In the early 1980s, HIV stole the spotlight from other sexually transmitted diseases, dominating the media with warnings to be virtuous because of the possibility of contracting AIDS. But while AIDS only affects about 0.6 percent of the US, its less celebrated relative, genital herpes--otherwise known as herpes simplex virus type 2 (HSV-2)--is far more prevalent.1 In fact, 17 percent of all US adults are infected, and among certain sub-groups the rate is much higher: Unbelievably, for instance, single women of all races between the ages of 45 and 50 have a prevalence rate between 50 and 70 percent!2 Forty-eight percent of all African-American women, are infected.3 And perhaps even more striking than the fact that one in every six people has the disease is the fact that only a small percentage of those infected -- as few as 10 percent--actually know it.
Now a new report confirms that even people who have no symptoms and no clue that they're carrying herpes can, nevertheless, spread the disease.4 The study, just published in the Journal of the American Medical Association, found that people who have herpes but no symptoms shed the virus in genital secretions 10 percent of the days they are tested, meaning they can infect sexual partners on those days. In contrast, those who manifest active herpes symptoms “shed" the virus about 20 percent of the time. Obviously, those with symptoms will likely be more circumspect than those who think they're disease-free, and so it's possible that those without symptoms are actually more likely to infect others.
How can so many people infected with genital herpes not even recognize that they're carrying the disease? For one thing, carriers of HSV-2 can remain asymptomatic for years. In fact, about 40 percent of those with HSV-2 don't manifest symptoms at all.5 Plus, when the symptoms of herpes do appear, they tend to be annoying and uncomfortable rather than catastrophic. The victim may get painful or itchy bumps and blisters in the genital area, lower-back pain, discharge, fever, muscle aches, or headaches, but the symptoms aren't necessarily severe.
As Dr. Peter Leone of the University of North Carolina explains in an NPR interview, “Most folks, if they have symptoms, the symptoms are pretty mild - burning or itching that may last for a couple of days and goes away. So what we see are folks who either get misdiagnosed or they treat themselves, and of course the symptoms go away so they think they don't have anything to worry about."6 Although 80 percent of victims will have subsequent outbreaks, future episodes tend to be even milder than the first, and so many people ignore the symptoms -- and the doctor.
Herpes also gets missed because of its ability to go dormant for months, years, and even decades at a time.7 It is possible, theoretically, for someone to be infected with herpes, have an outbreak, and not have another until 30 years later. Things that provoke an episode include stress, illness, too much partying, and even menstruation. Theoretically, your monogamous and symptom-free spouse of 25 years can suddenly have a herpes outbreak and infect you, even though neither of you had a clue about the herpes at the altar.
If herpes tends to be so minor that it can be missed, what's the big deal about getting infected? Beyond those painful genital bumps and a good dose of humiliation, the more serious consequences include the fact that sores can infect other parts of the body, should an infected person touch a genital sore and then another body part, including the eyes. Infected women who get pregnant stand a high risk of passing the disease to their babies, and infants can die from herpes. Most of all, though, herpes weakens the immune system over time and puts victims at higher risk for diseases like meningitis, hepatitis, and other STDs, including AIDS. Ninety percent of HIV-infected individuals also have an HSV-2 infection. Also, herpes puts women at greater risk for cervical cancer. In other words, you really don't want to get it, spread it, or be exposed to it.
Now that the news shows that herpes does indeed spread even in the absence of symptoms, doctors are urging people to get tested. Dr. Christine Johnston, who directed the study for the University of Washington in Seattle said, "The people who are symptomatic are really the tip of the iceberg. We are not having any impact on the epidemic by ignoring it." Testing involves either a simple blood test for antibodies to the disease, or a culture if there's an active sore.
If the doctor thinks you're having a first herpes outbreak, you may get a prescription for a ten-day course of an antiviral medication that supposedly will prevent future episodes. The doctor will probably tell you that you have to take the pills within three days of your first episode in order for the treatment to work, so in a panic, you may take the meds before getting your test results back. Unfortunately, but predictably, potential side effects include ugly possibilities like kidney damage, seizures, and death. Before taking any medication, make absolutely sure you have the disease, because other conditions, like genital yeast infection look similar.
Drug companies are working on an anti-herpes vaccine, and one can only imagine the side-effects possible once that hits the market. A safer bet is to make sure your partners are disease-free, as best you can. If you already have an infection, the usual advice for keeping your immune system strong applies. Get enough sleep, eat well, take immune system boosters and stay on the sunny side of life. And take comfort in the fact that you're hardly alone!
1 “AIDS Pandemic." Wikipedia. 4 June 2011. http://en.wikipedia.org/wiki/AIDS_pandemic
2 Flatow, Ira. “Even Without Symptoms, Genital Herpes Can Spread." 15 April 2011. NPR. 2 June 2, 2011. http://www.npr.org/2011/04/15/135442942/even-without-symptoms-genital-herpes-can-spread
3 “Analysis of National Herpes Prevalence." 22 April 2010. Centers for Disease Control and Prevention. 1 June 2011. < http://www.cdc.gov/std/herpes/herpes-NHANES-2010.htm>.
4 Harding, Anne. “Symptom-Free Herpes Contagious 10% of the Time." 12 April 2011. Health.com. http://news.health.com/2011/04/12/symptom-free-herpes/
5 “Herpes Symptoms." The Complete Herpes Information Center. 2 June , 2011. http://www.globalherbalsupplies.com/herpes/symptoms.htm
6 “Even Without Symptoms, Genital Herpes Can Spread." 15 April 2011. NPR. 4 June 2011. http://www.npr.org/2011/04/15/135442942/even-without-symptoms-genital-herpes-can-spread
7 “Med Help: STDs." 4 June 2011. <http://www.medhelp.org/posts/STDs/Herpes-dormancy/show/318477>