Herpes Simplex Virus type 2 (HSV-2) causes genital herpes. Understanding its transmission routes is important for prevention and management. This knowledge helps individuals make informed decisions regarding their health and the health of their partners.
Direct Contact Routes
HSV-2 is most frequently transmitted through direct sexual contact. This includes vaginal, anal, and, less commonly, oral sex. It transmits through contact with herpes sores, saliva, or genital fluids from an infected person. The virus can enter the body through mucosal surfaces or small breaks in the skin.
Risk of transmission is highest with visible sores, but HSV-2 can also spread when no symptoms are apparent. Condoms reduce transmission risk, but do not cover all infected areas, so transmission can still occur through contact with uncovered skin.
Spreading Without Visible Symptoms
HSV-2 transmission often involves “asymptomatic shedding,” where the virus is present and transmissible without visible sores. Many infected individuals have no or mild symptoms, unaware they can spread the virus. This shedding is a common way the virus spreads unknowingly.
Asymptomatic shedding can occur periodically and unpredictably. Studies indicate that HSV-2 can be detected on approximately 10.2% of days in individuals without symptoms, compared to 20.1% in those with symptomatic infections. During the first six months after infection, shedding can occur on 20% to 40% of days, decreasing to 5% to 20% on subsequent days. Most new infections are attributed to this asymptomatic shedding.
Mother-to-Child Transmission
HSV-2 can be transmitted from a mother to her baby, primarily during vaginal childbirth. This occurs if the mother has active lesions or is shedding the virus in her genital tract during birth. Most infants who contract HSV-2 are born to mothers who did not have a history or visible signs of active infection during pregnancy.
Less common routes include in utero (5% of cases) or postpartum (10% of cases) transmission. Postpartum transmission can occur through direct contact with an active lesion, such as a cold sore. Neonatal herpes can be severe, affecting major organs like the brain, with high mortality and morbidity. Prompt medical treatment improves outcomes for affected infants.
Common Misunderstandings About Transmission
HSV-2 is not transmitted through casual contact or inanimate objects. The virus does not spread from toilet seats, bedding, swimming pools, or by sharing items like towels, silverware, or soap. The virus is fragile and does not survive well outside the body on surfaces.
Casual non-sexual contact, like hugging or shaking hands, does not transmit HSV-2. Transmission requires direct skin-to-skin contact with an infected area or fluids. Everyday social interactions pose no risk for HSV-2 transmission.