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Dr Sean Cummings  
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Specialties: STD/STI HIV prevention

Interests: Hepatitis C, Men's Health, HIV Prevention
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Genital Herpes (HSV2) and HIV Disease: Why does it matter?

Jul 02, 2010 - 7 comments

Genital Herpes (HSV2)  and HIV disease:  Why does it matter?

There is good evidence from population studies of people infected with both HIV1 and also HSV2 that infection with Herpes Simplex 2 virus will both increase the amount of HIV1 which is shed in gental secretions and also it increases the rate at which HIV 1 is transmitted.
Treatment designed to suppress Herpes simplex 2 (HSV2) is established to reduce the amount of HIV1 RNA in blood and also genital secretions such as semen and vaginal secretions.
The impact of co-infection (having infection with HIV and HSV2) of HIV1 and HSV2 is very significant indeed with HSV2 and HIV1 co-infected individuals having very much more HIV1 RNA (ie the infectiouness of the individual is increased) in their genital secretions and also in their blood. This obviously means that their potential for spreading HIV either through asymptomatic HSV shedding or symptomatic HSV2 lesions is greatly increased. In addition, treatment for the HSV2 part of the co-infection has no effect on the HIV1 directly but does reduce the HIV1 viral load.
HIV viral load increases are associated with an accelerated course towards the development of AIDS defining diagnoses (AIDS is not the same as being HIV positive). The way anti HSV2 medications reduce HIV1 viral load is thought to be through partly interupting the “HIV inducing effect” of HSV2.
Unfortunately, we also know that people with HSV2 genital lesions are much more likely to acquire HIV1 from an HIV infected individual – by a factor of up to six times more likely.
Up to 60% of people living in the “West” with HIV have Herpes Simplex 2 (HSV2) infections whereas in Sub-Saharan Africa the figure is thought to be up to 90%.
A study by Nagot and others published in the NEJM (Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus. N Engl J Med 2007;356:790-9) looked at HIV1 and HSV2 co-infected populations in Sub-Saharan Africa and treated trial subjects with valaciclovir, an anti-HSV2 drug.

HIV1 is shed from HSV2 lesions and most of the shedding (85%) occurs without the actual physical appearance of HSV2 genital ulcers.

The effects were to markedly reduce the re-occurence of HSV2 lesions, and to markedly reduce the amount of HIV1 in both blood and also genital secretions.

The significance of this is that reducing the HIV1 viral load in the genital tract by treating the additional HSV2 infection may reduce the transmissibility of HIV1 infections (and probably HIV2 although this was not within the studied populations).

A further possible scenario is that people with HSV2 but not HIV will be at theoretically reduced risk of HIV acquisition if they suppress the appearance of HSV2 lesions by long term suppressive treatments such as aciclovir or valaciclovir. Aciclovir has the great advantage of being very cheap and very well tolerated.


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Avatar universal
by advice744, Jul 02, 2010
wat is genital harpis n if a person with hiv has harpis n i hug him n say both of r without clothes will it cause harpis to me along with hiv

Avatar universal
by advice744, Jul 02, 2010
is harpis visiable on the body or it only applies to gental harpis

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by Dr Sean CummingsBlank, Jul 02, 2010
Advice744 -f you have a general question then please ask it within the relevant Forum - STD's for this one.

Avatar universal
by janderson88, Jul 05, 2010
PLEASE HELP IT HAS BEEN 3.5 MONTHS!!!!!!

I Went away, was sexually active, came back and 2 weeks later had headaches, nausia, bad lower back pain, lower abdominal pain, was burning and tingling in urethra with urination, and without, FREQUENT urination, always having to go and felt like it was just going to leak out. I went to my doctor immediately, and was put on antibiotics, did a blood and urine test that came back perfect.

