Asymptomatic Stages: Latency and Shedding
Latency. After an outbreak, the herpes simplex virus goes into a stage known as latency. During that phase, HSV produces no symptoms at all, and the virus is not transmissible.
Asymptomatic Shedding. At certain times, the virus undergoes shedding. During this phase the virus replicates and is capable of being transmitted through fluids and infecting other people. This occurs during an outbreak, but, unfortunately, in a third to half of cases shedding occurs without any symptoms at all. One study reported that about 40% of all HSV-infected people experienced asymptomatic shedding of the virus more than 5% of the time. (Other evidence suggests shedding occurs much more often -- between 9 - 28% of the time.) About half of asymptomatic shedding episodes occur within a few days before or after an outbreak and last about 1.5 days. Asymptomatic shedding is much more common with HSV-2 than with HSV-1.
Recurrence Symptoms, Triggers, and Timing
Symptoms of Recurrence. Herpes simplex nearly always recurs. The anatomic site and the type of virus influence the frequency of recurrences. It usually takes the following course:
- Prodrome. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itching skin, pain, or an abnormal tingling sensation at the site of infection. The patient may also experience headache, enlarged lymph glands, and flu-like symptoms. The prodrome, which may be as brief as 2 hours or as long as 2 days, terminates when the blisters develop. About 25% of the time, recurrence does not develop beyond the prodrome stage.
- Outbreak. Recurrent outbreaks of HSV feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer. After blisters erupt, they typically heal in 6 - 10 days. Occasionally, the symptoms may not resemble those of the primary episode but appear as fissures and scrapes in the skin or as general inflammation around the affected area.
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