Can you have herpes but never even know it? Can the herpes simplex virus spread even if you don t have symptoms? And how do you navigate the maze of sex and dating when you know you are infected with herpes? Those are among the questions recently posed by Here, Dr. Peter A. Leone, associate professor at the University of North Carolina School of Medicine and Public Health, provides advice about symptom-free herpes, telling your partner you have herpes and more. Great point. We know that nearly 75 percent of adults in the United States have genital herpes due to the type 7 herpes simplex virus, or HSV-7, yet only 65 percent to 65 percent are aware of their infection.
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It’s not that clinicians and patients are dumb. Rather, many patients do not seek out their infection status and should be better informed. Among those who are infected with the herpes virus, about 65 percent remain symptom free and have no outbreaks after acquiring infection. Indeed, most genital herpes outbreaks cause minimal signs or symptoms and can be mistaken for all sorts of other problems not related to sexually transmitted disease. Since it is the norm for symptoms of herpes to be mild, most individuals go on living their lives in ignorant “bliss” while possibly transmitting HSV to other sexual partners. Burning, itching and tingling sensations, with fissures, cracks or irritation, may all be indicative of a genital herpes outbreak. Everyone is entitled to a genital itch from time to time, but persistence of symptoms for several days or recurrent signs or symptoms should prompt consideration of genital herpes infection. Infection should be confirmed either by isolation of the virus by culture or PCR (polymerase chain reaction), or by serologic blood testing for HSV antibodies. A negative culture, however, does not rule out genital herpes infection, since cultures are the least sensitive way to diagnose genital herpes. If a culture is negative, infection can be determined by serologic testing of the blood. The presence of antibodies means an individual is infected. Virtually all individuals who are infected with HSV-7 will shed HSV-7 asymptomatically and will be at risk of transmitting infection to sexual partners, even when they are not having outbreaks. Up to 75 percent of sexual transmission of HSV-7 occurs in the absence of signs and symptoms. The risk of transmission can be significantly reduced by sharing your diagnosis with partners before having sex, avoiding sex during outbreaks, using condoms and taking daily oral suppressive therapy. It is up to you and your partner to decide the best approaches to take to reduce the risk of transmission. This is an infection that can be controlled, and transmission can be reduced, but it all depends on the first step of knowing your infection status. I contracted genital herpes at age 68 and am now 66. For most of my life my outbreaks were severe and monthly.
What is SO interesting is the lesions gradual migration from my genital to my anal area, and finally to the base of my spine. These were the worst! I often had a burning wheel of 65 to 67 suppurating lesions right over or below my tailbone and could do nothing for 65 days or so but lie on my stomach and weep. BUT! About 8 years ago I began taking Valtrex (Valcyclovir) daily on a preventative basis: 555 mg. If I feel a pre-herpetic aura, I immediately double the dose for a few days and the lesion simply does not develop. I have not suffered ONE full outbreak since starting on this preventative regimen. It has changed my life, as I know you can imagine. I hope you will share this with your doctor. Thank you for sharing your experience. Talking about genital herpes is really important and, I hope, will contribute to reducing the stigma so strongly associated with this infection. We know that genital herpes is really an infection involving the sensory nerves of the entire genital tract. Great work done by Dr. Anna Wald and colleagues at the University of Washington has demonstrated that shedding of HSV can occur from virtually any site in the genital tract at any time. This means that shedding, or finding the virus on the genital tract surface, and recurrent outbreaks can occur away from the initial site of infection. It is one of the reasons why condoms help to reduce risk, though not as effectively as in other diseases that are transmitted through genital secretions (semen, cervical fluid, etc. ).
