Herpes Transmission: Are There Chances of Spreading Herpes While on Acyclovir Treatment?

Like other infectious diseases, herpes can easily spread with skin-to-skin contact with the infected person. Sexual partners are at higher risk of spreading herpes virus if any of them are infected. The infection is often passed during vaginal, oral or anal sex practices. Even during treatment, the infected person can transmit the infection to other people. Antivirals such as Acyclovir manage the symptoms, improve healing time, reduce severity and prevent recurrence.

What is Genital Herpes Infection?

Genital Herpes Transmission | Chances of Spreading Herpes While on Acyclovir | Infectious Diseases | Sexually Transmitted Diseases |

Genital herpes is a sexually transmitted disease that is quite common. The infection is caused by herpes simplex virus (HSV). In the United States estimatedly in every 5 adults, one person is infected with HSV. However many infected people have no or mild symptoms and they do not even realize that they are infected with HSV.

Once a person is infected with HSV, they may experience recurrent episodes of genital ulcers for many years. The vistu stays inside the body for several years however over time the the symptom has become less common. It is easily manageable with the right medication and self-care measures.

Genital herpes can be transmitted to other people even when the sufferer has no visible blisters or ulcers. Infected people are encouraged to use condoms or avoid sexual contact to avoid transmission.

Who Is At Risk Of Developing Herpes Simplex Virus Infection?

Herpes infections are very common. Anyone sexually active can develop HSV irrespective of gender and age. If you are exposed to the herpes simplex virus, you are more likely to contract the virus. Often it is asymptomatic so many people living with HSV never have symptoms of an episode thus they do not even realize that they are exposed to HSV.

The risk of acquiring genital herpes is associated with contact with genitals through vaginal, oral and anal sex. Having sexual contact without using effective barriers enhances your risk of developing genital herpes. These barriers include condoms and similar kinds of protectors such as dental dams which are meant to be used during oral sex.

You are at higher risk of HSV transmission if you are immunocompromised or you have HSV infected partners. If you are having sex or intimate contact without using condoms or other effective barrier methods you can easily contract the virus. Always remember that even these barriers may not be able to cover the infection site as sores can also appear on the inner thighs or buttocks.

Causes of Genital Herpes

Herpes simplex infection is contagious and can be easily transmitted through direct contact with the sores or the infection sites. Genital herpes is usually caused by herpes simplex virus type 1 but it can also be caused by herpes simplex virus type 2.

Herpes Simplex Virus Type 1

HSV 1 usually causes oral herpes or cold sores that are around the mouth and lips accompanied by fever. Around 80% of the population carry HSV 1 in ther bodies however only a few of them ever experience an oral herpes outbreak.

One can contract or transmit HSV 1 or oral herpes infection through direct contact with saliva, herpes sore and other bodily secretions during the episode. If the patient is shedding the virus, other people can contract it through direct contact with the infection site such as kissing, oral sex and other skin-to-skin contact.

Herpes Simplex Virus Type 2

Herpes simplex type 2 is usually associated with genital herpes. In recent years, increased cases of genital herpes infection have been reported which are transmitted through oral sex. Genital herpes is primarily caused by HSV 2 that involves sores around the genitals, anus, inner thighs, buttocks and even inside the vagina.

One can contract or spread HSV 2 through direct contact with a  sore, saliva and other bodily secretions during the herpes episode. The virus can be spread during viral shedding. The direct contact which can spread the virus includes kissing, oral sex, penetrative sex, sharing sex toys and other skin-to-skin contact around the infection site.

Signs And Symptoms of Genital Herpes

Genital herpes symptoms may vary depending on whether you have an initial episode or experiencing a recurrent episode. Even many patients suffering from genital herpes never experience visible symptoms.

Initial Episode of Genital Herpes

The first herpes outbreak is the most severe for most patients. Symptoms of initial episodes are more severe in women as compared to men. Usually, the first outbreak occurs within a few weeks after exposure to the virus. Symptoms get resolved within 2 to 3 weeks.

Symptoms of an initial episode of genital herpes include multiple blisters in the genital area. In the case of female patients mostly the vagina, vulva, anus, buttocks and thighs are involved whereas for male patients the penis, scrotum, buttocks, anus and thighs are involved.

Typically the symptoms include blisters that turn into painful ulcers. On the penis or outer labia, blisters may crust over and heal. After the first bunch of lesions appear, the new lesions may occur for 5 to 7 days.

Some patients may experience tender or swollen lymph nodes in the groin and flu-like symptoms such as fever, joint pain and headache. The patient may feel pain during urination.

