› Forums › Herpes Questions › Clarifying GHSV1 stats
 This topic has 7 replies, 3 voices, and was last updated 1 year, 12 months ago by Terri Warren.

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August 12, 2019 at 3:15 pm #45113Fermi12358Participant
Hi Terri, and apologies for abusing your word count:
1. What’s the best reference for the risk of someone who has OHSV1 contracting GHSV1? While I’ve seen the WHO’s comment that it’s unlikely and your comment on the forum that you’ve seen one case in 35 years, I’ve also seen comments to the contrary in the literature. Despite that, I cannot find any real data on this.
2. I’ve seen you cite Christine Johnston’s unpublished research on GHSV1 shedding rates. Can you share her conference presentation? If not, can you clarify the viral shedding rates she found? I’ve seen the 12%, but not differentiated by time with the virus.
3. I assume the viral shedding rate stats (whether Johnstons or those you cite in your handbook) include only asymptomatic days. Is that right?
4. Is contagion risk proportional to viral shedding rate? In other words, if we assume viral shedding rates of 2% for GHSV1, 14% for GHSV2, and 26% for OHSV1, can we say that exposure is 7x more likely to lead to infection for GHSV2 than GHSV1, and 13x more likely for OHSV1 than GHSV1?
5. If question 4 is in the right ballpark, then you might be LESS likely to get GHSV1 from someone with GHSV1 than from someone without it, assuming someone without it is more likely to have OHSV1. Could that possibly be right?
6. When asked on the forum about HSV1 genitaltogenital transmission rates, you stated “I personally have not seen a new case of HSV 1 genital infection where the person has not received oral sex, let’s put it that way.” That seems odd if contagion risk is proportional to viral shedding rate, since 2% of days is not trivial for a sexually active couple. Am I misunderstanding why genitaltogenital HSV1 transmission is so rare?
Thanks!
 This topic was modified 4 years, 6 months ago by Fermi12358.

August 17, 2019 at 12:33 pm #46317Terri WarrenKeymaster
1. What’s the best reference for the risk of someone who has OHSV1 contracting GHSV1? While I’ve seen the WHO’s comment that it’s unlikely and your comment on the forum that you’ve seen one case in 35 years, I’ve also seen comments to the contrary in the literature. Despite that, I cannot find any real data on this.
I would be interested in comments in the literature that you quote. Are those professional journals? Could you cite them for me? I honestly don’t think there is anything published on this. I know that Dr. Anna Wald, Dr. Hunter Handsfield and Dr. Ned Hook all agree with this statement. Hard to prove a negative
2. I’ve seen you cite Christine Johnston’s unpublished research on GHSV1 shedding rates. Can you share her conference presentation? If not, can you clarify the viral shedding rates she found? I’ve seen the 12%, but not differentiated by time with the virus.
She found 13.7% at 23 months out from new infection, 7.1% of days at 1112 months out and 1.3% at 2 years out.
3. I assume the viral shedding rate stats (whether Johnstons or those you cite in your handbook) include only asymptomatic days. Is that right?
It includes all days
4. Is contagion risk proportional to viral shedding rate? In other words, if we assume viral shedding rates of 2% for GHSV1, 14% for GHSV2, and 26% for OHSV1, can we say that exposure is 7x more likely to lead to infection for GHSV2 than GHSV1, and 13x more likely for OHSV1 than GHSV1?
I don’t know that it is as simple as that as there are multiple factors involved in transmission include noninfected partner immune status, etc.
5. If question 4 is in the right ballpark, then you might be LESS likely to get GHSV1 from someone with GHSV1 than from someone without it, assuming someone without it is more likely to have OHSV1. Could that possibly be right?
You are more likely to be infected by someone with oral HSV 1 than genital HSV 1
6. When asked on the forum about HSV1 genitaltogenital transmission rates, you stated “I personally have not seen a new case of HSV 1 genital infection where the person has not received oral sex, let’s put it that way.” That seems odd if contagion risk is proportional to viral shedding rate, since 2% of days is not trivial for a sexually active couple. Am I misunderstanding why genitaltogenital HSV1 transmission is so rare?
The shedding rate for people with well established HSV 1 is 1.3% of day – that’s four days out of the year. Even with lots of sex (and married couples average intercourse about twice a week or less), may no be easy to hit those four days.
Terri

August 17, 2019 at 7:44 pm #46331Fermi12358Participant
Thanks Terri,
I really appreciate the service you’re providing. That said, my comments below are kind of snarky because my impression now is that you’re playing pretty fast and loose with the stats you cite:
1. I can try to find the comments, but they don’t cite evidence, so I don’t think they’re that meaningful except as evidence that views on this point are not uniform. More importantly, this is not about proving a negative. It’s about estimating the rate at which one who already has OHSV1 contracts GHSV1. It should be possible (in principle) to find a class of people who shed HSV1 only orally and then measure what fraction of them later in life begin shedding HSV1 genitally upon exposure.
2. I suggest you not cite the 2% stat without being very clear that this is 2+ years out. Otherwise, it seems highly misleading.
4. FWIW, partner immunity shouldn’t factor in here. One’s contagion risk can be calculated independent of any partnerspecific factors, which should be an independent variable.
5. You misunderstand me. Assume 50% of the population has OHSV1, 10% of the population has GHSV1, 20% of the people with GHSV1 also have OHSV1 (because they got them at the same time), and OHSV1 is 13x more contagious than GHSV1 (based on viral shedding rates). Now imagine two sexual partners: person A has GHSV1 and person B does not (and has no clue about OHSV1). Person B is 1.8x more likely to give you GHSV1 (assuming oral and genital sex) than person A. If true, that would be extremely important: A GHSV1 diagnosis actually makes you SAFER!!
6. First off, the 1.3% stat is for people 2+ years out. You really need to make that explicit. But even assuming that, if a partner is contagious 4 days a year and people have sex 2x/week, then there’s a 28% chance of sex on each of those 4 days, meaning a 63% chance of having sex on a viral shedding day during the first year and an 86% chance after 2 years.

