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Shattering the Genital Herpes Myth

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WebMD Health News

March 22, 2000 (Atlanta) -- Many people who have tested positive for the virus that causes genital herpes, but say they have no symptoms of the disease, may in fact have the virus in their genital tracts, according to a study in this week's issue of The New England Journal of Medicine. This is important, researchers say, because it means that -- contrary to popular belief -- asymptomatic people are potentially infectious, and they could be unknowingly fueling the herpes epidemic.

Previous studies have found that almost 25% of adults over age 12 in the United States are infected with herpes simplex virus type 2 (HSV-2), but only 10% to 25% of people who have the infection report having lesions.

"Most genital infections are caused by herpes simplex virus type 2, and numerous studies have shown that most people with [HSV-2] infection don't give a history of genital herpes," study author Anna Wald, MD, MPH, tells WebMD. "There has always been a question of whether those people are shedding the virus -- meaning whether they have the virus present in their genital area -- or whether they are truly asymptomatic." Wald is an assistant professor in the department of medicine and epidemiology at the University of Washington in Seattle.

"So we followed men and women who were seropositive for HSV-2 and who denied a history of genital herpes. We taught [this group] what herpes looks like and explained what genital herpes was like, and we asked them to collect, on a daily basis, swabs of their genital area," Wald says. "It turned out that once they knew what herpes was, the majority became symptomatic with herpes. They recognized that they do in fact have herpes, but their outbreaks were short and infrequent."

The other major finding, she says, was that 83% of this group were potentially infectious.

The researchers recruited 53 people with no reported history of genital herpes but who were found to be HSV-2 seropositive on a blood test. All attended an educational session on genital herpes that reviewed lesion types and symptoms. Herpes lesions include blisters, ulcers, or crusted patches of skin in the buttocks or genital or anal areas. Other symptoms include pain or burning, tickling, tingling, or similar sensations. Herpes can also be pain-free.

This group was then compared to 90 subjects who were aware that they had genital herpes.

During the follow-up period, 26 of the women and seven of the men who had said they had no history of herpes reported having typical lesions in the genital area, with 19 of these people reporting more than one recurrence. Thirteen people reported genital symptoms but no lesions. A total of 46 of the participants reported having either lesions or other genital symptoms. HSV-2 was isolated by viral culture of the swabs at least once in 38 of the participants. Only one of the 53 had no clinical or virologic evidence of HSV infection.

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