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National Cervical Cancer Coalition


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 Post subject: Viral Shedding
PostPosted: Sun Sep 18, 2011 1:34 pm 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
Hi. I'm new to the board. This is a great resource - thanks!

I was infected with HSV2 four years ago. I was wearing a condom, and was infected in the pubic area below my navel. I guess I beat the odds. Proof that it can happen. I take Valtrex daily (500mg) and wear a condom when I have sex. My partner is negative. We would like to have unprotected sex once in a while but we're worried about shedding. Sometimes I get a tingly, itchy feeling but I haven't had a severe OB since I've been on Valtrex. Occassionally I will develop an itchy red patch, but then the Valtrex seems to kick in and it does not progress to an OB. A few questions:
1. How often do I shed the virus while on Valtrex? Is it 15 out of 100 days?
2. Do I shed, even when I don't get the tingly, itchy feeling?
3. Is it possible to self-swab for the virus, and get a lab to test for frequency of shedding? My doctor has been helpful but is such a service even available?

Thanks again.


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 Post subject: Re: Viral Shedding
PostPosted: Wed Sep 21, 2011 1:54 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
condoms only reduce transmission of hsv2 by about 30% on average. they aren't fool proof which is why we always recommend periodic testing even if you always use condoms. What testing did you have done to diagnose you as having hsv2?

I assume your current partner has had proper testing too and not just assumed negative?

1. How often do I shed the virus while on Valtrex? Is it 15 out of 100 days?

- far less with daily suppressive therapy. suppressive therapy reduces ob's by about 70% on average and shedding by 80-90% on average.

2. Do I shed, even when I don't get the tingly, itchy feeling?

- yes you are having times of viral shedding even without any obvious symptoms. It won't happen very often on suppressive therapy but it can and probably does still happen.

3. Is it possible to self-swab for the virus, and get a lab to test for frequency of shedding? My doctor has been helpful but is such a service even available?

- yes this can be done however it will cost you quite a bit of money to do daily swabbing as well as the results are meaningless in the big picture overall. Why? Because that's shedding for just those particular days and times, you might not shed a lot the month or two you would do swabbing but that isn't to say that say 6 months down the road you'll catch the flu and maybe shed more because your body is run down.


you taking daily suppressive therapy , avoiding sex during obvious genital symptoms and using condoms makes a female partner's risk on average 2-3%/year. Stop using condoms and it is on average 4-5%/year risk of transmission. Do you have to take full precautions just because you have hsv2? Actually no you do not - it's totally up to you and your partner what precautions to take. Many couples don't do anything other than avoid sex during obvious symptoms, it's their choice and overall, your female partner is still 90% likely each year NOT to contract hsv2 from you.

keep asking questions :)

betsy

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 Post subject: Re: Viral Shedding
PostPosted: Fri Jan 06, 2012 1:17 pm 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
Thanks for your helpful reply. I can't remember the kind of antibody blood test that I had, but it was done by a doctor who practices in a large US city and who knows his stuff.

I wish I had known that condoms are not a sure-fire way to prevent HSV2 transmission. It's amazing sometimes how poorly educated we are about HSV. Is the virus shed from the entire genital region, not just from the place of initial infection?

Re viral shedding, I read in the latest issue of The Helper about the new class of HPI anti-viral drug that's undergoing clincial trials. Sounds kind of promising, although my partner and I got our hopes up during the Herpevac vaccine trials, only to have them dashed.

In a best case scenario, how many years will it take AIC316 to progress from Phase II to Phase III trials to market?

Thanks.


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 Post subject: Re: Viral Shedding
PostPosted: Sat Jan 07, 2012 3:32 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
At least 5 years at the very minimum but I'm guessing longer since things aren't progressing quickly in this economy.

I'm a trust no one kind of person when it comes to herpes testing. If you just had a blood test for herpes and not also a lesion culture that was +, call, get the results of your testing and post them here - e.g. hsv1 igg 7.9 and hsv2 igg 3.3 or whatever they are just so we can be sure that indeed you did have the right testing done and don't need further confirmatory testing done.

daily suppressive therapy, condom use and avoiding sex anytime you have anything going on genitally keeps the risk to a female partner down to less than her risk of becoming pregnant while using the pill for birth control. It really does work and getting the risk of transmission down to less than 2-3%, isn't actually going to be all that significant to be honest. It's not really a case of "we need something that works better", it's a matter of using what precautions we know work properly more than anything.

betsy

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 Post subject: Re: Viral Shedding
PostPosted: Sun Jan 08, 2012 10:27 am 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
OK, I will try to get the details of my blood test, although this was four years ago and I haven't been in touch with my doctor since. Your stats about the risks if you're on suppressive therapy, use condoms, etc. are certainly reassuring, but given that I seem to have beaten the odds, so to speak, by getting it while using a condom, I'm a bit paranoid about infecting my partner. I'm more worried than she is, so your email is reassuring. One last question, for which I have heard different answers: can HSV2 be transmitted through oral sex? What are the chances of transmittal if I don't wear a condom but am on suppressive therapy and there's nothing going on down there?


