovir treatment. The frequency of detection of HSV in genital swabs was lower during pritelivir treatment than during valacyclovir treatment (relative risk [RR], 0.42; 95% CI, 0.21-0.82; P = .012; Table 2 and Figure 2A). The HSV copy number on the days that HSV was detected did not differ by group: for a mean 3.2 log10 copies/mL during pritelivir treatment vs a mean 3.7 log10 copies/mL during valacyclovir treatment (P = .83; Figure 2B). The frequency of subclinical shedding was significantly lower during pritelivir treatment than during valacyclovir treatment, 1.8% vs 4.1% (RR, 0.40; 95% CI, 0.20-0.81; P = .01; Figure 2C). The rate of shedding when patients reported genital lesions was not significantly different during pritelivir and valacyclovir treatment, 29.9% vs 37.1% (P = .76).

The frequency of shedding episodes was not found to differ by treatment, with 1.3 per person-months while taking pritelivir and 1.6 per person-months while taking valacyclovir (RR, 0.80; 95% CI, 0.52-1.22; P = .29). The proportion of episodes lasting less than 24 hours was higher during receipt of pritelivir vs valacyclovir (87% vs 69%, P = .005; eFigure 1 in Supplement 3).

Subgroup analyses by sex, age, and duration of genital herpes showed potentially stronger reductions in shedding and lesions for women and for those younger than 50 years. However, this study was not designed to compare efficacy between groups; and group differences were not tested statistically. Per-protocol analyses conducted on 51 persons who completed study medication without protocol deviations also showed similar results (eTable 1 in Supplement 3), except HSV quantity was significantly lower during treatment with pritelivir (pritelivir, log10 2.9 vs valacyclovir, log10 3.7, P < .001) and median duration of recurrences was not significantly lower during pritelivir treatment (3.0 days vs 6.0 days, P = .050). A sensitivity analysis that excluded the initial week of each group was also consistent (eTable 2 in Supplement 3).

 

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Thank you. There is so much out there that the information is overwhelming (what is true / what isn’t) I am concerned with the shedding stats as this was not even a “thing” 30 years ago. If no OB I understand that there is still a possibility of asymptomatic shedding. 

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Posted (edited)

I know I have read in some reports that outbreaks and shedding decrease with age, particularly those over 50..... I can't find the source of those reports relating directly to age >50.   However, this link below takes you to an interesting study regarding HSV2 shedding and age.... note the quote: "HSV-2 shedding may also decrease over time, as 2 studies demonstrated that subclinical shedding rates declined by approximately half after the first year of infection [6, 8]. Despite these observations, detailed data on genital HSV-2 shedding many years after herpes acquisition are limited.

This report is detailed but, it definitely shows the decrease in shedding with age but, please note that the study found that while shedding definitely decreases after the first year of exposure, it appears that shedding never actually stops with aging.... the shedding seems to reach some type of equilibrium over time but varies person-to-person.... so, even if you're over 50, you are still likely shedding but not nearly as much as the "early days.".... hope that gives  you the answer (and peace of mind) you were asking about.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058740/#:~:text=HSV-2 shedding may also,after herpes acquisition are limited.

 

Edited by CHT
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