Asymptomatic Viral Shedding

"Intermittent asymptomatic shedding occurs in persons with genital HSV-2 infection, even in those with longstanding or clinically silent infection."1

 

Transmission in the Absence of an Outbreak

  • Mertz et al showed that up to 70% of transmission of herpes may occur during periods of asymptomatic viral shedding2
  • Asymptomatic viral shedding can occur regardless of how many outbreaks patients experience*3
  • A study by Wald et al found that most patients shed virus asymptomatically4
  • A study of 110 women, followed for a median of 105 days, also found that 50% of episodes of asymptomatic viral shedding occurred more than 7 days from a symptomatic outbreak5

Asymptomatic viral shedding is not linked to outbreak frequency

  • Wald showed that the rate of asymptomatic shedding among women with 1 to 12 recurrences per year did not differ significantly from that of women without recurrences5
  • A second study by Wald showed that asymptomatic viral shedding occurred as often in seropositive patients without a history of symptomatic genital herpes as in seropositive patients with a history of symptomatic genital herpes (3.0% vs 2.7% of days)6
  • Whether or not HSV-2 seropositive patients have recognized outbreaks, the majority of patients will shed virus at some point in time6

Impact of asymptomatic viral shedding on patients

  • Patients cannot predict if, when, or where they might be shedding asymptomatically5
  • Avoiding sex during an outbreak may not be enough to reduce transmission to a partner5
  • Patients should be counseled to use safer sex practices including condoms at all times and should be told of additional options to protect their partner1
  • Daily therapy can reduce asymptomatic viral shedding3,7,8
  • Click here to learn more about ways to reduce the risk of transmission of genital herpes

The clinical significance of reducing viral shedding has not been established.

*Sample results from a prospective study to determine frequency of viral shedding in 110 immunocompetent
 female patients with a clinical history of genital herpes (median 1.3 years). Patients were followed for a median
 of 105 days. Specimens for culture were collected for a median of 82 days.

In immunocompetent heterosexual adults. Safer sex practices should be used with daily therapy with VALTREX.

 

  1. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR. 2006;55 (RR-11):1-92.
  2. Mertz GJ, Benedetti J, Ashley R, Selke SA, Corey L. Risk factors for the sexual transmission of genital herpes. Ann Intern Med. 1992;116:197-202.
  3. Data on file, GlaxoSmithKline.
  4. Wald A, Corey L, Cone R, Hobson A, Davis G, Zeh J. Frequent genital herpes simplex virus 2 shedding in immunocompetent women: Effect of acyclovir
    treatment. J Clin Invest.1997;99:1092-1097.
  5. Wald A, Zeh J, Selke S, et al. Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med. 1995;333:770-775.
  6. Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med.
    2000;342:844-850.
  7. Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350:11-20.
  8. Reitano M, Tyring S, Lang W, et al. Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose
    range-finding study. J Infect Dis. 1998;178:603-610.