Asian Fever

Herpes simplex virus (HSV)

Health Nurse

Supporting Member
Nov 24, 2004
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What is it?

Herpes is a common sexually transmitted infection that is caused by the herpes simplex virus (HSV). There are two different types:

• HSV Type 1 occurs most often on or near the mouth and is often called a cold sore
• HSV Type 2 occurs most often on or near the genitals and is often called genital herpes
• It is not uncommon to have Type 1 on the genitals and sometimes Type 2 on the mouth

How common is it?

Health Canada estimates that worldwide:
• 50% - 90% of adults have HSV type 1
• 20% - 30% of adults have HSV type 2

Dr Stephen Sacks studied 409 randomly chosen women in labour in a Vancouver hospital from May, 1985 and January, 1987. The study showed that there is an increased risk of having HSV type 2 as your number of partners increased. For example, 4.6 % of woman who had one lifetime partner had HSV type 2 and 55% of the woman who had over 10 partners had HSV type 2.



Transmission

Vaginal, anal, and oral sex are the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is capable of spreading herpes. A cold sore (HSV) on your partner’s mouth may develop as herpes on your genitals, if you have oral sex.

A person is more likely to pass on the virus when they experience an outbreak. However symptoms do not have to be present to spread genital herpes. Some people are unaware that they have genital herpes because their symptoms are so mild (e.g. bump or rash). 50-80% of people who have herpes don’t even realize they carry the virus, and unknowingly spread it to others.

You can also spread the virus when you have no signs or symptoms of herpes. This is called “asymptomatic viral shedding”. One study indicated that over the course of a year men shed virus 2% of the time and woman 4.3% of the time, when they had no symptoms of herpes.
Symptoms

Once you have been exposed to the virus symptoms usually develop within 2 to 20 days. .

Typical symptoms can include:

• Blisters, sores or cuts, which may be painful, itchy, burn or tingle.
• Redness and sensitivity
• Flu-like symptoms including swollen glands, headache, and muscle ache or fever.

Misdiagnosis is also common. Herpes can be mistaken for razor rash, zipper burn, pimples, bug bites, and recurrent yeast infection

Treatment

While there is no cure for genital herpes, there are treatment options available. There are oral medications that can be used to help lessen pain, and even shorten the length of the outbreak. Some people have frequent outbreaks and may be able to control the outbreaks by taking medication every day. These medications are available by prescription.


Other Facts you should know

HIV

People who have genital herpes may be more at risk for HIV. If you are exposed to HIV during sexual contact and have genital sores, HIV can find easy entry into the body.

Pregnancy

HSV that is passed to a baby before birth, or within the first 6 weeks of life, is called primary Neonatal Herpes. A baby’s immune system is immature and not prepared to fight the infections. Neonatal HSV disease is rare, but serious, and can lead to death.

About 1 in 5 Canadian women has genital herpes during pregnancy, but neonatal HSV is rarely seen in Canada. A safe pregnancy and delivery of a healthy baby is the norm in women with genital herpes or in those who have a partner with herpes. This is especially so when a women has had herpes prior to becoming pregnant. In this situation the mother will have antibodies circulating in her blood that will protect the baby during pregnancy and delivery.

The two situations in which the developing fetus may be at risk:

• A severe first time outbreak during the first 12 weeks of pregnancy can lead to miscarriage. This is very uncommon and a hazard that is also present with a number of other virus infections, including the flu.
• A first time outbreak in the last 12 weeks of pregnancy can cause neonatal herpes. Careful monitoring can reduce the risk to the baby.

Prevention

While you should always use a condom for extra protection, you can still have sex if you have genital herpes. It is important to avoid sexual contact if you have any sores (oral or genital) or symptoms

There are some things that you can do that can help reduce the chance of transmission

• Do not have contact with the area when there is an outbreak. (I.e. if you have a sore on your genitals you can still use your hands or mouth).
• Using a condom when not having an outbreak will reduce the chances of spreading HSV from asymptomatic shedding.
• Daily suppressive therapy reduces asymptomatic shedding.