August 24, 2019 at 9:44 am #47617Terri WarrenKeymaster
1. I can try to find the comments, but they don’t cite evidence, so I don’t think they’re that meaningful except as evidence that views on this point are not uniform. More importantly, this is not about proving a negative. It’s about estimating the rate at which one who already has OHSV1 contracts GHSV1. It should be possible (in principle) to find a class of people who shed HSV1 only orally and then measure what fraction of them later in life begin shedding HSV1 genitally upon exposure.
That research has not been done
2. I suggest you not cite the 2% stat without being very clear that this is 2+ years out. Otherwise, it seems highly misleading.
If you look above, I do cite the 2+ years out, and it isn’t 2%, it is 1.3%
4. FWIW, partner immunity shouldn’t factor in here. One’s contagion risk can be calculated independent of any partnerspecific factors, which should be an independent variable.
It really isn’t quite that simple as we don’t know all of the factors involved in transmission. For example, we know that antivirals reduce shedding by around 70% but transmission by only by only 48%. Something is going on there but we just don’t know all the factors involved in transmission or lack of transmission. So I would respectfully disagree that partner specific factors don’t play a role in calculating transmission.
5. You misunderstand me. Assume 50% of the population has OHSV1, 10% of the population has GHSV1, 20% of the people with GHSV1 also have OHSV1 (because they got them at the same time), and OHSV1 is 13x more contagious than GHSV1 (based on viral shedding rates). Now imagine two sexual partners: person A has GHSV1 and person B does not (and has no clue about OHSV1). Person B is 1.8x more likely to give you GHSV1 (assuming oral and genital sex) than person A. If true, that would be extremely important: A GHSV1 diagnosis actually makes you SAFER!!
Safer from what?
6. First off, the 1.3% stat is for people 2+ years out. You really need to make that explicit. But even assuming that, if a partner is contagious 4 days a year and people have sex 2x/week, then there’s a 28% chance of sex on each of those 4 days, meaning a 63% chance of having sex on a viral shedding day during the first year and an 86% chance after 2 years.
An 86% chance of having intercourse on a shedding day after the second year, when a person is shedding only 4 days a year? I’m sorry but that doesn’t make sense to me.
Terri

February 24, 2022 at 2:42 am #76641factual_basisParticipant
I am a lurker here with GHSV1. I want to set the math straight here.
2 years out after infection with 1.3% shedding, that is ~ 114 hours.
Let us generously say PIV sex 144 times a year (that is a lot IMO). Sexual act lasting 10 minutes on average (I am being generous here, average is 5.5 minutes).
That is 1440 minutes or 24 hours of sex/year.Now there is 8760 hours in a year. Within that span to match the 24 h with 114 h of shedding is (24/8760)*(114/8760) x 100% ~ 0.0036%/yr. Meaning, assuming the shedding remains the same i.e. 1.3% for 35 years of a relationship, chance of spreading is not more than 0.13%. I have also not accounted for the fact that as people get older, they have less sex.
Now we also have to make an allowance for not all shedding being causative of transmission, i.e. viral titers have to exceed a certain minima for transmission.

February 24, 2022 at 2:58 am #76642factual_basisParticipant
Over 35 years (edit) actually 12 % transmission odds. And these are assuming 1.3% stabilizes over 35 years, 144 times sex/year each lasting 10 minutes and every shedding event translating to a transmission.
Odds are you are more likely not to transmit this GHSV1 genitally to a partner than to transmit it even after 35 years.

February 24, 2022 at 3:12 am #76643factual_basisParticipant
12 % should read 0.12%.
Also, let us assume Dr. Christine Johnson’s subjects sampled only over an 8 hour window and sex occurs only during a certain 8 hour window,then risk of transmission per year is 24/2920*114/2920*100% ~ 0.032%/yr transmission risk.
Over 35 years that is. 1.11% risk of transmission.
And all this with generous assumptions that are weighed towards transmission.
Lifetime odds of dying in a car accident as of 2019 is 1/107~ 0.93%.
Therefore you are more likely to die in a car crash than to spread this to someone.
I did this math and saved money on therapy after my diagnosis 😂.

March 2, 2022 at 9:20 am #76689Terri WarrenKeymaster
On this post, I’m just answering questions for Fermi, but I do appreciate your comments, thanks. I’m sure others will really appreciate them as well.
Terri


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