Possibilities

[brokedown]

In a recent post you wrote:

"3) No, once infected with herpes simplex virus (HSV), infection persists for life. Some cases may be truly cured by the immune system after many years, but that probably is rare."

Assuming that some cases might be cured after a certain ammount of time - How would we know this? IF the following is true;

"With present testing there is no way to determine if a person is cured. With present testing a person who once had the virus will always test positive. Present testing is based on the herpes antibody. Antibodies, once created by the immune system to combat a new foreign invader to the body, never leave."

[H. Hunter Handsfield, M.D.]

Daily asymptomatic shedding doesn't occur.  Shedding usually occurs just like symptomatic outbreaks--i.e., several times a year there might be 2-7 days of shedding in a row.  The frequency is highly variable; most common in the first few months after acquiring infection, then somewhat less.  It can occur monthly in some people and only once or twice a year in others.

All this is for genital HSV-2, not HSV-1. Asymptomatic shedding of genital HSV-1 is much less common than HSV-2.

HHH, MD

[scotchie30]

I want to be sure I am understanding this...Does someone with HSV have viral shedding at some point everyday?  I heard the virus sheds maybe a total of one week throughout a whole year, and that the virus doesn't shed everyday.

[H. Hunter Handsfield, M.D.]

I have never heard of mouth-to-mouth transmission of HSV-2.  In theory it could occur, but chronic oral infection with HSV-2 is so rare that the odds are close to zero.

HSV-1 can be transmitted by intercourse, but it probably is uncommon (but not as rare as oral-oral HSV-2).  Most people who get genital HSV-1 don't have frequent recurrences and asymptomatic shedding of the virus in the genital area is uncommon, so genital-to-genital transmission is uncommon.

"Easy to spread" is relative.  In HSV-2 genital infections and HSV-1 oral infections, the virus periodically reactivates without prominent symptomatic outbreaks.  Many such outbreaks in fact are symptomatic, but with mild symptoms that are easy to ignore or forget about--a little itching, for example.  Other periods of reactivation are truly asymptomatic.  If the virus is present, it can be transmitted.  In fact, most genital herpes is transmitted by people who have few or no symptoms at the time.  (If you think about it, it makes sense:  people with painful genital sores tend not to have sex, so most transmissions don't occur with plainly obvious herpes.)

On the other hand, such asymptomatic shedding is intermittent, and not present the large majority of days.  But over the course of an ongoing relationship, the odds are that eventually sex will occur at a time when the virus is present and transmission will occur.

That is why every person with genital herpes due to HSV-2, regardless of whether or not they have symptoms, has an ethical obligation to inform all potential partners that they have herpes, before having sex.  And that, in turn, is one of the main reasons herpes is so frightening to sexually active people, even though the disease itself usually is mild:  its impact on forming relationships is a big deal.

I hope this helps.  Best wishes--  HHH, MD

[brokedown]

What are the chances of transmitting HSV2 by mouth-to-mouth contact  or HSV1 by genital-to-genital contact, if the infected person is shedding but shows little to No symptoms?

&

Is it EASY to spread the virus (HSV1 or HSV2) regularly asymptomatically(no lessions at all)?

[HHH,MD]

Either virus type can be transmitted to either the mouth or genitals.  Almost half of new genital herpes these days is due to HSV-1, usually acquired from a partner's mouth during oral sex.  Genital HSV-2 can be transmitted from genitals to mouth, but is much less common.  In either case, most infections of the "opposite" anatomic site don't cause ongoing recurrent outbreaks.  Genital HSV-1 doesn't reactivate often (about half of all infected persons don't get any recurrences at all); and almost nobody gets recurrent oral cold sores due to HSV-2.

I don't see many cases of initial oral herpes--probably because many people with such infections don't recognize the problem as sexually acqired, so they don't show up in STD clinics.  Although multiple lesions is said the be the rule, I'm sure some infections start with single lesions.

HHH, MD

[brokedown]

Correction: By 'hsv1/2 orally', i meant 1 or 2 not 1 & 2.

[brokedown]

If someone has hsv1/2 orally, what are the chances(%) of infecting someone else by mouth-to-mouth or mouth-to-genital contact, if you shed the virus asymptomatically?

Also;

In your many years of experience in this field, how many times have you seen a case of initial oral HSV infection begin with a single SORE(somewhat large ulcer that took a month to heal!,yet no pain)inside the mouth(near the cheek), unusually dry cracking lips, yet no "103 fever, bleeding gums"?

Thank you

[H. Hunter Handsfield, M.D.]

A bad joke among STD experts is "What's the difference between herpes and true love?  Herpes is forever."

Personally, I'm not so cynical about love, but the punch line is true.  Both statements you quote are correct, and there is no way to test or otherwise know that a person is free of HSV.  However, most people stop having symptomatic outbreaks as the years pass.

Regards--  HHH, MD