Herpes simplex virus: the importance of asymptomatic shedding

Herpes simplex virus (HSV) Is frequently shed after infection of the genita l or perianal area. HSV shedding, as determined by culture, occurs on about 3% of days for immunocompetent women and men, and more for persons with HI V infection or if measured by polymerase chain reaction (PCR). Most horizon tal and vertical transmission of HSV occurs during unrecognized or asymptom atic shedding, and the majority of HSV-2-infected persons are unaware of th eir infection. Many persons with 'asymptomatic' HSV-2 infection can learn t o recognize genital signs and symptoms as recurrences of HSV-2 infection. H owever, some shedding episodes remain truly asymptomatic even after patient education. Antiviral therapy dramatically reduces asymptomatic shedding, a nd trials to evaluate its effect on HSV transmission are underway.