Additional Links

HSV is a large topic and there has been much research done over the years. To keep this posting small we have only covered the main points. We have provided links below for those of you who would like to explore the subject more

Herpes is not usually a serious medical condition. But many people have emotional concerns and issues regarding herpes.

Here is a site that has great info on the infection, the emotional aspects of herpes and how to talk to partners.

http://www.herpessupport.org/

Other sites:

http://www.herpesresourcecenter.com/

http://www.stdresource.com/disease/index.php?page=edit&id=11&action=viewfull

Link with information in six languages:

http://www.herpesalliance.org/




HN
www.stdresource.com
 
Last edited:

SeeCupRider

New member
Jul 11, 2007
2
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Some Questions regarding HSV-2

Hello Health Nurse,

I was trying to estimate the risk of getting HSV-2 (assuming I don't have it) per encounter with an escort.

To do this, I wanted to estimate the %age of SPs who have it
AND
the probability of transmission per encounter with an SP who had it.

I also wanted to get an idea of how these risks would change depending on services. Suppose we take FK and FS (with condom) for granted, how much does the risk of HSV Transmission increase if you add DATY, BBBJ or BBBJTCIM? For BBBJTCIM, I was also wondering about HIV Transmission probability. For DATY and HSV-2, what are my chances of having HSV-2 on top of an oral HSV-1 infection, what are the risk of an oral HSV-2 infection being transmitted to your genitals? Lots of questions, sorry!

Getting back to pure statistics, I guess the 55% figure you quote for women who had had more than 10 sexual partners is a reasonable lower bound for the probability for escorts. This is a controversial question I imagine, don't answer it if you prefer not to.

For HSV-2 transmission, I have seen studies suggesting different numbers for monogamous couples, the probability for F to M always being lower than M to F. Assuming the woman wasn't on Valtrex, I think the probability of transmission for a year was not more than 5%. Assuming at least 100 sexual encounters for these monogamous couples a year, we would be estimating the probability per encounter to be at most 0,05%. I don't know what the sexual habits, particularly for oral sex, of the couples in the studies were but am presuming that they would include sex with a condom consistently.

If it was possible, would you critique and improve upon my guestimates?

Thank you very much.
 

SeeCupRider

New member
Jul 11, 2007
2
0
0
That was already a *lot* of questions I know...

I had a few more though...

1) I understand that people who have been recently infected with HSV-2 are more infectious in the first year...is there any way to characterise this pattern?

2) It has been suggested to me that the division I proposed about 5%year/100 encounters may be oversimplified because the relationship between transmission probability and the number of encounters may be non-linear. I was wondering about this.

3) I was wondering what you thought about certain strategies to reduce infection I have heard proposed : wearing boxers, cleaning after contact, cleaning with rubbing alcohol after contact. Are these effective at all?

4) For HSV-2, I was thinking that, if HSV-2 infections generally don't "stick" in the mouth (I have heard this) then, if you do DATY, you will probably force your body to be exposed to HSV-2 in the mouth, thereby potentially developping antibodies that might keep you from getting HSV-2 on your genitals. Is there any merit to this idea or is it just stupid?

Thank you so much again.
 

Health Nurse

Supporting Member
Nov 24, 2004
894
4
0
Hi
It is very difficult to estimate risk for one contact and I don’t believe the data available is that specific. It looks like you are better than I at probability math and have figured the odds as best one can given many factors. It is factors such as immune system and amount of virus present that make simple calculations difficult.
In general there is always some risk and in the end you have to determine what you are comfortable with given the information available. That “risk tolerance” is very individual and people learn from experience what their own comfort level is.
Yes, it is possible to have both HSV 1 and 2. Usually if you have one type it will give you some protection/immunity against the other type. It is also possible to transmit HSV 1 and 2 via oral sex ie from lips to genitals and vice versa.
Yes people with recent infections appear to be more infectious. Often outbreaks are fewer and asymptomatic shedding is less with time.
I don’t think wearing boxers would make a difference to transmission. We don’t recommend washing with alcohol as it is hard on skin and can cause reactions and rashes which may make you more susceptible to infections. If you want to wash after sex then use soap and water.
I don’t know the answer to the 4th question you asked about the HSV 2 in the mouth.

Hope that helps

HN
Stdresource.com
 
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