GHSV1 a question on statistics

[disappointed]

Hi Terri,

I’m in medicine. I was never taught that HSV1 could present as aphthous ulcers. I (F) was with a partner for months until I had a first outbreak that was diagnosed as GHSV1. He never had a typical cold sore or any type of genital outbreak. It has been over two years and that was my only outbreak. I was with a new partner for a few months (without valtrex, including unprotected sex) after which they tested negative (IgG). I understand that, theoretically, there will always be a non-zero chance of transmission – but my question is given that we do not have studies on specific cases such that would elucidate risk of someone who has had one outbreak ever vs someone who may have had more outbreaks. How do we better communicate this risk?

For a female with a once ever GHSV1 outbreak (2.5 years ago) who has evidence of an intimate partner not becoming infected over several months…
If on top of this, we were to use condoms exclusively as well as daily valtrex
I am also aware that not all ethnicities are equally vulnerable (i.e. esp non Caucasian) could this suggest not as easily to shed virus?
Finally, do we know by what age it is likely that most people seroconvert or what that chance is?
Are there any real chances of therapeutic vaccines that would eliminate risk of shedding?

Thank you.

[Terri Warren]

For a female with a once ever GHSV1 outbreak (2.5 years ago) who has evidence of an intimate partner not becoming infected over several months…
Was that confirmed with antibody testing? If yes, then this suggests that you aren’t shedding often, which I would expect after being infected with GHSV1 for more than two years. Christine Johnston’s work suggest that at 2 years out from infection, people shed on about 4 days out of a year.

If on top of this, we were to use condoms exclusively as well as daily valtrex
That would reduce it but because it is so rare anyway, we don’t know by how much

I am also aware that not all ethnicities are equally vulnerable (i.e. esp non Caucasian) could this suggest not as easily to shed virus?
We don’t have any data to suggest that, no.

Finally, do we know by what age it is likely that most people seroconvert or what that chance is?
We don’t.

Are there any real chances of therapeutic vaccines that would eliminate risk of shedding?
oh yes, but the research is focusing on HSV 2 but we already know from preliminary results that it benefits HSV 1 as well, at least in one example.

Terri

oh yes, but the research will focus mostly on HSV 2

[disappointed]

Hi Terri – Thank you for your thoughtful response.

Yes the partner’s status was confirmed with antibody testing (also after a period of no physical contact).

When we say transmission given at most shedding 4 days/year with the use of condoms and valtrex would be very rare, how should we interpret that? Do we have a number or % that it would be at least better than xyz%?

If I’ve never had any symptoms orally, should I worry about oral shedding?

[disappointed]

Sorry, I meant to add*
How is this, if it is, “very rare” different from say someone who had mono in the past and still has ebv and there have been cases of asymptomatic shedding documented at some point in the literature.
Or similarly, of varicella.

Thank you so much.

[Terri Warren]

I guess I’m not sure about what you are asking here. We have no data on transmission of HSV 1 genital infection, only shedding data.
We also know that if you’ve not had a recurrence within one year of being infected, there is an 88% chance that you may not in the future.

Terri

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