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Sexually transmitted infections

Genital Herpes Simplex Asymptomatic transmission

Asymptomatic transmission

Asymptomatic viral shedding is the primary mode of herpesvirus transmission. The infected partner is almost always unaware of the herpes infection. Therefore, highly motivated couples who are aware of the signs and symptoms of genital herpes and attempt to avoid sexual contact with lesions remain at substantial risk for transmission of genital herpes to the uninfected partner. Oral antiviral therapy substantially decreases but does not totally eliminate symptomatic or asymptomatic viral shedding or the potential for transmission.

Asymptomatic shedding.

Most persons who have serologic evidence of infection with herpes simplex virus HSV-2 are asymptomatic. The site of asymptomatic shedding is unknown. Virus has not been isolated from the semen or urethra after primary infection. Viral shedding can occur at any time. Asymptomatic shedding occurs most commonly in the first year after the primary episode (particularly the first 3 months), during the prodromal period, in the week after a symptomatic recurrence, and in HSV-2 infections vs HSV-l. The rate of subclinical shedding of HSV in the subjects with no reported history of genital herpes was similar to that in the subjects with such a history (3.0 percent vs. 2.7 percent). Among women with genital HSV-2 infection, subclinical shedding occurred on a mean of 2 percent of the days. The mean duration of viral shedding during subclinical episodes was 1.5 days, as compared with 1.8 days during symptomatic episodes. Women with frequent symptomatic recurrences also have frequent subclinical shedding and may be at high risk for transmitting HSV.