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Avatar universal

Curious Question

Is it possible to be truly asymptomatic with Gential Herpes, HSV2?  Like, will that person ever have an outbreak? And if thats the case and most doctors wouldnt normally suggest or run herpes testing in the absence of symptoms, wouldnt the percentage of the individuals that have HSV2 be higher? Im just curious. Like a scenario would be if a person found out they had HSV2 and antibody levels are at 6 or 7 or even a 4. something or 3.8, whatever but never had an outbreak, nothing indicating a herpes infection, no lesions, nerve pain, blisters, or spots, etc.? And the next question is then, why? Would it be that person's immune system? And would they viral shed all the time?
7 Responses
3149845 tn?1506627771
Hi 20% show symptoms and 80% show symptoms and dont associate it with hsv2.
genital hsv2 shedding occurs 15-30% of the time so its quite often.
Avatar universal
This has always vexed me a little too. I have seen the suggestion that 20% of people with the virus are truly asymptomatic but I believe as many as half of these probably had an initial outbreak. That means 80% of people do have symptoms including cold sores but for various reasons do not identify themselves as having genital herpes.

There have been studies that attempt to compare asymptomatic with symptomatic people. These include daily swabbing to check for shedding. These studies find that the rate of shedding outside of outbreaks is very similar. Another finding that is sometimes pointed out is that of the people who claim never to have had an outbreak, quite a few do during the observation period. I think they are looking harder and see things they missed previously.

I believe those with lighter or no symptoms do have a good immune system, probably one that is complete. The immune system needs to make up to 100 different forms of proteins including antibodies to fight the HSV virus, I suspect to be a good allrounder in producing all the elements is of great benefit.

Lot written about shedding lately. No denying it happens of course but very little is known about the levels that are required to be truly infectious with more than a negligible probability. As with most viruses, the viral load is quite proportional to the chance of infection. Hence the shedding studies that detect a few copies of virus tell us little about infectiousness.
Avatar universal
Thank you for your in-depth response. See, its all too confusing. I mean if that person really had HSV 2 and did monitor themselves, what would they notice that was not noticed before? Itching in the genitals? Doesnt everyone itch down there? Soreness in the muscles, Tingling? And what about the conflicting info about having HSV 1 prior to contracting HSV 2? I know that having HSV 1 may cause someone to seroconvert longer in the production of HSV 2 antibodies. Is this what causes a person to maybe miss or not have some of the typical symptoms of HSV 2? I would think that seroconverting would cause an initial outbreak to happen or am I mistaken?
Avatar universal
Having HSV then being infected with another type means your body has some defenses that mostly mean you avoid the severe first outbreak that can accompany a new infection. All this means is that you get to your longer term patterns severity and frequency a but sooner.

Seroconversion appears to experience only a minor delay when you already have HSV. In some studies there is not a significant difference and it may be that other factors play a stronger role.

I think you've got the right point, we are always itchy down there, getting a rash now and again, a fungus, pimples, shaving cuts, ingrown hairs, hair follicle issues, little cysts and blocked ducts. Most people have no education about herpes and its symptoms such if that they don't seek medical advice due to mildness or easing of symptoms in a few days then they may not know.
1998092 tn?1391242845
This might help. During a conversation with Dr. Anna Wald at the University of Washington last August, I learned an interesting tidbit that hasn't been talked about a whole lot in the H community at large: the possibility that there are indeed "low-shedders," if not "no-shedders."

It's a little complicated, but she explained that the median number of years that serodiscordant couples (one with, one without, HSV) who enrolled in their research studies had been together was 18 months. They were confirmed to be serodiscordant by swab tests. None of these couples had used suppressive therapy beforehand. There's no data on how many of them had faithfully been using condoms, but regardless, condoms only provide about 30% protection against transmission. The fact that the median length of time that these relationships had lasted without transmission to the non-H partner was as long as 18 months would seem to indicate a possibility that the positive partner may not be shedding at the "normal" rate the rest of us do. Of course, other factors come into play, including those of possible infidelity during the prior 18 months, but the field did seem to be large enough to consider that this was not a factor in a reasonable percentage of cases.

It would certainly explain the situation of some members of my support group who swear they never passed it on during years of discordant relationships, assuming, of course that these non-transmissions were confirmed by testing.
1998092 tn?1391242845
The caveat, by the way: there's no guarantee that any one of us is a low- or no-shedder. There's no way to tell without swabbing every few minutes of every day. Per Terri Warren, up to 90% of people with HSV are unaware that they have the virus due to a lack of recognizable symptoms. A percentage of these are asymptomatic but do still shed virus. According to a 2008 study, HSV-2 sheds asymptomatically about 20% of days, and HSV-1 about 12% of days.
Avatar universal
Other studies are also emerging that suggest a HSV negative person may if exposed to the virus actually build some of the immune defenses, particularly those in the skin but not the blood borne IgG. Hence it may also be that the chances of transmission reduce owing to the response of the negative partner. Again it is not clear under what circumstances these people build such defense as opposed to others who become infected.
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