Persons with herpes simplex virus type 2, but without symptoms, still shed virus

Persons who have tested positive for herpes simplex virus type 2 (HSV-2) but do not have symptoms or genital lesions still experience virus shedding during subclinical (without clinical manifestations) episodes, suggesting a high risk of transmission from persons with unrecognized HSV-2 infection, according to a study in the April 13 issue of JAMA, a theme issue on infectious disease and immunology.

Anna Wald, M.D., M.P.H., of the University of Washington and Fred Hutchinson Cancer Research Center, Seattle, presented the findings of the study at a JAMA media briefing at the National Press Club in Washington, D.C.

" is one of the most frequent sexually transmitted infections worldwide, with global estimates of 536 million infected persons and an annual incidence of 23.6 million cases among persons aged 15 to 49 years. In the United States, 16 percent of adults are seropositive, but only 10 percent to 25 percent of persons with HSV-2 infection have recognized . Moreover, most HSV-2 infections are acquired from persons without a clinical history of genital herpes," according to background information in the article. Thus, the risk of sexual transmission does not correlate with the recognition of clinical signs and symptoms of HSV-2 but most likely correlates with the activity of the virus on the genital skin or mucosa (viral shedding).

Dr. Wald and colleagues compared the rates and patterns of genital HSV shedding in 498 immunocompetent HSV-2-seropositive persons between March 1992 and April 2008. Each participant obtained daily self-collected swabs of genital secretions for at least 30 days. The rate of viral shedding (the presence of virus that is actively replicating, and can thereby be transmitted to another person) was measured by polymerase chain reaction (testing method for viral DNA) from the swabs.

Among the findings of the researchers, HSV-2 was detected on 4,753 of 23,683 days (20.1 percent) in 410 persons with symptomatic genital HSV-2 infection compared with 519 of 5,070 days (10.2 percent) in 88 persons with asymptomatic infection. Genital HSV was detected at least once in 342 of 410 persons (83.4 percent) with symptomatic HSV-2 infection and in 60 of 88 (68.2 percent) persons with asymptomatic HSV-2 infection during the 2 month study.

Subclinical genital shedding rates were higher in persons with symptomatic infection compared with asymptomatic infection (2,708 of 20,735 [13.1 percent] vs. 434 of 4,929 [8.8 percent]). "However, the median [midpoint] amount of HSV detected during subclinical genital shedding episodes was similar in persons with symptomatic and asymptomatic infection," the authors write.

Persons with symptomatic infection had more frequent genital shedding episodes compared with persons with asymptomatic infection (median 17.9 vs. 12.5 episodes per year). Days with lesions accounted for 2,045 of 4,753 days (43.0 percent) with genital viral shedding among persons with symptomatic genital HSV-2 infection compared with 85 of 519 days (16.4 percent) among persons with asymptomatic infection. This indicates that the bulk of days of shedding in persons with asymptomatic HSV-2 is unrecognized, and people may engage in sexual activity not knowing that they are at risk for transmitting the virus to sexual partners.

"Our findings suggest that 'best practices' management of HSV-2-infected persons who learn that they are infected from serologic testing should include anticipatory guidance with regard to genital symptoms, as well as counseling about the potential for transmission. The issue of infectivity is both a patient management and a public health concern. The primary concern of many HSV-2-seropositive persons is the risk of transmission to sexual partners; in our experience this is the main source of angst in patients with genital herpes."

The researchers note that several methods have been identified that partly reduce the risk of HSV-2 transmission to sexual partners. "Condom use, daily valacyclovir therapy, and disclosure of HSV-2 serostatus each approximately halve the risk of HSV-2 transmission. However, these approaches reach a small portion of the population and have not had an influence on HSV-2 seroprevalence in the last decade. One of the reasons for such a limited effect is that few people are aware of their genital HSV-2 infection, and routine serologic testing, although available commercially, is recommended only in limited settings. We hope that these data will result in further discussions regarding control programs for HSV-2 in the United States."

More information: JAMA. 2011;305[14]1441-1449.

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cora
not rated yet Apr 12, 2011
Most people have herpes may feel lonely and shamed. But 70 million are afflicted with STD in the U.S. alone. There is an exclusive community herpespeople,com for singles and friends with herpes. If you just need to find someone to talk to or need help or advice, this is the best place. Never feel lonely again!
cora
not rated yet Apr 13, 2011
My friend got genital herpes several years ago. life's hard for him sometimes..always been rejected. To help more people living with STDs, we created online herpes support organization STDdatings.com in 2001, only serving poz people with Herpes(HSV 1,HSV 2),HIV,HPV,Hepatitis. If you or someone you know is living with STDs, please come visit our site and add us as friend. Never live in your own dark corner.
Tina_Johnson
not rated yet Apr 14, 2011
I myself have had genital herpes for almost 2 years now. its great being able to talk to other people in the same situation. I personally have found peace and happiness. If you havent, you will. Ignorance and denial is not the solution. Be informed Learn the truth Here Hsoulmate.com. Which has more than 680000 memebers according CNN and it have provided many services such as chatting,blogs,test center,STD couselor,forum etc. I am still glad that I had the opportunity to confirm that having Herpes doesn't have to be a limitation.
positiveguy
not rated yet Apr 28, 2011
About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases, U.S. health officials said. Maybe this is the reason that why there are more than 680,000 members on the STD dating site STDmingle. com. Hope all the people take care and find love.