HSV-1 questions

[questions81]

Dear Terri,

Thank you for providing this service.

My girlfriend has G-HSV-1. I do not have HSV-1 (confirmed). I’d like to know what my risks are of getting it from her (I am a male, uncircumcised).

She has had G-HSV-1 for 8 years – two outbreaks, the initial one and one two years ago.

Here is my math. Assuming G-HSV-1 sheds 2/3 less than HSV-2 – if my chance of getting it from her is 4% with HSV-2 then that would be reduced to about 1.3% given it’s HSV-1. From there, if she is on supressive therapy, it would be reduced theoretically another 50% (bringing chance to 0.7% roughly), and then if we use condoms, another 50%, meaning 0.4% roughly, per year. Does that check out to you? I’ve read in studies that you are roughly 30% more likely to get HSV if you are UNcircumcised (as I am), meaning the risk would rise again closer to 0.7% assuming valtrex and no condoms. I realize this is all highly theoretical given there isn’t clear data, but this ROUGH math makes sense to me given what we know. What do you think?

Lastly, I want to ask you. We’re in a committed relationsip, likely looking towards the long term. Ideally we’d like to be able to have sex without condoms OR suppressive therapy. But I’d still like to not get this from her. Do you have patients who don’t use supressive therapy or condoms and don’t transmit HSV-1 in the long term? I saw on an earlier thread that you haven’t seen a case of HSV-1 transmitted genitally in your practice. Does this mean that to your knowledge, none of your patients has transmitted it to a partner and that you haven’t seen a case in your clinic that you KNOW to have been genital to genital? I’ve also read that men are LESS likely to get HSV-1 genitally in the first place than women. Is that true?

Thank you very much. I am trying to make this less of a big deal in my head because this girl is very important to me.

[Terri Warren]

First, let me say even if you tested negative by the IgG test, that test misses 30% of infections compared to western blot so you may or may not be actually infected. And retesting over and over with IGG does not help clarify the picture.

If you actually are uninfected, then I think your math is about right.

It is correct that I have not seen HSV 1 genitally transmitted via intercourse, correct.
I think men and women are equally likely to get HSV 1 genitally

Terri

[questions81]

Thanks Terri. Good to know about the western blot, I’ll definitely take it into consideration.

A follow up: Why would men and women be equally likely to get HSV1 genitally from intercourse when the figures are substantially different for HSV-2 for women and men (likelihood at 10% and 4% per year, respectively, from what I’ve seen?) Have those numbers changed?.

Also, could you clarify a bit more about the 3-5% shedding statistic for HSV-1? Does that figure include days with lesions or is it just subclinical? Does some of that subclinical shedding occur right before lesions appear? And is it a mix of old and new infections (e.g. would you expect that number to go down a bit over time?)

Lastly, would you expect someone who has had few recurrences of the virus to shed less than someone who has more frequent recurrences?

Thank you very much!

[Terri Warren]

A follow up: Why would men and women be equally likely to get HSV1 genitally from intercourse when the figures are substantially different for HSV-2 for women and men (likelihood at 10% and 4% per year, respectively, from what I’ve seen?) Have those numbers changed?.

The reason is because most HSV 1 is from oral sex and mouth to genitals is about the same in men and women. With HSV 2 and intercourse, women are more likely to become infected because they have a penis in their vagina rubbing virus in during intercourse. They are receptive with intercourse and that is the big risk. Oral sex is application of mouth to genitals and that risk is anatomically similar enough that I don’t think there is much difference there. I’ve not checked on the statistics of that recently however. I could be wropng

Also, could you clarify a bit more about the 3-5% shedding statistic for HSV-1? Does that figure include days with lesions or is it just subclinical? Does some of that subclinical shedding occur right before lesions appear? And is it a mix of old and new infections (e.g. would you expect that number to go down a bit over time?)

It is a total of days and a mix of old and new infection. Those are old numbers and there is a new study that has been done that may reveal new information when published

Lastly, would you expect someone who has had few recurrences of the virus to shed less than someone who has more frequent recurrences?

Definitely

Terri

[questions81]

Hi Terri,

When you say “it is a total of days” do you mean days with AND without lesions?

And could you please elaborate a bit more on why you would expect to see less subclinical shedding from someone who has fewer recurrences of the virus? Could you explain a bit more about this?

Thank you!

[Terri Warren]

Yes, total days is with and without lesions.

When we do daily home swabbing studies on people who have recognized outbreaks and on people who simply test antibody positive for HSV 2 but do not have outbreaks, we see more shedding in the symptomatic group

This is your final post on this subscription. If you have more questions, feel free to renew

Terri

• This reply was modified 5 years, 6 months ago by Terri Warren.

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