Shedding light on viral shedding

Dear The asymptomatic,  

Herpes is one of the most prevalent sexually transmitted infections. Therefore, clearing up the terminology around viral shedding will be useful to many readers. The herpes virus makes its home in the nerve cells of an infected person. The virus will, at times, travel along the nerves up to the surface of the skin; this process is called viral shedding. This process can happen regardless of whether a person is symptomatic, so it’s a good idea to get tested and take medication or use barrier methods of contraception to reduce transmission, if you’re infected.   

Sometimes, shedding is accompanied by other symptoms such as blisters or sores, in a phase aptly named symptomatic shedding. Other times, shedding occurs without any noticeable symptoms — known as asymptomatic shedding. During either type of viral shedding, the herpes virus can be passed on to others by direct skin-to-skin contact — especially from anal, oral, or vaginal sex. The frequency of viral shedding varies greatly from person to person and is influenced by the strain of herpes with which someone is infected. There are several different strains, each with their own symptoms. The two associated with sexual transmission are herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Of these two, viral shedding is most frequent with HSV-2. Regardless of how often it happens, all people carrying the herpes virus experience periods of shedding at one time or another.   

Now, time to tackle your question about recognizing viral shedding, and more specifically, asymptomatic shedding. Unfortunately, the process of asymptomatic shedding is invisible to the naked eye. Unless a person is experiencing a herpes outbreak (symptomatic viral shedding), it’s very difficult to determine whether they’re shedding the virus at any given time. However, it’s worth noting that a person is most contagious when herpes blisters are present. This is a clear indication that viral shedding is taking place and to take precautions to prevent spreading the virus. Strategies would include temporarily avoiding intimate or sexual contact with others. Interestingly, because people are more likely to engage in sexual activity when they’re not experiencing symptoms, it’s more common for herpes transmission to occur when asymptomatic.   

The good news is that herpes medications are now available which greatly reduce (but don’t eliminate) asymptomatic viral shedding and herpes outbreaks, substantially lowering the risk of herpes transmission. Using condoms or other barrier methods outbreaks can further reduce the risk. One consideration to be mindful of down the road is the potential for a herpes vaccine. Although one isn’t approved for HSV-1 or HSV-2, clinical studies show promise for vaccine candidates. One vaccine even shows strong potential to reduce viral shedding for up to one year in adults with symptomatic HSV-2 infection. This provides some hope for people living with herpes to further reduce transmission to partners. You may want to keep up checking up on updates to this latest research to see what changes have been made. In the mean time, to learn more about herpes, you can check out the Herpes category in the Go Ask Alice! Sexual & Reproductive Health archives.  

Hope this sheds some light on viral shedding!