A few patients can have headaches, vomiting, nausea or difficulty urinating. These symptoms develop when the nervous system gets affected by herpes infection.

Some patients may notice burning, tingling or itching at the infection site before the small and painful blisters appear. These may appear as one blister or a small group. These blisters ultimately burst and crust over before they start healing.

Recurrent Herpes Outbreak

Some patients who contract HSV only have one time episode while others continue to experience recurrent episodes at certain intervals. As the body starts to create antibodies for HSV, the frequency and severity of recurrent episodes reduce with time.

Recurrent episodes usually involve less severe symptoms which resolve rapidly. Blisters may be less painful during recurrent episodes. Blisters in the recurrent outbreak mostly heal within several days.

Patients with few episodes may begin to notice early signs at the infection site which usually appear before the blisters appear. The symptoms include pain, itching, tingling, burning.

Illness, sunlight, stress and fatigue can trigger a recurrence of herpes outbreaks. In female patients, menstrual periods may also trigger an outbreak.

Genital Herpes Diagnosis

The diagnosis of herpes depends on the medical history of the patient, signs and symptoms and the test results. It is highly important to distinguish genital herpes from other STDs (Sexually Transmitted Diseases) particularly ones that involve genital ulcers such as chancroid and syphilis. 

Several tests may be performed to diagnose genital herpes. These tests are done to identify the type of herpes virus (HSV 1 or HSV 2) responsible for the infection. The tests depend on the symptoms and whether you have ulcers or blisters.

Polymerase Chain Reaction (PCR)

PCR testing and culture are common tests for patients with active ulcers. PCR is a highly sensitive testing process to determine the herpes virus in cells and secretions from the genital and urinary tracts.

Culture Test

The culture test is performed to determine if the herpes simplex virus is present in ulcers or blisters. A herpes culture detects the virus in around 50% of people with genital ulcers. The culture is more likely performed to detect the virus when ulcers are fresh and open as compared to when they are older and in the healing phase. For that reason, it is suggested to check with your healthcare provider within 48 hours of the initial symptoms.

Blood Test

The blood test can be performed when the patient has no visible ulcers but has a history of ulcers. The blood test can detect antibodies to herpes simplex virus Types 1 and 2. Positive test results show that the person was infected with HSV in the past. The result may be negative during the initial episode because antibody formation takes a few weeks.

Genital Herpes Transmission and Associate Risk Factors

As mentioned above, the herpes virus is mostly transmitted through intimate partners during vaginal, oral or anal sex. A person may also catch herpes infection post-exposure to a cold sore on the lips of the infected person (during oral sex). In this case, genital herpes most likely occurs because of HSV type 1.

Person-to-person transmission may occur even if there are no visible ulcers to either person. However, transmission does not occur after exposure to environmental surfaces such as door knobs, bedsheets or toilet seats etc.

The chances of transmission from an infected man to an uninfected woman partner are greater than the risk of transmission from an infected woman to an uninfected man. Like other sexually transmitted diseases, the chances of contracting herpes are higher depending on how many sexual partners you are involved with, how often you have sexual contact and how rarely you use condoms during sexual intercourse.

The risk of transmitting herpes is much greater when you have signs and symptoms of an active infection.  However, the infected person can transmit the infection even without visible ulcers.

A study investigated genital herpes transmission rates in heterosexual couples when only one partner was affected initially. Over a year, in 10% of couples, the virus was transmitted to other partners. In 70% of couples, infection occurred at a time when there were no signs or symptoms.

The proper use of antiviral medication and condoms can reduce the risk of transmitting the infection in sexual relationships. It is extremely important to practice safer sex to prevent your partner from catching herpes.

Herpes Virus Transmission During Childbirth

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Research performed in the United States, in 2021 states that around 1 in every 1000 newborn babies was diagnosed with neonatal HSV.  As the virus can lead to serious complications such as premature childbirth, thus it is extremely important to inform your healthcare professional if you feel like having HSV.

If you contracted herpes before pregnancy and experienced recurrent genital herpes infection, you can transmit the infection to your baby during delivery. The risk is even higher if you contract herpes virus during pregnancy, particularly during late pregnancy. Conscious planning and precautions during pregnancy and delivery can reduce the risk of transmission.

In such cases, health care professionals prescribe preventive antiviral therapy for women with recurrences during pregnancy. For women who experience an outbreak at the time of labour, mostly cesarean delivery is recommended.

Genital Herpes Treatment

There is no complete cure for herpes however various herpes treatments are available which can effectively resolve the symptoms. These treatments do not kill the herpes virus but make it inactive and help relieve the symptoms.

