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Genital Herpes Transmission ~ Risk ~ Latency ~ Viral Shedding
Transmission of Herpes Viruses
Herpes (types 1 and 2) can be transmitted through skin to skin contact, kissing, sexual
intercourse, and oral sex. The mucous membranes (mouth, nose, ears, throat, genitals, and anus)
are most susceptible to infection with HSV. The cervix and urethra are also high target areas. Also
susceptible are any areas that may be subject to abrasion, and warm, moist areas such as the upper
thighs, underarms, hairline, lower back, perineum, scrotum, and buttocks - any areas when sweating is
common.
Herpes is most easily passed through inoculation from active lesions. The virus may also
spread during times when there are no symptoms, and from sites that are seemingly inactive. Most
incidences of genital Herpes occur during genital-to-genital contact. There is, however, a significant
percentage of genital herpes infections resulting from oral to genital sexual contact. A person with an
active oral herpes outbreak (aka "cold sore") who engages in oral sex upon their partner will
in all likelihood pass the virus on to the partner's genitals. Most of these oral to genital
transmissions will be of the type 1 variety, although type 2 incidence is not uncommon. Many times the
partner who carries the virus is not even aware of an outbreak. In most cases, however, close
examination may reveal a history of some of the symptoms listed previously.
Inoculation (transmission) and autoinoculation (self-infection) of genital Herpes occurs primarily through
vigorous intercourse, masturbation, anal sex, and oral sex with an infected member. Herpes can be
passed via the use of sexual stimulators such as vibrators.
usually via touching a sore with a hand and then touching another susceptible area, such as the mouth
or eyes. This complication is more common during a first episode because of higher amounts of virus
present during that time and the lack of antibodies. Herpes is also more likely to spread to compromised
epithelial tissue - skin that has suffered cuts, abrasions, scrapes, etc. Simple handwashing can prevent
this type of virus transfer. The Herpes Virus actually very weak outside the body and is killed by soap.
While the Herpes virus can survive for several hours on surfaces, it's viability starts to degrade
rapidly. In addition, the virus would have to contact a susceptible area like a mucous membrane or
scratch. So the chance of acquiring Herpes via something such as a toilet seat or towel is extremely
remote.
Risk of Herpes Transmission
In studies of transmission of genital Herpes in couples, the annual risk of transmission
averaged 5 to 10% per year for those abstaining from sex during outbreaks. The risk of
acquisition was much higher (16.9%) for women, but somewhat lower for those who already had HSV-1.
There is some evidence that people who have HSV-1 are more resistant to the HSV-2. This should not
be interpreted as immunity but rather as a higher resistance factor. The transmission rate was also
lower for those who used condoms. The greater risk of acquisition for women may be due partly to
anatomy, and partly because, generally, men tend to have more frequent outbreaks, while women tend
to have more severe outbreaks. More frequent outbreaks means more times there is virus on the
surface of the skin, and hence a greater the risk of transmission.
The best way to avoid transmission is to abstain from sexual activity during prodrome and
outbreaks, and to use condoms the rest of the time. While consistent use of condoms affords
some measure of protection, the nature of HSV is such that condoms may not cover the site of active
virus, and therefore condoms are not a guarantee against transmission of the virus. For example, if the
virus is active on the scrotum (which isn't covered by a condom), and the scrotum comes in contact with
the partner's genitals, the virus could be transmitted.
The risk of transmission for HSV-1 from the oral to the genital area is much higher than the
risk of transmission of HSV-2 from the genital to the oral area. In addition, the recurrence and
shedding rate for genital HSV-1 is much less than for HSV-2 - this is why getting a culture to determine
the viral type can come in handy. And although HSV-2 can be transmitted to the mouth, because HSV-2
"prefers" the genitals, the recurrence rate of oral HSV-2 is statistically very low - about once every ten
years. Many people are not aware that their "cold sores" can be transmitted to their partner's
genitals during oral sex, so it's important to refrain from such activity during outbreaks and
prodrome.
Latency
Once infected, the Herpes virus stays in the body. After outbreak, the virus goes into "latency."