After 3 weeks on the antibiotics I started to get a little bit itch around my genitals. I then was given a swab test, and put on another week of antibiotics. Also did a lower abdomen ultrasound, everything came back perfect. I then saw another doctor and was put on an antibiotic for a prostate infection, which 10 days later I ended up having an allergic reaction too (rash all over my body) and was taken off of it and put on cipro for 42 days. The effects of the cipro were less then desirable but I stuck it out hoping all would be well. Here is where the dermatology comes in, I had developed iching in my genital area and then brown patches on my penis and was told by my doctor that it could be Candida, after doing my research I decided that it is very likely due to the long time of antibiotic use and over cleaning of genitals for fear of an std. I had a hiv test at the beginning of this process which was perfect and after the 3 months which was perfect as well. I have been MENTALLY DRAINED with worry of an std mainly worried about herpes, well terrified. I was given ketoderm cream for the candida after I MADE my doctor look and try and make a diagnosis and then dark patches have since subsided after using it and after finishing my 42 days of cipro. 2 weeks after finishing my symptoms were back, lower back pain, lower abdominal pain, but mostly frequent urination and feeling that i could not keep it in. Due to the horrible effects that i had been experiencing from the antibiotics I did not take my last prescription that he gave me and the symptoms have since gone away though due to all this antibiotic use I am still severely itchy, and very sensitive, if I masturbate my skin become inflamed and irritated, I also now have a mark due to friction (i think) that has been there for 3 weeks and hasn't changed just looked a bit red so i am not masturbating at all in fear I will hurt myself. Also I have sevear rectal itch. and aching in my genital area. I took a few doses over the course and after the course of antibiotics of a yeast pill called fluenza or something like that and have a fantastic diet so I think I have kicked the candida out of my body and now I have had to try and diagnose myself and I think what it is is a mild case of eczema after all this antibiotics and candida. So my doctor gave me a prescription for Clobetasol Propionate cream 0.05% and I have been using it for 1 day.... I am still terrified that I could have herpes though I have had no kinda of blisters or scabs and I check daily (which is driving me insane)  also I have aching within my rectum.... which seams to subside as time goes by. PLEASE PLEASE PLEASE HELP ME I have had every test there is (except herpes blood test) which would set me at ease if it came back negative but everything else looks perfect I also spoke with a urologist who seams to think i just had inflammation of the pelvic floor. Now the main thing that is bothering me is the discoloration of my penis which is going back to normal, there are some lighters spots on my penis head.... and the itching which is there and worrying me every day... I can't wait to hear what you have to say. Thank you sooooooo much!!!!!!!!

Avatar universal
by viper1984, Jun 13, 2011
I had all the same symtoms and got a swab test and they said I had herpes and now the pain is all over my body I started treatment its my first day of it hope ur clean guy.

Avatar universal
by Clarification114, Nov 28, 2014
Sean - interesting journal.

How can hiv be spread through asymptomatic hiv shedding?

And does this apply to oral sex too. Ie if someone performed oral sex on someone with hiv and hsv2 - and caught oral hsv2.. Would the chance of catching hiv from this oral experience increase?

It is this article purely based around unprotected genital sex?

Avatar universal
by lalitharajsinghi, Nov 29, 2014
Dear Sean,

Your explanation is fantastic
I have a question in general

HSV-2lgM and HSV-2lgG results related
urologist reply please!!

HSV-2lgM ratio <1 is normal which shows in lab report
HSV-2lgG RU/ml < 20 is normal value level which shows in lab report

Mine is HSV-2lgM <0.1
HSV-2lgG is 3.0
chlamyden is negtiv
HIV Negativ


< 20 RU/ ml is taken standard in European lab.in Germany,Lab

I think my straight doubt is negative should mean zero why the titre shows 3 RU/ml instead of as zero.
will people/virgin have zero RU/ml?

I had unprotected sex with xgirlfriend for 2 years.
then after break up with her and no partner for a year
then married a year ago
will I get possiblity in future?
will this 3.0 RU/ml effect my wife?

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