Asymptomatic Shedding and Transmission
Somewhat surprisingly, more than 80% of HSV-2 infections are asymptomatic, subtle enough that they remain unrecognized, or misdiagnosed because genital ulcers are absent. (p458) Even in the absence of any clinical manifestations, herpes can reactivate from its usual dormant state and be transmitted via skin to skin contact to sexual partners through a process called asymptomatic shedding. In fact, the majority of new HSV cases are transmitted from source individuals who have no apparent lesions. By means of sensitive DNA amplification tests conducted on anogenital swabs, HSV has been detected in almost all asymptomatic seropositive individuals about 20%-25% of days. The minimum amount of detectable HSV needed for transmission to occur to a sexual partner has not yet been established. Therefore, it is not known if each instance of detectable HSV necessarily represents potential infectivity. The rate of shedding appears to decrease with time elapsed since primary infection by up to 70% after 10 years. (p S20) Given these findings, experts advise that all seropositive individuals should be considered potentially infectious to their sexual partners, even if the risk of transmission cannot be quantified.
Journal for Nurse Practitioners. 2014;10(3):194-199. © 2014 Elsevier Science, Inc.