Hey, Doctor Bob!  Sure, it's a fact.  It's estimated that more than
half of all herpes carriers (some estimates go as high at 75% or
even 90%) have either never experienced an outbreak or have had
symptoms so mild as to be unnoticed or mistaken for something else.

I must say I'm a little surprised that you've come to this place as
a reference, but, be that as it may...

The most definitive test is the culture, but you need to have a
fresh outbreak for to take the swab of material from.

The gold standard blood test is the Western Blot, which is only
available from the University of Washington in (or near) ol'
Seattle.

http://depts.washington.edu/herpes/herpes_qa.htm#testing

The link has a phone number.  Give them a call, Doctor Bob.

There are other new tests, updates of the older ELISAs, about as
reliable as the Western Blot, and also pretty good at typing the
disease, or differentiating between HSV1 and HSV2.

You might check out this place:

http://www.focusanswers.com/cms/cms.asp?cms_AHPX8DYOM

If you really want to stick your nose into who gave what to whom
when, consider that a recent herpes infection will show a high level
of IgM antibodies with a slowly building level of IgG antibodies.  A
mature infection will show little to no IgM and a steady level of
IgG.

Hope that helps,

Mike

Yes, it is a fact that people can be completely asymptomatic yet still shed
enough to be contagious.  It is also a fact that some people have symptoms
so mild that they don't even recognize them.

There are quite a few blood tests that are around these days.  The very best
one is the Herpes Specific Western Blot test.  If you are in Canada or the
USA, then this test is available to you.  But sometimes you have to be
crafty in getting it as many doctors don't know anything about it.

Many doctors are ignorant about the facts about herpes.  I would check back
here with any diagnosis that this doctor makes as many of us have been given
such wrong information it is actually scary.

Also, if this patient has ever had a cold sore, then he has herpes.  Many
people don't recognize cold sores as the same virus that can show up as
genital herpes.

ar

Within the terms of science, yes it is a well established phenomenon and
is generally regarded by many as the most common form of transmission of
the viruses in question. It was first seen in pregnant women at least 20
or so years ago and rang obvious alarm bells. Investigation since then has
rather nailed it down in terms of description. There's only so much use
random people on Usenet can be though....so here's a few more in depth
bits including citations - give them a read and decide from there.

There is a reasonable review in J Antimicrob Chemother. 2000 Apr;45 Suppl
T3:1-8, by Koelle and Wald. The abstract covers the salient points and is
accessible in Pubmed.

You might also wish to consider genital HSV1 not just HSV2 - again this is
something only a clinician can go into rather than someone on Usenet.

Go to www.pubmed.com and plug asymptomatic shedding and HSV in as keywords
and trawl the primary data. There is quite a lot with both simplex
viruses.

You might also want to look at the follwing paper in the Journal of the
European Academy of Dermatology and Venereology, volume 16 (2002), pages
564-572,  It was written by Strand et al and entitled Current treatments
and perceptions of genital herpes: A European-wide view.

It was written by a set of clinicians on a European panel to consider the
title issues. It covers the limitations of the clinicians and their
knowledge and the limits of the patients in terms of awareness, correct
dissemination of information etc and covers a bunch of European surveys.It
considers management, diagnosis and imprtantly what counselling a
physician needs to give their patients. One of the statements given there
is the following, that a patient should be told that (and I quote)
'Asymptomatic shedding during periods without noticeable symptoms is the
MAJOR risk of transmission' [emphasis is mine not the paper's]

There is a paper out there, which I don't have to hand which established
that in monogamous couples where there is serodiscordance then the
transmission rate of virus (not visible disease please note) is around
4-5% of couples per year get the negative person convert. This is avoiding
sex around outbreaks so picking up to a large extent the clinical effect
of asymtomatic shedding....30 years using th 4% figure my quick
probability check suggests about 20-25% of couple would manage to have not
passed the virus on in that time (BIG caveat there - it assumes the model
stays the same over that period of time compared the 3-5 the study that
gave that number went over) - there is supposed to be a female bias in
having an easier time picking it up and then of course only a proportion
of the infected people show disease themselves....but plucking the figure
of 1% of couples (REPEAT - that is just an estimate extrapolating a
bunch of figures ie the seroconversion rate, the basic 80-90% of people
don't see disease transferred direct to the converting people, some for
slightly easier female risk than male) could do as you describe above as a
guess suggests bad luck but not total implausibility in the
situation....its a total nightmare to transfer those kinds of population
stats to any individual couple remember and as I said there may be several
things missing from the estimate so don't use it as a direct figure and
adapt it based on other data including things as below....

There is a paper that initially appeared in the ICAAC in San Diego, but
was later put out in peer reviewed form that started to give some
information on viral load and disease and that lower viral load in the
infected individual (from taking antivirals) seemed to reduce the nmumber
of people getting disease in the seroconverting groups....

Oh and going back to HSV1.....oral sex is a source of genital herpes and
while 15-20% of the western world carries HSV2 primarily genitally, about
70-90 of adults carry HSV1 and oral to genital transmission of HSV1 can
hapopen by various routes and about 30% of new genital herpes cases these
days are coming from HSV1....I think oth the UK Public Health Lab Service
and the US NIH or CDC have some webpages on that....HSV1 can shed silently
too.

I can cite the US NHANES III study wherein they had 8467 people asked
whether thay had ever had genital herpes (ie symptoms). Of the 8302 in
that survey who answered no, 21.6% were found to be seropositive for HSV2.
Of the 167 who answered yes, 81.5% were positive for HSV2, the rest
presumably covered by HSV1 in the genital location. So there are a large
number who test positive yet have no history.

While the numbers vary (European incidence of HSV2 is slightly lower than
the US from most studies) as to the precise details in any country....the
basic phenomena exist the world over.

That NHANES II survey is in New England Journal of Medicine, Volume 337,
pages 1105-1111 published in 1997. Authors are Fleming et al.

Depends on the territory you are in.....you will get different answers.

Culturing from lesions gives direct evidence that any given outbreak is
viral in origin but is prone to false negatives (near 50% If I remember
correctly). Typing from that is also accurate. Some countries consider
this the required definition as it ties disease agent to disease.

There is a Western Blot test from 2 labs in the world (one in the US and
one in Canada) that for a while was far and away the best blood test. Many
people here consider this the best, it used to be but I think the case is
harder to argue these days due to the limited availability and the
improvements below.
Older ELISAs used to be prone to crossreactivity. The most recent
generation have pretty much got rid of that issue, and are widely
available but you need to be sure of getting a good type specific ELISA...

Blood tests can be done anytime and once antibodies develop give answers
reliably and tell you what any person carries assuming no weirdnesses (and
like any diagnostic they are not 100% just close). As such the ease of use
makes these a first line choice in some places....

What is available again goes back to what is used and licensed in any
territory so up to the labs to ask....any lab should be able to tell you
what test they perform and the cited senstivity and specificity of their
test.

There are a couple of websites out there that list the comparative data.
Returning to that European paper I mentioned earlier (the JEADV one) there
is some discussion of this sort of thing in the diagnosis section.

This is a complex set of answers I guess but the data is out there and
accessible.

Tim
--
When playing rugby, its not the winning that counts, but the taking apart
ICQ: 5178568

Don't rule out the possibility that he has been having outbreaks all along
and didn't recognise them. Or, that he saw them, went to the doctor and was
then mis-diagnosed. I went to 5 doctors over a period of 7 years, dropped my
pants and showed them the sores and they told me it was "Foliculitous" or
some other un-related disease.