Antiviral Medication

The blisters usually improve without treatment however for severe and frequent outbreaks antiviral medications are prescribed. Antivirals effectively help reduce the number of herpes episodes and comfort the severity of symptoms.

Most prescribed antiviral drugs include Acyclovir, Famaciclovir and Valcyclovir. Antiviral medications such as Acyclovir also help diminish the chances of transmission during an outbreak or shedding it when there are no noticeable symptoms.

Acyclovir is the oldest and most affordable antiviral medication for herpes treatment. Usually, it necessitates more frequent dosing than other antiviral drugs. The dosage and length of the antiviral treatment are based on whether the is initial or recurrence.

Acyclovir treatment is most effective when you begin it within 72 hours of the first symptoms. Patients with a previous history of recurrent genital herpes are advised to have antiviral medication in their home so that they can begin right at the first signs of a recurrent episode.

Suppressive Therapy

Suppressive treatment is an antiviral treatment that should be taken every day to prevent outbreaks. It helps reduce the frequency and duration of recurrence and may also reduce the risk of spreading herpes to susceptible partners.

Suppressive treatment may also be suggested if you are in a sexual relationship with a partner who has no history of genital herpes or antibodies to type 1 or 2. One study shows that suppressive therapy can effectively reduce the risk of transmitting the virus by around one-half.

Chances of Spreading Herpes While on Acyclovir

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Acyclovir is the commonly prescribed treatment for oral and genital herpes. It helps manage symptoms, prevent herpes outbreaks, lower the frequency of outbreaks and reduce the risk of transmission.

Taking Acyclovir treatment helps suppress herpes and also decreases the chances of spreading the virus to the uninfected partner by 50%. Acyclovir works by preventing the spread of the virus inside the body. It does not provide 100% protection from spreading herpes. You may spread herpes to your partner while on Acyclovir.

If you are under Acyclovir treatment for genital herpes, it will not prevent you from transmitting the infection to your sexual partner. It is advised to avoid sexual intercourse if you have lesions or initial signs of an outbreak. Even if you have no visible symptoms of infection, transmission may occur due to asymptomatic shedding.

Randomised Controlled Trial To Evaluate The Effectiveness Of Acyclovir To Decrease Herpes Simplex Virus Transmission From Coinfected People

Daily suppressive treatment with Valacyclovir decreases the risk of sexual transmission of HSV type 2 in HSV 2 serodiscordant heterosexual couples by 48%. Whether the suppressive treatment decreases HSV 2 transmission from coninfected people with HSV2 and HIV is not known.

In this randomized controlled trial a daily dose of Acyclovir 400 mg is given twice in an African HIV 1 serodiscordant couple in which HIV 1 infected partner was HSV2 seropositive. The partnerships were identified in which HIV-1 susceptible partners were HSV2 seronegative to evaluate the effect of Acyclovir on the chances of HSV2 transmission.

911 HSV 2 / HIV 1 serodiscordant couples were randomly assigned to daily doses of Acyclovir or placebo. 68 HSV 2 seroconversions were observed, 40  in the Acyclovir group and 28 in the placebo group.

Among HSV 2 susceptible women, unprotected sex and vaginal drying practices were important risk factors for HSV 2 acquisition, having more children was protective. Among HSV 2 susceptible men just aged ≤30 years was linked with the increased risk of HSV 2 acquisition.

In conclusion, the treatment of African HSV 2 HIV 1 infected people with daily Acyclovir did not increase the risk of HSV 2 transmission to susceptible partners. More effective preventive options are needed to reduce the transmission of HSV 2.

Acyclovir and Valacyclovir for Suppression of Shedding HSV in Genital Tract

Valacyclovir shows better oral absorption and more prolonged serum concentrations as compared to oral Acyclovir. A double blind clinical trial was performed to determine the clinical efficacy of Acyclovir and Valacyclovir on herpes simplex virus shedding.

69 immunocompetent people with genital herpes (HSV2) were administered oral Acyclovir, Valacyclovue and matching placebo for 7 weeks. The patients were provided genital mucosal swabs daily for HSV detection through viral culture and PCR.

HSV was detected at least once in 90% of patients by culture and 98% by PCR. During the placebo, the HSV shedding rate was 15.4% of days by culture, and the subclinical shedding rate was 6.6% by culture. Both antiviral medications were linked to lower HSV shedding by culture and PCR as compared to placebo. No significant difference was observed in frequency and amount of HSV by PCR between the Acyclovir and Valacyclovir groups.

In conclusion, even though the viral replication suppression is not complete, Acyclovir and Valcyclovir are highly effective in suppressing the frequency and amount of genital HSV sh