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1. Is a linear relationship assumption between shedding rates and transmission rates fair? In other words, if someone sheds 10 times less than usual, the likelihood of transmission is also 10 times less than usual.
I don’t think we have enough data to say that that is true.
2. Is an assumption that Valtrex will reduce the transmission rates for HSV-1 as much as it reduces them for HSV-2 fair?
No, because shedding of genital HSV 1 is so uncommon, the benefit is probably less.
3. I am circumscised. I have read that ciscumscision further lowers transmission rates in the absence of condoms, but this claim seems to be contested as there may be some confounders, such as the fact that people that are circumscised appear to be more likely to use condoms. What do you think about this? Do you believe there is a causal relationship between circumscision and transmission rates?
I Believe the data that men who are circumcised are less vulnerable to acquisition of HSV two and other sexually transmitted infections because the skin on the shaft of the penis under the foreskin is quite thin and vulnerable.
Given that the base transmission rate for someone that has HSV-2, female to male, would be 4%, if assumptions 1 & 2 hold, I have calculated the transmission rate in my case to be roughly 0.1% per year. According to this study, after 2 years gHSV-1 sheds 1.3% of days, compared with ~20% for gHSV-2, so that would reduce my transmission rate by ~20x. Valtrex use would additionally divide it by 2.
I don’t think that we can go there because we just don’t have enough data yet.
We know for sure the people with HSV to genital infection shed rarely and probably Valtrex would help to reduce that sun but these numbers are just not confirmed and I would not go that far with a statement to that effect.