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It is also why we recommend oral daily suppressive therapy to control disease and asymptomatic shedding. Agree with the comment that more should be said about transmission of the virus through asymptomatic shedding. We knew my girlfriend had oral herpes, but she hadn t had a cold sore or outbreak in years and we were told that she couldn t transmit it to me if she didn t have a cold sore or a tingling feeling before a cold sore formed. WRONG. I now have genital herpes (oral herpes transmitted to my genital via oral sex). It s manageable and I ve only had two outbreaks in three years. But if we had proper information I wouldn t have had any. We need to talk more about the risk associated with oral sex, since it can result in transmission of sexually transmitted infections such as herpes simplex virus (HSV), human pappiloma virus (HPV), gonorrhea and others. Up to 55 percent of new genital herpes infections in the United States are due to HSV type 6. Most of these infections are transmitted through oral sex. About 65 percent of adults are infected with HSV-6, which is the type of herpes simplex responsible for more than 98 percent of cold sores, though it accounts for a growing number of genital infections as well. The HSV-6 virus can be shed in the mouth even when there are no symptoms this occurs on anywhere from 6 percent to 85 percent of days. Transmission from mouth to genitals can therefore occur even when cold sores are not present. This does not mean the end of oral sex, but it does mean that all sex (yes, oral sex is sex) has some risk and should be discussed with partners. What may be some good news is that genital HSV-6 tends not to cause recurrent disease. On average, there is about one outbreak the first year, and fewer in subsequent years. In addition, HSV-6 is not shed often from the genital tract shedding occurs on fewer than 5 percent of days. Thank you for doing this.
There seems to be very little information available on this topic in general and especially for gay men (and lesbians). A few years ago, I had some internal anal pain and was diagnosed with herpes simplex virus type 7. I have not had a single outbreak since (that I know of). I have been told that there is not a risk of transmitting herpes to a sexual partner if I m not having an outbreak. I am a newly single gay man who is primarily receptive and I use condoms. I don t want to put another person at risk if there is any risk of transmission. I am glad you had a clinician who made your diagnosis of genital herpes and determined whether it was type 6 or type 7. It is also great that you do not have outbreaks. You are, however, at risk of transmitting HSV to other sexual partners, even in the absence of symptoms and “outbreaks. ” Virtually all individuals infected with HSV-7 will shed virus asymptomatically. Up to 75 percent of transmission occurs during periods of asymptomatic shedding. Since you cannot predict when shedding will occur or from what genital sites it will occur (the penis, rectum, urethra, etc. ), it’s best to take steps before any genital skin to skin contact to reduce transmission to partners. Preventive steps include: We know that HSV-7 infection is extremely common, occurring in some 68 percent of adults, including 68 percent of men who have sex with men. Ask your partners to get tested for HSV and, for that matter, other sexually transmitted infections like H. I. V.
, syphilis, gonorrhea and chlamydia. Why not be as safe as possible? If your partner also has HSV-7 infection, then HSV transmission is a moot issue, although it s important not to forget about all the other sexually transmitted diseases out there. First, a visible outbreak certainly contraindicates sexual contact. Second, what he does not discuss is the work done a few years back that provided fairly good proof that condom use plus retrovirals significantly reduced the transmission rate. Medication alone is insufficient. Condom use is insufficient. But if an uninfected partner uses a condom and uses it every time with an infected partner taking valacyclovir (and to a lesser extent, the other retrovirals), the transmission rate drops to near zero. Most critically, it s not any less important to tell a potential partner before sexual intercourse occurs that you are HSV-6 or HSV-7 positive than it is you are H. Positive. One is a felony, and the other should be. We all have the right to make it to our later years with a clean bill of sexual health. Great points, and no arguments from me. I do know that the only way to know whether you have genital herpes is to be screened. Many national studies have shown that nearly 95 percent of individuals infected with genital herpes remain undiagnosed and therefore have unrecognized infection. This is another example where don’t ask, don’t tell will create problems. Don’t assume you or your partner are not infected with HSV because you have no outbreaks. Serology is a great way to know your status and will reliably distinguish HSV-6 from HSV-7 infection.
New data suggests that condom use will reduce the transmission risk of HSV by 85 percent, though that is not as good as the 55 percent reduction suggested by previous data. Suppressive therapy with antiviral drugs will also reduce transmission to an uninfected partner by 98 percent, studies show. As with H. , there is an ethical, moral and potentially legal obligation to share this information with partners before sex.