HERPES

Can I ABSOLUTELY Guarantee she will not get Infected with Herpes?

Dear Dr. Tom:

1. How effective is suppression therapy in stopping asymptomatic shedding? 2. It appears from your other answers that familial contact with a carrier increases the risk of contracting HSV by non-infected family members. If so, what precautions can be taken (in light of your advice that every infected person be presumed to be an asymptomatic shedder) by non-infected family members who absolutely don’t want to get the disease? Please be candid and painfully honest. Specifically, what physical contact and context can an infected person (with known genital HSV) safely be around extended family if the goal is to not elevate the risk of the non-infected above ordinary social risks we take every day in the public arena? 3. What is the probability that a non-infected female fiancé will eventually get the disease from her genitally infected husband (HSV-2). What will be her experience with the disease, given that she already has another chronic auto-immune disease (eg. Type 1 diabetes). Are there any safeguards she can take to ABSOLUTELY guarantee she will not get infected? 4. Where can we go to further research the risk of transmission of HSV to family (non-spousal) members (both children and adults)?

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Dr. Tom’s Response:

Dear Anonymous Who Asks 4 questions:

1. The effectiveness of suppression therapy to curtail or control asymptomatic shedding of HSV is currently under clinical investigation, but the results won’t be known for some time. The Glaxo-Wellcome Co., manufacturer of valtrex, is collaborating with medical investigators at the University of Washington on a program involving married couples, only one partner of which is infected with HSV. This study was described to the public within recent months in the Miami (Fla) Herald and also in one of the Seattle newspapers. Since it has just begun, obviously no data are available. The manufacturers are optimistic about the drug?s effectiveness through some smaller preliminary evaluations that have been made and published. 2. Remember the most fundamental principle of infection control: Keep the infectious agent away from a susceptible host. If this aim can be achieved, no infection can possibly result. Adapting that principle to a household is a matter different for every family, but these are some general infection control practices: Share no personal items, towels, washcloths, bedding, underclothing, toothbrushes (some do). Make sure that tampons/sanitary napkins are disposed of aseptically. Adopt the same standards of housekeeping that would be used in a first class community hospital: scrub each item after use; routinely wipe down with a sanitizer such locations as lavatory bowls, toilets, shower basins; add a small amount (non-destructive) of chlorine bleach to the laundry. Insure that dishwashing is hot and rinse is thorough. Handwashing should become a religion. Individual soap bars or small containers of personal soaps should be adopted. Family nutrition should be highly respected as a supporting pillar of overall health. If any family member develops lesions this should be revealed to the entire household, and no shame or social aversion should be attached to the occurrence. This might be difficult with teenagers who can tend to be quite private and status conscious. The prodromal phenomenon is most often the preliminary warning of an outbreak. Fluid from the lesions should be avoided. Serious effort should be made, if possible, to determine if infected household member(s) is/are virus shedder(s). The best way is virus culture. Not cheap. Counsel with a family physician can expedite this; patience should be employed, because multiple samples may need to be taken. 3. There are no ABSOLUTE safeguards except to remove the genitally infected virus carrier out of the other person’s life. (Remember the original principle)…. Hardly acceptable. Presence of some form of auto immune disorder compromises the uninfected person somewhat, because the body’s natural immune functions help to protect, and those functions are frequently altered, weakened or compromised in auto-immune diseases. The U. of W. valtrex study will probably reveal a good bit more about how married couples live normal lives where only one is infected and remains so. There are many examples of that out there today. Protected sex will provide additional protection not offered by the broad infection control practices outlined above. We must not lose sight of the fact that HSV is a STD. 4. I suggest posing questions(s) of this nature to the American Social Health Association (ASHA) P. O. Box 13827, Research Triangle Park, NC, 27709, 919-361-8400. Their Herpes Hotline is 919-361-8488. I suggest also contacting the Centers for Disease Control (CDC) in Chamblec, (Atlanta) Georgia. Both of these organizations can supply educational, instructional, advisory and statistical material. ASHA will charge for certain of their publications. CDC is U.S. Health and Human Services, and usually has no charge for materials supplied. ASHA has a book available: Managing Herpes, newest ed. pub. Feb. 1998, $24.95 in paperback. One of their officials told me via telephone that copies may be ordered from the major chain bookstores. Best wishes to all of you.

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