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==Frequency of Viral Shedding==
==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.<ref name="pmid16238897">Leone P (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16238897 Reducing the risk of transmitting genital herpes: advances in understanding and therapy.] ''Curr Med Res Opin'' 21 (10):1577-82. [http://dx.doi.org/10.1185/030079905X61901 DOI:10.1185/030079905X61901] PMID: [http://pubmed.gov/16238897 16238897]</ref>
*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|antiviral therapy]], versus 10.8% of days without, and is estimated to account for one-third of the total days of viral shedding.<ref name="pmid16238897">Leone P (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16238897 Reducing the risk of transmitting genital herpes: advances in understanding and therapy.] ''Curr Med Res Opin'' 21 (10):1577-82. [http://dx.doi.org/10.1185/030079905X61901 DOI:10.1185/030079905X61901] PMID: [http://pubmed.gov/16238897 16238897]</ref>


*Asymptomatic shedding is more frequent within the first 12 months of acquiring HSV, and concurrent infection with [[Human Immunodeficiency Virus|HIV]] also increases the frequency and duration of asymptomatic shedding.<ref>{{cite journal | author = Kim H, Meier A, Huang M, Kuntz S, Selke S, Celum C, Corey L, Wald A | title = Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men. | journal = J Infect Dis | volume = 194 | issue = 4 | pages = 420-7 | year = 2006 | id = PMID 16845624}}</ref>  
*Asymptomatic shedding is more frequent within the first 12 months after acquiring [[HSV]], and concurrent infection with [[Human Immunodeficiency Virus|HIV]] also increases the frequency and duration of asymptomatic shedding.<ref>{{cite journal | author = Kim H, Meier A, Huang M, Kuntz S, Selke S, Celum C, Corey L, Wald A | title = Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men. | journal = J Infect Dis | volume = 194 | issue = 4 | pages = 420-7 | year = 2006 | id = PMID 16845624}}</ref>  


*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 seen in the frequency of asymptomatic shedding when comparing persons with 1 to 12 annual recurrences to those that have no recurrences.<ref name="pmid16238897"/>
*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.<ref name="pmid16238897"/>


==Treatment==
==Treatment==
[[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).<ref name="pmid11298543">Chosidow O, Drouault Y, Leconte-Veyriac F, Aymard M, Ortonne JP, Pouget F et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11298543 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: [http://pubmed.gov/11298543 11298543]</ref><ref name="pmid9215092">Bodsworth NJ, Crooks RJ, Borelli S, Vejlsgaard G, Paavonen J, Worm AM et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9215092 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: [http://pubmed.gov/9215092 9215092]</ref><ref name="pmid9293612">Fife KH, Barbarash RA, Rudolph T, Degregorio B, Roth R (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9293612 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: [http://pubmed.gov/9293612 9293612]</ref><ref name="pmid9739972">Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9739972 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: [http://pubmed.gov/9739972 9739972]</ref><ref name="pmid9040303">Mertz GJ, Loveless MO, Levin MJ, Kraus SJ, Fowler SL, Goade D et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9040303 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: [http://pubmed.gov/9040303 9040303]</ref><ref name="pmid16540883">Wald A, Selke S, Warren T, Aoki FY, Sacks S, Diaz-Mitoma F et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16540883 Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding.] ''Sex Transm Dis'' 33 (9):529-33. [http://dx.doi.org/10.1097/01.olq.0000204723.15765.91 DOI:10.1097/01.olq.0000204723.15765.91] PMID: [http://pubmed.gov/16540883 16540883]</ref>
===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).<ref name="pmid11298543">Chosidow O, Drouault Y, Leconte-Veyriac F, Aymard M, Ortonne JP, Pouget F et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11298543 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: [http://pubmed.gov/11298543 11298543]</ref><ref name="pmid9215092">Bodsworth NJ, Crooks RJ, Borelli S, Vejlsgaard G, Paavonen J, Worm AM et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9215092 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: [http://pubmed.gov/9215092 9215092]</ref><ref name="pmid9293612">Fife KH, Barbarash RA, Rudolph T, Degregorio B, Roth R (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9293612 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: [http://pubmed.gov/9293612 9293612]</ref><ref name="pmid9739972">Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9739972 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: [http://pubmed.gov/9739972 9739972]</ref><ref name="pmid9040303">Mertz GJ, Loveless MO, Levin MJ, Kraus SJ, Fowler SL, Goade D et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9040303 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: [http://pubmed.gov/9040303 9040303]</ref><ref name="pmid16540883">Wald A, Selke S, Warren T, Aoki FY, Sacks S, Diaz-Mitoma F et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16540883 Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding.] ''Sex Transm Dis'' 33 (9):529-33. [http://dx.doi.org/10.1097/01.olq.0000204723.15765.91 DOI:10.1097/01.olq.0000204723.15765.91] PMID: [http://pubmed.gov/16540883 16540883]</ref>


==References==
==References==
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{{reflist|2}}
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Latest revision as of 22:09, 29 July 2020

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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.

Overview

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]

Treatment

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]

References

  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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