Teri Warren a nurse Practioner spoke about the question of the different strains and transmission. Some of the bottom are links to fact about percentages of transmission to non-infected HSV partners.

She explained if you have type 2 and are with someone with type 2 no problem, you both have it and can't give it any further.

However, if you have type 1 genitally and are with someone that has type 2 then the type 1 person can get type 2 also.

The type 2 person can not get type 1 since type 2 is a stronger virus of the type 1.

Remember though you both have herpes even though they are different strains. So what does it really matter, right?

HSV 1 vs HSV 2

HSV 1prefers the trigeminal nerve areacauses all cold sores and fever blistersaccounts for 1/3 of all new genital infectionsrecurs infrequently in the genital areacauses most ocular herpes and encephalitisdoes NOT protect against getting HSV 2 but can make new HSV 2 more likely to be subclinicalpresents special risks for newborns

HSV2causes 2/3 of new genital infectionsrecurs 4-5 times per year in the genital areais very rarely oral and recurs .01 x per year if oral infection does occurDoes protect against getting HSV 1can be present for years without any symptoms

Differences in type and location and frequency of recurrences:
HSV 1 Orally 2-3 times per year HSV 2 Orally .01 times per year
HSV 1 genitally 0-1 times per year HSV 2 genitally 4-5 times per year

NHANES data shows increasing HSV 2
21.9% of the people in the US over the age of 12 are infected with HSV 2
25% of the people in the US over 18 are infected with HSV 2
Ethnic minorities more often infected than whites
Infection in whites is growing more rapidly than infection in minorities.

She also brought up that we all should get type tested and that you have to ask your doctor specifically for type testing. She highly recommends the Western Blot but there is a new one that is cheaper and just as reliable...Meridan Premiere ELISA for HSV 1 & 2

What are the chances of getting herpes in a year from an infected person?The overall average rate is 7 %
HSV 1 negative women 12.37%
HSV 1 negative men 3.3%

HSV 1 positive women 10.4%
HSV 1 postive men 2.1%

As for treatment she recommends:

First Episode Treatment
Acyclovir 400mg TID for 10 days
Valtrex 1000mg BID for 10 days
Famvir 250mg TID for 10 days (not FDA approved)

Episodic Therapy
Acyclovir 400mg TID for 5 days
Valtrex 500mg BID for 5 days
Famvir 125mg BID for 5 days

New study by Leone, et al, shows that Valtrex 500mg twice a day for 3 days as effective as 500mg twice a day for 5 days

Suppressive Therapy
Acyclovir 400mg twice a day daily
Valtrex 500mg once a day daily for people with 8 or fewer outbreaks per year
Valtrex 500mg twice a day or 1000mg once a day if 9 or more outbreaks per year
Famvir 250mg twice a day

There are stats on transmission within couples.

Paper: Effect of Condoms on Reducing the Transmission of Herpes Simplex Virus Type 2 from Men to Women Authors: Wald A, Langenberg A, Link K, Izu A, Ashley R, and others Reference: JAMA 2001; 285: 3100-06 (June 27) http://www.arcmesa.com/cont_ed/mddigest/06-28-01.html

Transmission of HSV may occur both during clinically evident outbreaks and asymptomatic virus shedding. Even though the risk is significantly higher with active herpetic lesions, asymptomatic viral shedding is probably the primary mode of transmission (13). It occurs by close personal contact (mostly sexual contact) and it appears to be most efficient from men to women. Studies of serologically discordant heterosexual couples report transmission rate between 10 - 12 % per year (14,15). http://www.mf.uni-lj.si/acta-apa/acta-apa-00-1/rogl.html

Rate of acquisition of HSV-2 over a one year period

Over a one year period, 1 in 10 people with genital herpes having sexual contact without the use of condoms will pass the virus on to their partner even if they avoid sexual contact when symptomatic. This was shown by the following study:11144 couples were evaluated over a mean 334 days. All these evaluated couples avoided sexual contact during visible genital herpes recurrences.

The transmission rates given below, therefore, are for those who normally would consider themselves safe from infection: Overall infection rate nearly 10% Among 13 couples where transmission occurred, 9 cases (70%) occurred when the infective partner was asymptomatic and 4 occurred during prodrome or within hours of the first lesion being observed.

From infective male to uninfected female nearly 17%
From infective female to uninfected male nearly 4%
So males transmit to females more readily than vice versa.
From infective male to uninfected female with HSV-1 antibodies about 9% with no HSV antibodies nearly 32%
So those who already have had previous HSV-1 infection gain some protection against genital herpes infection through having prior infection http://www.herpes.org.nz/medical_manage/mm_transmission.html

There are studies being done to see how being on suppression will affect rates of transmission.

Previous research showed that suppression can reduce subclinical viral shedding ("asymptomatic" shedding) a great deal, but there it wasn't known how that would affect transmission. From what I've read, even though the research is still in progress, herpes researchers seem to believe that suppression *probably* does reduce risk of transmission.

Hope that assists you all, I know I learn a lot from both of them.

Smiles And Hugs!

Marisa :)