I'm curious to see if anyone knows the answer to this!

[ash2018]

Hi all!

 

I have read and know that you're most contagious during your first year of having the virus. So my question is: if you have HSV and carry it for a period of time before you have an outbreak (possibly years), are you most contagious for a year after that first outbreak? Or was "the most contagious" year the initial year after infection?

 

I know when you have an outbreak happening that's when you're most contagious in general. I'm more curious about the viral activity with asymptomatic shedding and such, as they say this decreases with time, so in theory even if a first outbreak was years later the viral shedding should be lower years into the infection correct?

 

Hopefully the question makes sense!

[Katidid]

Great question! I have no idea

[ash2018]

@Katidid it's amazing how much there *is* to know about these viruses!

[Katidid]

Yes, I've had it 35 yrs and still have questions

[HikingGirl]

I swear I've read within the first year of infection, but I can't think of the source. I'll check my Terri Warren book to see if I can find reference to it.

[ash2018]

@HikingGirl thank you for checking! That's what I was thinking, my mind comes up with all kinds of questions! I wouldn't think there's any way to easily study this, unless someone is diagnosed via blood test when asymptomatic and swabbed for shedding (in study format) and then outbreaks later on and has the same swabbing performed

 

@Katidid you are a true veteran! :)

[optimist]

It is most contagious within the first several months of contracting the virus. Then there's a second drop off after two years. This relates to asymptomatic shedding.

 

Having symptoms vs. not having symptoms makes a difference in overall shedding rates because additional shedding is occurring right before and after outbreaks. Average annual shedding rates between symptomatic and asymptomatic people differ for this reason, the average for genital HSV2 being roughly 20% and 10% respectively. IIRC, the full difference between the 20% and 10% is believed to be due to the additional shedding occurring on either side of outbreaks. I don't recall the shedding rate the first few months but it is significantly higher than 20%. Even with GHSV1 which generally sheds less frequently than HSV2, the shedding rate is very high the first few or several months.

 

Please note, this is all based on research I read a while back, maybe a year ago. I'm not a medical professional but do recall delving into this topic a while back from the perspective of a carrier.

 

[ash2018]

@optimist thank you! I have GHSV1 and was just diagnosed the end of June, my outbreak was the beginning of June. My IgG however was positive 9.48 so I've had it for at least a few months and never knew it/was asymptomatic. I now wonder though if my past vulvar pain (started in 2009) was related to HSV. I never had any lesions or opens areas at that point that I know of, but I had nerve pain. Thinking back no one ever did any sort of blood tests while figuring out what was wrong so I will never know for sure. After over a year it was diagnosed as vestibulodynia. I got pretty much 100% better taking a medication for the nerve pain but would flare every year or two. Makes me wonder...

[optimist]

@ash2018 Did you have a swab test that identified that outbreak as HSV1? Or only the IgG?

[ash2018]

The swab identified it first and then I followed up with a blood test @optimist

[optimist]

I see. Yes, if both the swab and IgG were positive for HSV1, sounds like you'd been infected for some time before your first noticeable outbreak. I had wondered if perhaps you'd contracted HSV2 on top of an existing HSV1 infection. That's why I asked if you'd had a swab test that identified the infection as genital HSV1.

 

Edit to add: I know somebody who went to the doctor with what the doc thought was likely a genital herpes infection. He had classic primary outbreak symptoms. Doc said they did not do swabs and gave him a lab slip for IgG testing. IgG test came back negative and the doc said it was a false alarm, he was not infected. Of course it's possible the guy did not have herpes and it was a false alarm, but if it was a primary outbreak, it would not have registered on the IgG test because it would have been too early. I wonder how often this kind of thing happens.

[ash2018]

@optimist I wanted the IgG testing to get an idea of if it was new for me or not. I've been in a monogamous relationship for two years, so this all blindsided me. I was one of the typical stories you hear - I was tested at planned parenthood right when my fiancé and I met so I assumed I knew my full status, not knowing they don't test for HSV. Although thinking back now, even if I had an IgG positive for HSV1 on a routine testing, I would have assumed it was probably oral in the absence of any symptoms. I also wanted to make sure that I did only have HSV1. I was on eggshells until I got the call with the results. The diagnosis was hard enough to accept, I wanted to make sure there wasn't anything else I needed to know about.

 

The sad part is that situation with the person you know probably happens way more than we would like to think. It's along the same lines of doctors telling people they don't have to disclose if they aren't having an outbreak because they can't pass it on. The lack of education regarding these viruses in the medical community is astounding, and I say that as being someone who works in the medical field.

[ash2018]

@optimist - I also had to see THREE medical providers before finally the third thought to swab for HSV. And by that time I was almost completely healed. The first two who saw things at earlier stages should have no doubt thought about HSV. Yet they wrote it off as other things. The first cuts because I described how I had scratched myself prior to the open areas appearing and the second as a fungal infection caused by scratching... again, this shows lack of education on these viruses in the medical community

[optimist]

@ash2018 None of the doctors I've encountered so far has been well informed about transmission. There is no effort to reduce transmission in the U.S., only to manage symptoms for the minority with symptoms, so perhaps that's why their knowledge of both transmission and less obvious symptoms (that do not medically require diagnosis and treatment) is limited. IME, they do not even think of antivirals as a tool to reduce transmission, just to treat symptoms of primary outbreak or frequent recurrences in those who get them, though it is possible to get a prescription strictly to reduce transmission if you are sufficiently proactive about requesting it.

 

Also, all of the medical professionals I've spoken with have had the attitude that most people have HSV (whether oral or genital or unknown location) and it is generally no big deal, tests results are not reliable, etc. In a way, I appreciate that they are remaining medically objective in treating genital herpes exactly as they treat cold sores, rather than advising people to treat one differently than the other based on stigma. OTOH, their perspective does not reflect the reality of societal views and expectations regarding genital herpes.

[ash2018]

@optimist luckily the midwife I saw last, the one who immediately questioned HSV when I mentioned a swollen lymph node in my groin, seems to have more knowledge than a lot of the docs I hear stories about. She did offer me suppressive therapy to suppress and also reduce transmission. She was realistic in saying in regards to sex with my fiancé and I, that we're getting married and probably won't want to use condoms, so taking the medication as well as avoiding sex during an outbreak would reduce the chances a lot. The only thing I can say made me question her knowledge was ordering an IgM blood test as well as an IgG. But other than that, she seems relatively knowledgeable. She used to work at a planned parenthood which may have something to do with that