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 Post subject: Re: Viral Shedding
PostPosted: Mon Jan 09, 2012 4:32 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
it's 4-5% risk/year of transmitting hsv2 to her without using a condom.

you can transmit hsv2 to the oral area but the odds of such are pretty low. discuss with your partner whether it's worthwhile to have protected oral sex or not.

just call the clinic and ask them to read your test results to you and write them down. The secretary or nurse can do that for you.

betsy

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 Post subject: Re: Viral Shedding
PostPosted: Sat May 25, 2013 11:30 am 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
I've been on Valtrex (brand not generic) since I was diagnosed in 2008. It was effective in preventing OBs and then in March of this year I got complacent and decided that maybe I didn't need to be on suppressive therapy. After about two weeks, the OBs came back with a vengeance, more severe than ever. Not blisters but fissures/cuts, and in places I had never had OBs before - shaft, glans. The OBs are every day. I increased my daily dosage to 1g (taken once) hoping that it would help, but it hasn't prevented OBs, just made the healing more rapid. Plus I've been getting a tingly sensation down the back of my leg and buttocks for the first time. This has been very upsetting and I don't know what to do. Do you know why the Valtrex isn't working, after having been generally effective for almost five years? I started a new job, a stressful one, in Jan and I haven't exercised much since then, but otherwise I haven't had any major lifestyle changes.


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 Post subject: Re: Viral Shedding
PostPosted: Tue May 28, 2013 3:18 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
These aren't herpes issues going on at this point. you should see a dermatologist for a further work up. something else is going on down yonder.

betsy

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 Post subject: Re: Viral Shedding
PostPosted: Wed May 29, 2013 3:00 am 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
Why do you say this isn't herpes? Only because the symptoms are not responding to the Valtrex? I've read that OBs don't always take the 'classic' form of blisters, but can also resemble paper cuts, which mine do.


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 Post subject: Re: Viral Shedding
PostPosted: Thu May 30, 2013 6:40 am 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
many things can cause these symptoms. what you are currently experiencing is very atypical for herpes plus you are on suppressive therapy which is keeping your herpes down to a dull roar. having the symptoms in multiple areas and for such a short time is more indicative of something non-herpes. just because you have herpes, doesn't mean everything in your genital area is due to it.

really, see the dermatologist and then come back and tell me I was right :) usually it's a fungal infection causing these symptoms but several other things it can be too.

betsy

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 Post subject: Re: Viral Shedding
PostPosted: Fri May 31, 2013 11:45 pm 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
OK. Can you recommend a good clinician or dermatologist in NYC? I will be there in July. Based on the experience of many on this board, half the doctors need to be educated themselves. Thanks.


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 Post subject: Re: Viral Shedding
PostPosted: Sat Jun 01, 2013 5:52 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
I can't even recommend a good restaurant in NYC let alone a medical provider :( I don't live there so I have no experience with providers in the area.

betsy

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 Post subject: Re: Viral Shedding
PostPosted: Sat Jun 08, 2013 4:19 am 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
Can you recommend a good provider somewhere else?


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 Post subject: Re: Viral Shedding
PostPosted: Mon Jun 10, 2013 12:28 pm 

Joined: Thu Dec 31, 2009 8:38 am
Posts: 8
What does 'viral load' mean? Is that the amount of latent viruses in your system after infection? And what determines viral load? If you catch the virus early and start treatment with Valtrex, does that reduce your viral load from the very beginning? Most of the literature says that OBs decrease with time. Is that because your body's immune system/antibodies attack the latent viruses and reduces the load? My OBs are not decreasing with time - what does that say about my viral load, if anything?


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 Post subject: Re: Viral Shedding
PostPosted: Thu Jun 13, 2013 8:50 am 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
we don't really use viral load with herpes outside of research. we don't measure it like we do for hiv. we do know that there is as much active virus during shedding periods whether there are active lesions or not.

one study showed that after 5 years of being infected with hsv2, 1/4 of folks have less ob's, 1/4 have more and all the rest stay about the same.

betsy

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