People with asymptomatic herpes simplex virus (HSV) shed the virus less often than those with symptomatic disease, but they still pose significant risk of transmission, according to a new study.
The study included 498 patients who were seropositive for HSV-2. The participants collected swabs of their genital secretions for at least 30 days. In the 410 patients who had symptomatic disease, the virus was detected in 20% of samples. In the 88 people with asymptomatic cases, virus was found in 10% of samples. Although patients with symptoms had more subclinical shedding of virus, the amount of virus detected during these episodes was similar in people with and without symptoms. The study authors concluded that asymptomatic patients shed virus less frequently, but that the difference is attributable to their having less frequent genital lesions.
The study highlights the risk of disease transmission by people with unrecognized infections, the researchers noted. Although this study categorized patients as symptomatic or asymptomatic, disease manifestations actually vary along a broad continuum. The majority of people found to be seropositive do not have a history of genital herpes, but a substantial proportion of apparently asymptomatic patients will recognize recurrences after they've been diagnosed and educated, the authors said. The results were published in the April 13 Journal of the American Medical Association.
One of the purposes of this study was to address uncertainty about proper management of asymptomatic patients. The authors concluded that best practices should include anticipatory guidance with regard to genital symptoms and education about transmission risk. Proven methods of reducing transmission include condom use, daily valacyclovir therapy and disclosure of positive status. However, the strategies are only effective in diagnosed patients, who are a minority of the HSV-2 positive population, noted the authors, who called for a rethinking of current testing and control programs.
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