Asymptomatic HSV-2 Shedding

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Introduction

Genital herpes is one of the most prevalent sexually transmitted infections in the world today; approximately 45 million adults in the United States are seropositive for herpes simplex virus type 2 (HSV-2).^[1] Although the infection itself is generally not life-threatening, it has a significant morbidity and impact on patients' lives,^[2] and has profound public health implications with respect to the transmission and acquisition of other sexually transmitted infections, including HIV infection.^[3,4]

The ability of HSV-2 to establish latency in sensory nerve ganglia and to undergo periodic reactivation and frequent asymptomatic shedding across mucosal surfaces creates a lifelong potential for transmission to sexual partners and for the possibility of neonatal infection in pregnant women. Further, HSV-2 infection has been demonstrated to significantly increase the transmission and risk of acquisition of HIV.^[3-5] At present, there is no cure for genital herpes infection, but treatment strategies are available to alleviate the acute symptoms of herpes outbreaks, suppress recurrences, reduce asymptomatic shedding, and lower the risk of transmission.

Oral antiviral therapy, until recently, had been prescribed for patients with genital herpes either to alleviate the acute symptoms and signs of an outbreak (initial or episodic treatment) or to prevent HSV reactivation and the subsequent development of recurrent outbreaks (suppressive therapy). The use of chronic, daily antiviral therapy to reduce transmission of genital herpes is a new indication and signifies the most significant development in the management of genital herpes since the introduction of acyclovir.