Herpes simplex asymptomatic shedding

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Lakshmi Gopalakrishnan, M.B.B.S.


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.[1]
  • Asymptomatic shedding is more frequent within the first 12 months after acquiring HSV, and concurrent infection with HIV also increases the frequency and duration of asymptomatic shedding.[2]
  • 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 observed between the frequency of asymptomatic shedding in people with 1 to 12 annual recurrences versus those with no recurrences.[1]


Medical Therapy

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).[3][4][5][6][7][8]


  1. 1.0 1.1 Leone P (2005) Reducing the risk of transmitting genital herpes: advances in understanding and therapy. Curr Med Res Opin 21 (10):1577-82. DOI:10.1185/030079905X61901 PMID: 16238897
  2. Kim H, Meier A, Huang M, Kuntz S, Selke S, Celum C, Corey L, Wald A (2006). "Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men". J Infect Dis. 194 (4): 420–7. PMID 16845624.
  3. Chosidow O, Drouault Y, Leconte-Veyriac F, Aymard M, Ortonne JP, Pouget F et al. (2001) Famciclovir vs. aciclovir in immunocompetent patients with recurrent genital herpes infections: a parallel-groups, randomized, double-blind clinical trial. Br J Dermatol 144 (4):818-24. PMID: 11298543
  4. Bodsworth NJ, Crooks RJ, Borelli S, Vejlsgaard G, Paavonen J, Worm AM et al. (1997) Valaciclovir versus aciclovir in patient initiated treatment of recurrent genital herpes: a randomised, double blind clinical trial. International Valaciclovir HSV Study Group. Genitourin Med 73 (2):110-6. PMID: 9215092
  5. Fife KH, Barbarash RA, Rudolph T, Degregorio B, Roth R (1997) Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Study Group. Sex Transm Dis 24 (8):481-6. PMID: 9293612
  6. Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL (1998) Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. Collaborative Famciclovir Genital Herpes Research Group. JAMA 280 (10):887-92. PMID: 9739972
  7. Mertz GJ, Loveless MO, Levin MJ, Kraus SJ, Fowler SL, Goade D et al. (1997) Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Collaborative Famciclovir Genital Herpes Research Group. Arch Intern Med 157 (3):343-9. PMID: 9040303
  8. Wald A, Selke S, Warren T, Aoki FY, Sacks S, Diaz-Mitoma F et al. (2006) Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis 33 (9):529-33. DOI:10.1097/01.olq.0000204723.15765.91 PMID: 16540883

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