While latent, HSV lives in a kind of state of suspended animation, in the nerve centers in the spine:
genital HSV in the sacral nerve roots (ganglia) at the base of the spine, and oral-facial HSV in the
trigeminal nerve roots at the base of the neck. When reactivated due to a physical or emotional stimulus,
HSV begins to replicate, and travels the nerve pathways to the surface of the skin.
Viral Shedding
Once infected with any type of Herpesvirus, the person remains capable of transmitting virus for the rest
of their life even when showing no symptoms due to a process called viral shedding. Shedding means
that the virus is active on the skin, and risk of transmission is high. HSV sheds at prodrome, during
outbreaks, during healing periods after outbreaks, but also at random times where there may
be no noticeable symptoms at all. This is called "subclinical shedding" or "asymptomatic shedding."
Asymptomatic Shedding
Asymptomatic Shedding is the release of the virus on the skin when there are no symptoms.
These asymptomatic shedding episodes occur (according to studies) typically 3 to 10 days in the year,
so although the risk is minimal it does exist, because one can't necessarily tell when those days are.
During an episode of asymptomatic shedding, virus often sheds from several different sites in the area
concurrently. And there is new research suggesting that shedding occurs more frequently than
previously thought. In a study published in the mid-1990s, researchers found that half of the episodes
of subclinical shedding of HSV occurred within seven days of a symptomatic recurrence. Unfortunately,
asymptomatic shedding is not detectable by any procedure or test available outside a research study. It
should be noted that for the first 6 months to a year after a primary episode, shedding may occur much
more frequently. The incidence of asymptomatic shedding is greatest during the first year or two after
infection.
Shedding can occur randomly and sporadically and seems to some degree influenced by sites of
infection and viral type, severity and frequency of outbreaks, though studies remain unclear. Thus, the
more outbreaks one has, the more severe one's outbreaks are, the higher the incidence of shedding.
HSV-2 seems to shed more often than HSV-1, particularly in genital infections. Some medical experts
believe asymptomatic shedding is responsible for most cases of transmission. Suppressive acyclovir
therapy has been shown in some studies to reduce the rate of shedding by up to 95%.
See the Health&Wellness and Treatments pages for more information and tips for reducing
outbreaks and improving whole body wellness.
Transmission of Herpes Viruses
Herpes (types 1 and 2) can be transmitted through skin to skin contact, kissing, sexual
intercourse, and oral sex. The mucous membranes (mouth, nose, ears, throat, genitals, and anus)
are most susceptible to infection with HSV. The cervix and urethra are also high target areas. Also
susceptible are any areas that may be subject to abrasion, and warm, moist areas such as the upper
thighs, underarms, hairline, lower back, perineum, scrotum, and buttocks - any areas when sweating is
common.
Herpes is most easily passed through inoculation from active lesions. The virus may also
spread during times when there are no symptoms, and from sites that are seemingly inactive. Most
incidences of genital Herpes occur during genital-to-genital contact. There is, however, a significant
percentage of genital herpes infections resulting from oral to genital sexual contact. A person with an
active oral herpes outbreak (aka "cold sore") who engages in oral sex upon their partner will
in all likelihood pass the virus on to the partner's genitals. Most of these oral to genital
transmissions will be of the type 1 variety, although type 2 incidence is not uncommon. Many times the
partner who carries the virus is not even aware of an outbreak. In most cases, however, close
examination may reveal a history of some of the symptoms listed previously.
Inoculation (transmission) and autoinoculation (self-infection) of genital Herpes occurs primarily through
vigorous intercourse, masturbation, anal sex, and oral sex with an infected member. Herpes can be
passed via the use of sexual stimulators such as vibrators.
usually via touching a sore with a hand and then touching another susceptible area, such as the mouth
or eyes. This complication is more common during a first episode because of higher amounts of virus
present during that time and the lack of antibodies. Herpes is also more likely to spread to compromised
epithelial tissue - skin that has suffered cuts, abrasions, scrapes, etc. Simple handwashing can prevent
this type of virus transfer. The Herpes Virus actually very weak outside the body and is killed by soap.
While the Herpes virus can survive for several hours on surfaces, it's viability starts to degrade
rapidly. In addition, the virus would have to contact a susceptible area like a mucous membrane or
scratch. So the chance of acquiring Herpes via something such as a toilet seat or towel is extremely
remote.
