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You Can Have Herpes And Not Know It
(05/04/2004) by Ellen Rapp
We've all heard about the discomfort associated with genital herpes: the painful blisters, the days of waiting for an outbreak to subside. What many people don't know is that herpes often strikes without any noticeable symptoms. In fact, researchers say, the majority of people infected with herpes simplex 2 – the virus associated with genital herpes - don't know it.
Statistics on asymptomatic herpes are understandably difficult to compile. However, according to researchers at the Centers for Disease Control (CDC)in Atlanta, more than 45 million Americans (one out of five adolescents and adults) harbor the virus herpes simplex 2 – with more than three-quarters unaware that they are infected.
"Someone might have a little genital itching and not recognize it as a herpes outbreak," says Catherine Laughlin, Ph.D., chief of virology at the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. "Or they might feel nothing at all, and still be able to transmit the virus."
No one knows for certain why the virus causes symptoms in some people and not in others. Researchers believe it might have something to do with certain inherent properties in an individual's immune system. It is now known, however, that people who have recognizable herpes outbreaks can also have some asymptomatic episodes. In fact, someone may have asymptomatic herpes for years before developing genital herpes symptoms and mistake that outbreak for a first episode.
Some people can harbor the herpes virus all their lives without having any sort of outbreak. Once the virus enters the body, it moves along nerve pathways to the nearest nerve ganglia, near the base of the spine. As long as it stays there, in the nerve cells, it cannot be transmitted.
But once the virus is reactivated, it returns to the skin, where it multiplies and "sheds." This means that the carrier is capable of transmitting the virus as long as he or she has intercourse while the shedding occurs. (Exactly what causes the virus to be reactivated is still unknown, though some of the more commonly named factors are stress and, in women, menstruation.)
The same virus that results in no symptoms for one person may cause painful symptoms in his or her partner. Worse, a pregnant woman with herpes simplex 2 who is shedding virus at the time of delivery can pass the infection on to her baby, resulting in possible brain damage to the infant or even death.
However, according to Laughlin, the rate of asymptomatic transmission “is believed to be lower” than the rate of transmission that occurs with an active outbreak. This is because asymptomatic outbreaks tend to be shorter in duration than a recognizable outbreak, and less virus is shed.
While genital lesions can also occur with asymptomatic herpes, they are minute and generally can’t be seen with the naked eye. Even doctors may not be able to detect any signs of the virus, unless a test is performed at the time of viral shedding.
A man or woman who is worried about asymptomatic herpes can have a tissue culture taken from the genitals to test for the virus. But this isn't very practical. While tissue culture is still considered the gold standard for herpes testing, it will not detect infection with herpes simplex 2 unless the patient is shedding the virus while the culture is being taken.
"To be certain, you'd have to be cultured every day," says Benjamin Raab, M.D., a dermatologist with a private practice in Naperville, Illinois and former professor of clinical dermatology at Northwestern University Medical School in Chicago.
Blood tests can also detect the presence of herpes simplex 2, but according to the Centers for Disease Control’s Web site, “the results are not always clear cut.”
The use of condoms during sexual intercourse, as with other sexually transmitted diseases, reduces the risk of herpes infection. However, if either partner has herpes and is shedding the virus, it can still be transmitted via skin on the genitals that is not covered by the condom.
There is currently no cure for herpes, though there are antiviral medications, such as Valtrex, that can shorten outbreaks in those with symptoms and help prevent future outbreaks. Vaccines to prevent the transmission of herpes simplex virus 2 are under development.
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