HSV-2 in non-sexual ways, prevalence in children

[jack0109]

Dear EWH,

I stumbled upon a study on the internet which got me rather worried and extremely confused. The study talks about high prevalence of HSV-2 in children. My understanding was that HSV-2 is only passed by sexual ways. How can this be explained as I have asked in various support groups and did not get a clear answer. So i decided to ask here in medhelp.I understand that spread of HSV-2 in a family is mainly from sexual abuse and is it possible to spread it other ways such as, not cleaning hands and changing diapers, sharing utensils, etc. The link of the study is as below:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16891495

http://www.ncbi.nlm.nih.gov/pubmed/16891495

Is the trend in America alike where less then 5% of children have HSV-2 and it stays that way until they are sexually active from 12 years old onwards.Im guessing the 5% comes from mother-to-child transfer.

Thank you.

[Skeptic00]

A related discussion, HSV-Type 2 was started.

[Edward W Hook, MD]

Nothing more to add.  EWH

[jack0109]

I have already searched the whole internet and pubmed and did not come up with any scientific study, so I was wondering if you are aware of any particular study. If not then its fine.

[Edward W Hook, MD]

Sorry, I'd suggest you try the library or some other internet search engine. The literature is vast.  EWH

[jack0109]

I have no further questions, I only asked for any citations for our earlier discussion. It will be useful from a scientific point of view. Thank you.

[Edward W Hook, MD]

Sorry, this thread has ended.  Further questions need to start as a new thread.  EWH

[jack0109]

Most people on the internet state that the virus dies very quickly outside the body, but so far I have found 4 studies with the finding of enough moisture the virus lives for hours even in extreme temperatures. I was wondering if you know of any studies which looks into how quickly the virus dries out and dies in room temperature. It sure will be helpful, there will be scientific backing to those claims.

[Edward W Hook, MD]

My answer regarding your question about the scrotum was included "You are correct".  Scrotal herpes is rare.  In aprt becasue of the type of skin found on that area, as well as the different sort of contact.  And that will be my llast answer.  Try to relax, it will make life more pleasant.   EWH

[jack0109]

Sure end of the discussion, what about the question on the scrotum, is that considered vulnerable as in a mucous membrane. I thought that the skin is thick enough to prevent viral entry?Are condoms for male sufficient?

[Edward W Hook, MD]

You are correct.  IT is now time to stop worrying about hypothetical situations and move on.  No firther questions please.  EWH

[jack0109]

Okay thanks. I am assuming that study done about virus being alive on toilet seats after 4 hours would probably not have much weight since in this case everyone would be infected.

Is the condom sufficient to protect males from acquiring the virus. I would assume the skin on the scrotum is thick enough for viral entry

[Edward W Hook, MD]

thanks Dallasfan.

To Jack0109.  the data on the performance of HSV serologcial testing for HSV-12 in children is limited.  I really do not know how the test performs in North American children.  I would anticipate it would not work well among kids in Africa such as those included in the study you cited.  This wil end this thread.  Take care.  EWH

[Dallasfan]

I hope Dr, Hook won`t mind if I add a brief comment. The transmission of Herpes via inanimate objects seems to be a common topic. Years ago , when I was doing some grad work in chlamydia, I had the chance to help the graduate assistant working with her research in Herpes, specifically type 2. I can tell you the virus is very fragile and often is lost in transport from the STD clinic to the lab. Herpes just doesn`t survive well. I hope this helps.

[jack0109]

Also I understand that HSV-2 testing are not accurate on children?

[jack0109]

Okay so that explains everything. Very last to end the discussion. So I am assuming HSV-2 does not spread in a domestic environment in a family from mother-to-children even while changing diapers or such because of the same reasons as explained above. Only route is via sex. Thanks

[Edward W Hook, MD]

While I can understand the theoretical situation in which a person might acidentally pick up HSV or some other STD from an inanimate object such as a toilet seat, door knob, etc, the fact of the matter however is that these organisms are just not very tough and do not survive well in the open air or on inanimate objects.  There has never been an STD transmitted in the fashion that you suggest and thus it really is not a realistic concern.  The only way to realisticvally get an STD in a public toilet is to have sex in the public toilet.  That's not to say that handwashing is not a good idea but conerns related to picking up STDs in that way do not have any basis.  EWH

[jack0109]

Thank you for your answer, it makes sense now glad that I asked. My last question, I read around last night and came to find out that STDs including herpes cannot be spread with a "handjob". How is this so? What happens if some of the viral particles or liquid is on the hands and massaged to a persons genitals.

A professional and office environment will be, lets say someone goes to the toilet and another person who has genital herpes scratches and while coming out from the toilet shakes hand(assuming he did not wash his hands) with this person who goes in to pee. While peeing he hold his penis. Is there a plausible risk here to be infected? With all the walking Im assuming there is some force exerted to massage the virus in the genital area.

Is washing hands before peeing the only possible way to avoid an infection in a restroom environment?

Thank you.

[Edward W Hook, MD]

Thanks for ask king your question using your own post.  As I said, as a rule we do not engage in debate regarding articles and papers seen in the literature or on the internet on this site.  In this case I am willing to engage in a brief discussion.  

The paper you reference may not be relevant to a North American or Western European setting. The authors clearly acknowledge this and state only that their study MAY reflect non-genital transmission.  They are by no means emphatic on this . The data presented are from a selected group of Tanzanian children seen at a special clinic rather than generated from the more general population.  Almost 20% of them had HIV.  In addition, the antibody test results which are most striking were not done by well standardized commercial tests but  "home brew" assay developed by the investigators which compared pretty well, but by no means perfectly, with data for better standardized tests.  The test the used had a false positive rate of almost 8% as well.  Finally, numerous other studies published in the scientific literature indicate that, even using commercial blood test which perform well in the U.S.,  blood tests performed on sera from Africa are more difficult to rely upon because of high false positive rates possibly related to high rates of antibodies relating to other kinds of infection.  For all of these reasons, unless you live in Tanzania, and possibly not even then, I would not put too much emphasis on these results.  They are not likely to be relevant to your situation.  

Furthermore, I would add that studies of he virus have shown that the herpes viruses biologically "prefer" to cause infections at certain sites with HSV-1 being more likely to infect the mouth and lips and HSV-2 being more likely to infect the ano-genital region.

for all of these reasons, non-genital transmission of HSV on hands, eating utensils, etc is just not an issue.  

Finally, regarding why studies suggest that even a few young children have antibodies to HSV, that has not been studied.,  Possibilities include cross reaction to other viruses (remember HSV is related to the chicken pox virus for instance) and other source of false positives.

I hope these explanations are helpful to you.  EWH