Risk of Herpes Transmission
In studies of transmission of genital Herpes in couples, the annual risk of transmission
averaged 5 to 10% per year for those abstaining from sex during outbreaks. The risk of
acquisition was much higher (16.9%) for women, but somewhat lower for those who already had HSV-1.
There is some evidence that people who have HSV-1 are more resistant to the HSV-2. This should not
be interpreted as immunity but rather as a higher resistance factor. The transmission rate was also
lower for those who used condoms. The greater risk of acquisition for women may be due partly to
anatomy, and partly because, generally, men tend to have more frequent outbreaks, while women tend
to have more severe outbreaks. More frequent outbreaks means more times there is virus on the
surface of the skin, and hence a greater the risk of transmission.
The best way to avoid transmission is to abstain from sexual activity during prodrome and
outbreaks, and to use condoms the rest of the time. While consistent use of condoms affords
some measure of protection, the nature of HSV is such that condoms may not cover the site of active
virus, and therefore condoms are not a guarantee against transmission of the virus. For example, if the
virus is active on the scrotum (which isn't covered by a condom), and the scrotum comes in contact with
the partner's genitals, the virus could be transmitted.
The risk of transmission for HSV-1 from the oral to the genital area is much higher than the
risk of transmission of HSV-2 from the genital to the oral area. In addition, the recurrence and
shedding rate for genital HSV-1 is much less than for HSV-2 - this is why getting a culture to determine
the viral type can come in handy. And although HSV-2 can be transmitted to the mouth, because HSV-2
"prefers" the genitals, the recurrence rate of oral HSV-2 is statistically very low - about once every ten
years. Many people are not aware that their "cold sores" can be transmitted to their partner's
genitals during oral sex, so it's important to refrain from such activity during outbreaks and
prodrome.
Latency
Once infected, the Herpes virus stays in the body. After outbreak, the virus goes into "latency."
While latent, HSV lives in a kind of state of suspended animation, in the nerve centers in the spine:
genital HSV in the sacral nerve roots (ganglia) at the base of the spine, and oral-facial HSV in the
trigeminal nerve roots at the base of the neck. When reactivated due to a physical or emotional stimulus,
HSV begins to replicate, and travels the nerve pathways to the surface of the skin.
Viral Shedding
Once infected with any type of Herpesvirus, the person remains capable of transmitting virus for the rest
of their life even when showing no symptoms due to a process called viral shedding. Shedding means
that the virus is active on the skin, and risk of transmission is high. HSV sheds at prodrome, during
outbreaks, during healing periods after outbreaks, but also at random times where there may
be no noticeable symptoms at all. This is called "subclinical shedding" or "asymptomatic shedding."
Asymptomatic Shedding
Asymptomatic Shedding is the release of the virus on the skin when there are no symptoms.
These asymptomatic shedding episodes occur (according to studies) typically 3 to 10 days in the year,
so although the risk is minimal it does exist, because one can't necessarily tell when those days are.
During an episode of asymptomatic shedding, virus often sheds from several different sites in the area
concurrently. And there is new research suggesting that shedding occurs more frequently than
previously thought. In a study published in the mid-1990s, researchers found that half of the episodes
of subclinical shedding of HSV occurred within seven days of a symptomatic recurrence. Unfortunately,
asymptomatic shedding is not detectable by any procedure or test available outside a research study. It
should be noted that for the first 6 months to a year after a primary episode, shedding may occur much
more frequently. The incidence of asymptomatic shedding is greatest during the first year or two after
infection.
Shedding can occur randomly and sporadically and seems to some degree influenced by sites of
infection and viral type, severity and frequency of outbreaks, though studies remain unclear. Thus, the
more outbreaks one has, the more severe one's outbreaks are, the higher the incidence of shedding.
HSV-2 seems to shed more often than HSV-1, particularly in genital infections. Some medical experts
believe asymptomatic shedding is responsible for most cases of transmission. Suppressive acyclovir
therapy has been shown in some studies to reduce the rate of shedding by up to 95%.
See the Health&Wellness and Treatments pages for more information and tips for reducing
outbreaks and improving whole body wellness.
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