Herpes simplex asymptomatic shedding

, Associate Editor(s)-In-Chief: ; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
HSV asymptomatic shedding occurs at some time in most individuals infected with herpes.

Frequency of Viral Shedding

 * Asymptomatic shedding can occur more than a week before or after a symptomatic recurrence in 50% of cases. However, it is believed to occur on 2.9% of days while on antiviral therapy, versus 10.8% of days without and is estimated to account for one third of the total days of viral shedding.


 * Asymptomatic shedding is more frequent within the first 12 months of acquiring HSV, and concurrent infection with HIV also increases the frequency and duration of asymptomatic shedding.


 * There are some indications that some individuals may have much lower patterns of shedding, but evidence supporting this is not fully verified - no significant differences are seen in the frequency of asymptomatic shedding when comparing persons with 1 to 12 annual recurrences to those that have no recurrences.

Treatment
Aciclovir, famciclovir, and valaciclovir appear equally effective for episodic treatment of genital herpes and also aid in the suppression of symptomatic and asymptomatic viral shedding. Antiviral therapy has shown to reduce asymptomatic HSV shedding by about 80% to 90% in clinical trials. Although the threshold for infection from asymptomatic shedding has not been established, small studies have shown that valaciclovir appears to suppress asymptomatic shedding better than famciclovir. Acyclovir (400 mg twice daily) has been shown to suppress asymptomatic shedding at least as well as valaciclovir (1000 mg daily).