Confirmed Contagious: Silent Herpes

The current issue of JAMA, the Journal of the American Medical Association, includes an important study: Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons With HSV-2 Infection. We know that the vast majority of people who are infected with genital herpes are UNAWARE that they have this disease, so it is critically important to know whether someone who has disease, but doesn't KNOW it, can still pass that disease on to a partner. How can infected people not know?

First of all, not all herpes infections are obvious. The classic herpes lesion is a painful cluster of blisters sitting on a bright red base. However, these blisters may not be visible, especially on a woman, since they can be hidden up inside the vagina. Additionally, many people have very mild symptoms, such as intermittent burning, itch, or discomfort with intercourse. If you are not checked for herpes with a specific antibody blood test, both you and your medical provider can easily miss this diagnosis!

Back to the research...This study was done on roughly 500 patients, both men & women, all of whom tested positive for Herpes Simplex Type 2 (HSV-2) by a blood test, though only 82% were already aware that they had herpes symptoms. Those that did know they were infected averaged 4 break outs per year, and had ~8 years history of having the disease. Every participant swabbed their genital area daily, regardless of symptoms. None of the patients were allowed to take anti-viral medications during the trial.

The results? Yes, people who experienced obvious herpes lesions shed MORE virus- translation, they were potentially infectious to partners. However, here is the important part: People who only knew that they had herpes because of the positive blood test STILL SHED VIRUS (meaning were infectious to others) 10% of the time, and the amount of virus present was the same quantity in people aware or unaware of their lesions.

BOTTOM LINE: This study again confirms that you are infectious to other people if you have a positive blood test for herpes, whether or not you have any symptoms. GET TESTED, and be sure your PARTNER GETS TESTED, too!

The $7 Million Case of Herpes

Before I leave the topic of STD transmission and lawsuits, I want to share another case. This one took place in California last year, and involved a 56-year old woman catching genital herpes from a 77-year old man. Basically, he had a twenty five year history of genital herpes outbreaks, yet did not disclose this history nor did he wear a condom. He is a very wealthy man, king of a hair product empire, and well-off enough to give his girlfriend a BMW as a gift (which she was allowed to keep, along with the $7 million.)

Now, I do not know all the details of this case. Was his quarter of a century battle with herpes recent, or in his remote past? If he had worn a condom, would that have made a difference? If you get herpes from someone who is a college student (rather than a multi-millionaire business man), how much will you be awarded?

Here is what I think is important:
1. Please note the AGES- 77 and 56!
2. Note that he had a recurring disease for over 25 years- these are not trivial infections...
3. This is a smart, educated, very successful man with full knowledge of his disease, yet he chose not to disclose.
4. Condoms cover only part of the anatomy, and herpes is spread through direct skin-to-skin contact, so condoms HELP but do not 100% prevent herpes.
5. He was indeed, held LIABLE.

BOTTOM LINE: To REPEAT YET AGAIN, STDs can occur across any age, race, gender, or socio-economic boundaries- Buyer BeWARE!

Myth#7 - You'd KNOW if you had an STD

Why the heck would you NOT know if you caught an STD? Wouldn't you have SOME kind of symptom? Burning, itch, blisters, or discharge? Well...NO. The difficult thing about STDs is that most sexually transmitted infections are SILENT. Which ones?

Don't be fooled that the "beautiful people"- the smart, educated, wealthy, witty, or even "parent-approved" dates are automatically disease-free. STDs don't care how many years of school you've completed or how many bucks are in your wallet.
BOTTOM LINE: You cannot tell by looking (or feeling) who has an STD!

Myth #3 Herpes Algebra

Same cookie, different crumble...Myth #3 is that you can only spread herpes when there are visible blisters. WRONG!

The herpes virus can be spread whether or not there are any visible sores. So, if parter A gets cold sores (meaning the blisters from herpes that occur outside the mouth, usually on or near the lips), he or she can pass this infection to partner B by kissing or oral-genital contact. Partner B could then develop oral or genital herpes, depending upon the site of contact. If, however, partner B already gets cold sores, then he/she will not get a new case of herpes (assuming both parties have herpes simplex type 1, which can be confirmed with a blood test.)

Confused? Let me say it differently. Once you have one type of herpes, you will not get that same type of herpes in a different spot on your body. You may, however, get a different type. The common example is that if you have cold sores, which are most often herpes simplex virus (HSV) type 1, you are still susceptible to getting genital herpes from HSV type 2.

The important point here, though, is that although herpes is thought to be most contagious immediately before, during and after blisters are present, the LACK of blisters (in between outbreaks) does NOT equal NOT contagious. A great reference book for herpes if you have further questions is: The Good News about the Bad News by Terri Warren.

BOTTOM LINE: Herpes is ALWAYS potentially contagious, whether or not you see blisters.
PS. Jump forward to the $7 Million Herpes Case!