It is possible to have herpes for years without knowing it. Many individuals who carry the herpes simplex virus (HSV) are unaware they have been infected. This often happens because the virus can remain hidden in the body, or its symptoms are so mild they go unnoticed or are mistaken for other common conditions. Estimates suggest that 75% to 90% of people with genital herpes do not realize they are infected.
The Latent Nature of Herpes
Herpes can go undetected for extended periods due to the virus’s ability to establish latency. After an initial infection, the herpes simplex virus travels along nerve pathways and settles into sensory nerve cells, typically near the spinal cord. In this latent state, the viral genetic material remains dormant within the nerve cells, producing no infectious virus particles. The virus can reside there for years without causing symptoms. However, various triggers, such as stress, illness, hormonal changes, or ultraviolet light exposure, can prompt the dormant virus to reactivate and travel back to the skin surface.
Recognizing Subtle Signs
When the herpes virus reactivates, it may lead to symptoms that are often subtle and easily dismissed. While some individuals experience characteristic blisters and sores, many have atypical or unnoticeable signs. These mild manifestations can include small cracks in the skin, areas of redness, persistent itching, or minor irritation that quickly resolves. Such signs might be mistaken for everyday skin issues like razor burn, ingrown hairs, pimples, or insect bites. Sometimes, a person might only experience a brief tingling, itching, or burning sensation in the affected area, known as prodromal symptoms, without any visible lesions appearing.
Understanding Transmission
Herpes can be transmitted even without visible sores or symptoms, a phenomenon called asymptomatic shedding. This occurs when the virus reactivates in nerve endings and travels to the skin surface, releasing infectious viral particles without causing noticeable lesions. These viral particles can be present on mucous membranes or skin, allowing transmission through skin-to-skin contact, including during sexual activity. A significant proportion of new herpes infections are acquired from partners unaware they have the virus or are not experiencing an active outbreak. This silent shedding mechanism makes herpes highly transmissible.
Getting Tested
For individuals concerned about a possible herpes infection, specific tests are available. While viral culture or PCR (polymerase chain reaction) tests can detect the virus directly from an active lesion, these methods are not suitable for asymptomatic screening. Blood tests, also known as antibody tests, are used to detect past exposure to the herpes simplex virus.
These tests identify antibodies, primarily immunoglobulin G (IgG), which the immune system produces in response to the virus. IgG antibodies typically become detectable several weeks after infection and remain in the bloodstream for life. A positive IgG antibody test indicates exposure to HSV at some point, but it does not specify when the infection occurred or if there is a currently active outbreak. Routine asymptomatic screening for herpes is generally not recommended by health organizations due to the potential for false positive results and the psychological impact of a diagnosis.