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Managing herpes infections Click a topic below for an index of articles: New Material Home Help us Win the Fight!
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Bobby Flay is an American celebrity chef, who is also the owner of 12 restaurants spread across the America. Richwald, MD, MPH Sexually Transmitted Diseases and Herpesvirus Infection Slide 10. Definitions We're going to talk about 3 presentations of genital herpes infection. The 6 pictures I just showed represent classic genital herpes, which is recurrent and most often painful and irritating. One is unrecognized, or inapparent infections, and the other is subclinical HSV shedding. The first involves clinical lesions that do not look like classic herpes but are caused by HSV infection.

The second, subclinical shedding, occurs when people have virus that is retrievable from the skin, but there is no manifestation of disease. In other words, there are no classic ulcers, and there is no unrecognized or inapparent infection. Subclinical Viral Shedding Let's talk first about subclinical shedding. When I was trained in the 1970s, I was told that if you had a herpes outbreak 4 times a year (once every 3 months) and there were 90 days between outbreaks, you shed virus asymptomatically perhaps 1% of those days or 1 in 90 days. We now know that within the first few years of being infected, most people are shedding somewhere between 10% and 20% of days; in some cases, individuals shed considerably more than that. Transmission The reason we now have at least 50 million Americans infected with HSV-2 has to do with sexual transmission from infected individuals who do not have classic genital herpes lesions to uninfected partners. Responsibility for most transmission has to do with transmission while people either are asymptomatic, but shedding virus, or alternatively have atypical or unrecognized clinical herpes. Genital Herpes In other words, the HSV on the front of your genitals can be spread to other areas through toweling, wearing clothes, sexual foreplay and sharing of sex toys. HSV-2 Seroprevalence According to Age This is a graph of age vs prevalence of this virus.

Using new accurate antibody tests, we find that by the age of 30, almost 25% of Americans have HSV-2 antibodies. Of those 25 who have HSV-2 antibodies, 10% of the 25% (or 2-3% of the total number) will have a history of classic genital herpes.
And that is what we have been aware of over the last 5 decades - that is, patients having classic painful recurrent genital lesions. These presentations of herpes, nonclassical in appearance, actually are 8 to 10 times more common than classic genital herpes. Because when infectious diseases are initially discovered, the most obvious and classic manifestations are the ones we classify as a particular disease. As time goes on, we have developed better tests and gained a more accurate picture of the full spectrum of genital herpes infection.

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