Screening for Asymptomatic Genital Herpes

Is Serologic Testing Worth It?

Leia Raphaelidis, FNP


Journal for Nurse Practitioners. 2014;10(3):194-199. 

In This Article

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.[9] (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.[11] 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.[12] 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.[13] The rate of shedding appears to decrease with time elapsed since primary infection by up to 70% after 10 years.[12] (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.[14]