Genital Herpes and Viral Shedding

While there are still misconceptions about genital herpes, how it is spread and what it means to be infected, we know a lot more than we did 5 years ago.  Having a frank conversation with an STD testing counselor or your doctor about how to manage an infection and prevent its transmission to your sexual partners is now more important than ever.

Medical researchers estimate that 1 in 4 adults in the United States over the age of 18 is infected and as many as 90% are unaware that they are infected.  Research shows that persons with asymptomatic genital herpes infection can not only transmit the disease but are the main source of transmitting HSV-2 (genital herpes) through viral shedding, with up to 70% of new infections resulting from viral shedding by persons who have no clinical signs or symptoms.

When it comes to genital herpes, what you see is not what you get.  Persons in the study who swabbed their genitals daily show that they shed the virus often – averaging 18% of the days for those infected with HSV-1 and 15% of the days for those infected with HSV-2.  This study also showed that asymptomatic persons shed the virus at the same rate as those who have up to 12 outbreaks a year.Genital Herpes and Viral Shedding

Most patients with genital herpes aren’t associating symptoms like bug bites or poison oak on the buttocks or thighs, vaginal yeast infections, friction burns on the penis, or “recurrent shingles” with the disease.  However, once a person is told they have genital herpes, they can recognize its symptoms.  But the problem is that even when a person recognizes subtle outbreaks, they have no idea when viral shedding occurs.  Medical experts say that nearly 50% of viral shedding occurs at random while the other 50% happens just before, during or after an outbreak.  Because viral shedding is so hard to predict, experts are now focusing on the behavior of the virus itself.

As a result of this approach, genital herpes is viewed as a disease that is spread by persons who are chronically infected with a virus that is shed from genital mucosa whether the person exhibits symptoms or not.  But this shift means nothing for persons with genital herpes unless they get tested.  A person with high blood pressure won’t know they have high blood pressure unless they get tested.  The same is true with genital herpes.  STD testing allows a person who doesn’t show symptoms to identify recurrences and gain some control over their ability to spread an infection to their sexual partners.

What counselors are now able to tell patients is that there is no day a person with genital herpes can tell his or her sexual partner that they won’t get infected because there’s no way to tell what day a person is infectious.  Such counseling is honest and accurate and gives patients a more thorough understanding of genital herpes.  It also empowers the infected person to have a better conversation with their sexual partner.

While regular condom use and daily use of valacyclovir therapy can reduce these rates by around half, medical experts say there will always be some degree of risk.  Exploring a hypothetical situation involving Zach and Vanessa helps to understand this risk.  Let’s assume that Zach admits to Vanessa that he is infected with genital herpes and offers to use condoms every time they have sex.  Vanessa can’t handle this and moves on.  A week later she meets Dylan.  Worried that she’ll get infected, she asks Dylan right away if he has herpes.  Certain he’s uninfected he tells her he is not that kind of guy.  But in reality he has genital herpes and is asymptomatic.  Satisfied with his answer, Vanessa sleeps with him, using birth control bills rather than condoms.  Two months later, she’s infected with genital herpes.

Vanessa is not alone.  Having genital herpes doesn’t alter the core of one’s being or their worth and the gifts they bring to the world.  Genital herpes happens to people in monogamous relationships or with 50 partners.  They are rich and they are poor.  In Chicago, STD testing is the beginning to taking control of your sexual health.  Knowing if you have an STD empowers you to get treatment and prevent spreading the disease.


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