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From Dr. Peter Leone: Herpes transmission risk per sex act explained


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Hi all you awesome H Oppers!

 

There has been questions here and there in our community boards about whether the risk of transmission can be broken down by a per-sex-act percentage. Percentages and risk can be a confusing thing to try to understand, and sometimes an even more confusing thing to try to explain. :) But it's super important that we all wrap our heads around it, both so we can understand it for ourselves and help to convey it to others, at the very least during your disclosure talks to help educate. Education and spreading the facts helps STOP the spreading of fear and stigma. It's important for future intimate partners to understand the risk. Yes, it is very low if precautions are taken and sex is avoided during outbreaks, but it's also not miniscule either. Here's the breakdown of the %s as a refresher:

http://herpeslife.com/rates-of-herpes-transmission/

 

Here's the (inaccurate) logic that some have tried to employ to minimize the risk: "If it's a 10% chance of passing herpes to a woman per year and we have sex 100x over the course of the year, then there's a 0.1% chance (10% divided by 100) of passing herpes each time we have sex, right?" This is a misleading way of thinking of herpes transmission rates. Dancer and I have done our best to explain it in those posts, but I also wanted to get a medical professional's opinion on it.

 

So I asked our friend Dr. Peter Leone, one of the top herpes doctors in the nation (yeah, he's the guy I interviewed in the video embedded at the bottom of this post), and he responded with this:

 

- - -

 

There is no data on risk of HSV transmission per sexual act. There are too many variables involving the type of sexual act, the duration of exposure, the quantity of viral shedding at the time of sexual exposure, circumcision status of a male partner, etc. All of these variables makes it almost impossible to quantitate risk per sex act. We can do gross estimates on transmission rates over time because these are simple binary events — yes/no — but even then, there are differences based on gender and probably duration of the relationship. This article describes a model that comes up with a transmission threshold of 10,000 copies: Schiffer, et.al;J. R. Soc. Interface. 2014 11 95 2014. But there are assumptions and limits:

- Predict transmission is unlikely at viral loads less than 104 HSV DNA copies.

- Most transmissions occur during prolonged episodes with high viral copy numbers.

- Many shedding episodes that result in transmission do not reach the threshold of clinical detection

 

Even if you knew the individual risk, it would provide little help on what to do for any given sexual act other than all the current recommendations.

 

- - -

 

FYI, Dr. Leone is the New York Times consultant on herpes. Here is more from him:

http://consults.blogs.nytimes.com/2010/05/28/can-oral-sex-spread-herpes/

http://www.npr.org/2011/04/15/135442942/even-without-symptoms-genital-herpes-can-spread

 

... and the interview I had with him when he stopped by our local support group in NC:

 

THE FACTS:

 

For more on the facts, please download our handouts and e-book:

http://eepurl.com/b4IPP — e-book + handouts

 

... and watch the Herpes Facts video I made here:

 

Notes:

  • My mother is now in hospice with end-stage cancer, so I am at her house a lot these days helping where I can until she passes. Thank you in advance for understanding if I am not as quick to respond as I normally would be. This is a precious and bittersweet time …
  • This content is for informational purposes only. This information does not constitute medical advice or diagnosis. I'm not a medical professional, so please take this as friendly peer support. 

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