Viral Shedding with Asymptomatic HSV-2 Infection

Richard T. Ellison III, MD


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In This Article

Abstract and Introduction


Both symptomatic and asymptomatic HSV-2 disease are associated with frequent viral shedding.


Asymptomatic herpes simplex virus type 2 (HSV-2) infection is well described, but its natural history and relative transmissibility remain unclear. In this prospective study, researchers evaluated the frequency of viral shedding and genital lesions among 88 adults with newly diagnosed, asymptomatic HSV-2 disease and 410 adults with previously identified, symptomatic HSV-2 infection. All study participants collected genital swabs daily for at least 30 days and maintained symptom diaries. Median follow-up was 57 days.

Individuals with asymptomatic HSV-2 infection had a significantly lower frequency of viral shedding than individuals with symptomatic infection (10.2% vs. 20.1% of all observation days). However, shedding was still found at least once in 68.2% of asymptomatic individuals. During follow-up (which included educational sessions on HSV-2), 21.6% of individuals with initially asymptomatic disease reported genital lesions, and these patients had both more-pronounced and more-prolonged shedding than those who remained asymptomatic. Both viral shedding and genital lesions were more common in white patients than in others.


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