Herpes Simplex Virus type 2 (HSV-2) is a common viral infection primarily associated with genital herpes. This virus has a notable characteristic: its ability to remain inactive, or “dormant,” within the body for extended periods, often years, without producing any noticeable symptoms. The virus can persist silently, making its presence unknown to the infected individual for long durations.
Understanding HSV-2 Latency
Latency for HSV-2 signifies that the virus does not disappear from the body but instead retreats into specific nerve cells. Specifically, HSV-2 establishes this dormant state within the sacral ganglia, which are clusters of nerve cells located near the base of the spine. In this latent phase, the virus is not actively replicating, which explains the absence of symptoms. This ability to lie dormant in nerve cells is a defining characteristic of herpesviruses, allowing them to persist in the human host for a lifetime.
Triggers and Reactivation
Despite its dormant state, the HSV-2 virus can reactivate, leading to a recurrence of symptoms known as an outbreak. Various factors can trigger this reactivation.
Common triggers include physical or emotional stress, other illnesses such as colds or the flu, and a weakened immune system. Hormonal changes, like those experienced during menstruation, can also play a role in stimulating the virus. Additionally, physical friction in the genital area or exposure to sunlight may contribute to reactivation in some individuals. When reactivation occurs, the virus travels from the sacral ganglia to the skin or mucous membranes, resulting in sores or lesions.
Transmission and Diagnosis During Dormancy
A significant aspect of HSV-2 is its potential for transmission even when the infected individual shows no visible symptoms, a phenomenon known as “asymptomatic shedding”. During asymptomatic shedding, the virus can be present on the skin surface and capable of transmission, even without any sores or lesions. This aspect contributes significantly to the spread of HSV-2, as individuals may unknowingly transmit the virus. Most sexual transmissions of HSV-2 occur during these periods of asymptomatic shedding.
Diagnosis of HSV-2 typically involves different methods depending on the presence of symptoms. If active lesions are present, a healthcare provider can take a sample from the sore for a viral culture or Polymerase Chain Reaction (PCR) test, which detects the virus’s genetic material. For individuals without current symptoms, a blood test is the primary method to diagnose latent HSV-2. This test looks for type-specific antibodies produced by the immune system in response to past HSV-2 exposure, indicating a prior infection.
Living with Latent HSV-2
Living with HSV-2 means understanding its chronic, lifelong nature, though its latent characteristic often results in long symptom-free periods for many individuals. While there is currently no cure for HSV-2, various strategies can help manage the condition effectively. Avoiding known triggers can help reduce the frequency of outbreaks. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are available to manage outbreaks when they occur, reducing their severity and duration.
These antiviral medications can also be taken daily as suppressive therapy to reduce the frequency of future outbreaks by 70% to 80% and to significantly lower the risk of asymptomatic viral shedding. Suppressive therapy has been shown to reduce the risk of HSV-2 transmission to sexual partners by about 50%. For many, HSV-2 is a manageable condition.