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National Cervical Cancer Coalition


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PostPosted: Mon Oct 18, 2010 12:32 pm 

Joined: Sat Oct 16, 2010 10:34 pm
Posts: 2
Location: US
I'm confused about some issues and have several quetions. I hope that's okay to have several in one post.

I have had herpes for over 10 years. I have been taking acylcovir 2x daily for the past year (I've done this once or twice before, too.) I have had no outbreaks as long as I take the acylovir; without it, I've only had one or two outbreaks a year since the first bad year with 6 or 7 oubreaks. The only outbreaks I've seen (or my gyno has seen) are on one buttock.

So, some questions:

1) How much does the acyclovir reduce asymptomatic shedding? Are there studies of days of shedding on suppression?
2) I read that if people only avoid sexual contact during an outbreak that transmission is low--but what about all the asyptomatic shedding? I also read that most transmission occurs during asymptomatic shedding? This seems contradictory?
3) Would asymptomatic shedding occur at the usual outbreak site (butt) or elsewhere (genitally) or both?
4) I read that autoinnocultion is rare and usually at the first outbreak--would the chance of this be further reduced by acyclovir? Are cuts on hands, etc, a risk after these many years? (Bad habit of pulling off my gloves while gardening...)

Also, regarding location:
5) The outbreak area on my butt doesn't mean that's the site of infecton, or does it? (Doesn't matter, really, I've just been asked by someone.)
6) Am I shedding elsewhere during an outbreak or just there? I'm guessing I'm shedding genitally too based on what I read ,but not sure.

Thanks.


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PostPosted: Mon Oct 18, 2010 3:54 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
1) How much does the acyclovir reduce asymptomatic shedding? Are there studies of days of shedding on suppression?
It reduces shedding of the virus by about 80% or so on average. You still can shed the virus even while on daily suppressive therapy but it's greatly reduced. So for instance if the virus is typically active 10 days out of every 3 months on average, being on daily suppressive therapy would take it down to 2 days out of those 3 months that it was active. the odds of you having sex on those 2 days in general is low which is why it also helps to reduce transmission to a partner. less shedding of the virus means less times your partner will have contact with you when the virus is potentially active ( I am mathematically impaired so I have to keep it simple but that's pretty close to how active the virus would typically be during that time period )


2) I read that if people only avoid sexual contact during an outbreak that transmission is low--but what about all the asyptomatic shedding? I also read that most transmission occurs during asymptomatic shedding? This seems contradictory?
yes if you just avoid sex during obvious genital symptoms the rates of transmission are low but not impossible obviously. rates of transmission just doing that vary according to gender. The reason why most times it's transmission when symptoms aren't present is because the vast majority of people who have hsv2, have no idea they have it until they are tested. Don't know that you are infected and you'll have sex probably when you have an itchy spot or some other milder symptom of herpes. the study that 70% of all genital herpes infections are transmitted when no symptoms were present was if I recall one of those in hindsight type studies where they asked folks newly infected with herpes if their partner had had symptoms of herpes when they had sex - most said no. Most folks assume if you had genital herpes you'd have very obvious and painful symptoms so if they don't have those, they assume they aren't infected and don't abstain from sex when things are going on in the genital area.

3) Would asymptomatic shedding occur at the usual outbreak site (butt) or elsewhere (genitally) or both?
when you have ob's on your buttocks, you are shedding from the area of the lesion and also from the entire anogenital area. In between obvious recurrences you are shedding periodically from the anogenital area. The skin on the buttocks is too thick for the virus to shed from without obvious lesions present.


4) I read that autoinnocultion is rare and usually at the first outbreak--would the chance of this be further reduced by acyclovir? Are cuts on hands, etc, a risk after these many years? (Bad habit of pulling off my gloves while gardening...)
I've only ever known 1 person to give themselves herpes on their hands after being infected for years. she is a quilter and pricks her fingers often and ended up with whitlow many years into being infected. for most folks, it's not going to happen. spreading the virus to other body parts even during the initial infection is very unusual too.

5) The outbreak area on my butt doesn't mean that's the site of infecton, or does it? (Doesn't matter, really, I've just been asked by someone.)
no it doesn't mean that's where you infected with the virus at. it's just a location the virus likes to reoccur at for you.

6) Am I shedding elsewhere during an outbreak or just there? I'm guessing I'm shedding genitally too based on what I read ,but not sure.
see above

keep asking questions!

betsy

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PostPosted: Mon Oct 18, 2010 8:10 pm 

Joined: Sat Oct 16, 2010 10:34 pm
Posts: 2
Location: US
Besty, many thanks for your prompt and very thorough response!


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