Article Where Dr. Leone and Handsfield Mention HSV-2 Shedding Rates

[surfsup]

https://thehairpin.com/how-i-found-out-i-didnt-have-the-herpes-i-d-been-living-with-for-four-years-5a30c2ac9efc#.islwdmr2d

 

Check out this article. It's not even the reason I am posting this, but I am totally flabbergasted that the author went YEARS thinking she had genital herpes and did disclosures and everything, when she did not have it. All going off a nurses' visual examination of her genitals. I find it hard to believe someone would accept this (in this day and age with medical information massively available on the web) and not get tested to confirm. Anyways, whatever, I just had to mention that because I find it incredibly bizarre.

 

This article is a bit of a kick to the groin for anyone with HSV-2 for sure. It really minimizes HSV-1 and makes HSV-2 into a scary monster if you read into it too much.

 

It also has Dr. Leone and Handsfield (who are national herpes experts in the USA) quoted as saying:

 

"With HSV-2, you not only have frequent symptomatic outbreaks, but you have high rates of the virus being present in the absence of symptoms,” Dr. Handsfield said. In fact, 70 percent of HSV-2 transmissions happen without symptoms, since people with HSV-2 shed practically all the time, said Dr. Leone."

 

Uhhh, have I been missing the boat completely or something, but I was under the impression that shedding without symptoms DOES occur, but certainly not "practically ALL the time"? I feel like those of us with HSV-2 take solace in the fact that the trifecta -- avoiding sex during outbreaks, using condoms, and antivirals -- can reduce the percentage of transmission to a very low number. If I am completely missing something obvious, please let me know, but it seems like what these doctors are saying doesn't jive with the relatively low transmission rates when you're being responsible. Are they just talking about people who have HSV-2 but do not know it and are therefore more of a risk for spreading it?

 

It was also interesting hearing them mention that Genital HSV-1 is on shaky grounds in their minds for requiring mandatory disclosure...

 

------------------------

 

"Doctors, including these two experts, strongly agree that people with genital HSV-2 should always disclose, since they’re likely to pass along the infection without symptoms.

 

As for genital HSV-1? That’s less solid ground, because there’s no precise data and it hasn’t been formally studied, Dr. Handsfield said.

“You cannot find consensus on this,” Dr. Leone said. “You won’t find clear recommendations.

 

“I’ll be honest with you,” he continued, “I even question whether or not you need to disclose that you have genital HSV-1 to someone. If you’re not having an outbreak [of genital HSV-1], you’re probably not shedding, and you’re not going to be transmitting it to somebody else. And we don’t think that genital-to-genital transmissions are very common, so why are we telling folks to disclose? You may feel obligated and think that ethically, it’s something you should do. I would encourage you to do it if you feel that way. But from a biological standpoint, I’m not really sure we can make any recommendations around your need to disclose.”

[optimist]

@surfsup Here are a couple articles featuring info and guidance from Dr. Leone:

 

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

 

https://consults.blogs.nytimes.com/2010/06/01/dating-sex-and-herpes/?_r=0

 

He does focus more on HSV2 than HSV1, though he acknowledges up to half of new genital herpes infections are caused by HSV1. His greater concern about HSV2 seems to be related to HSV2 increasing vulnerability to contracting HIV by 2-3x (much of his work is focused on HIV prevention). He also mentions greater frequency of recurring symptoms among those with HSV2, though he acknowledges symptoms are typically minor and indistinguishable from those caused by HSV1.

 

He feels everyone "who wants to know their status" should have the option of being screened for HSV1 and HSV2 and acknowledges HSV2 is extremely common. He notes 50-70% of unmarried women in the 45-50 year old age range are infected with HSV2 and that the only way to know your status is to be tested as most people do not have the "classic symptoms" that alert people to the fact that they may have genital herpes. At the same time, he also mentions the psychological trauma upon diagnosis due to the realization that it can be transmitted to future partners (this seems stigma related to me, but that's just my opinion) and he feels this is a reason doctors avoid testing patients for HSV. He also thinks many doctors are behind the curve on asymptomatic shedding. He provides a statistic of 10-20% of days of shedding with HSV2 (without antivirals) with those who are asymptomatic being closer to 10% and those with recurring outbreaks closer to 20%.

 

Edit to add: Reading over one of those articles again, it seems pretty clear to me that Dr. Leone's focus on HIV prevention is the source of his greater focus on HSV2. His philosophy appears to be that knowing one if infected with HSV2 allows a person to take preventive measures (disclosure, condoms, antivirals) that reduce spread of HSV2 and therefore reduce rates of HIV. This makes sense considering the focus of his work on HIV. Someone focused on Alzheimer's prevention may be more focused on HSV1, while someone focused on neonatal herpes may be equally concerned about HSV1 and HSV2. JMHO.

[surfsup]

@optimist -- thanks a lot for the articles and the context on him talking in regards to HIV. Going to read those articles, but wanted to respond before I headed out the door. Those statistics of 10-20% days of shedding without antivirals is more what I have been accustomed to hearing. I was just perplexed to hear him say "practically all the time" regarding people with HSV-2 shedding. Do you know what he is talking about?

[optimist]

@surfsup The author of the article did not use quotes for that sentence, so I suspect it was either a misinterpretation or taken out of context. Perhaps it was in reference to the fact that some people who have HSV2 are asymptomatic and a minority of those who are asymptomatic do *not* shed. This would be a small minority of those infected with HSV2 who do not shed asymptomatically. Most do, and the average for those people is 10% of days per year. So perhaps she misconstrued his assertion that almost everyone with HSV2 sheds virus a significant amount of time (10-20% of days, on average), even if they are asymptomatic. Just a guess.

[surfsup]

@surfsup The author of the article did not use quotes for that sentence, so I suspect it was either a misinterpretation or taken out of context. Perhaps it was in reference to the fact that some people who have HSV2 are asymptomatic and a minority of those who are asymptomatic do *not* shed. This would be a small minority of those infected with HSV2 who do not shed asymptomatically. Most do, and the average for those people is 10% of days per year. So perhaps she misconstrued his assertion that almost everyone with HSV2 sheds virus a significant amount of time (10-20% of days, on average), even if they are asymptomatic. Just a guess.

 

Gotcha. Good catch on the fact it was not him saying those words as a direct quote. Chalk another one up if you read it on the Internet it doesn't mean it's true. What a frustrating article for anyone with HSV-2. :)

 

[ihaveittoo]

In case you have not seen it, here is a video Adrial made with Dr. Leone.

 

 

 

[Parsley]

Just my own case. I have only been tested pos for 2 weeks now. I have been with my husband for 21 years, never used condoms, I had never had a ob until now (if I am now, symptoms are extremely mild, no visible lesions) After my test results, my husband got tested. (We have been separated 3 months and he has been seeing soneone rlse so we both suspected he shared it from her) My husband tested negative for both types. (I tested pos for both)

This means that I have to have had it for at least 25 years, while taking none of the trifecta of precautions and yet still did not transmit it to my husband.

As for me, I am a total mess right now. As if it wasnt enough that I am likely losing my best friend of 36 years/husband for 20, I now have to mentaly cope with this diagnosis as well.

[JohnJay]

Why is it that HSV2 has the risk to HIV and HSV1 doesn't seem to?