Natural Clearance of HSV-2 Infection
No, individuals do not clear HSV-2 naturally—the infection is lifelong and incurable once established. 1
The Permanent Nature of HSV-2 Infection
Genital herpes is explicitly characterized as a "recurrent, incurable viral disease" by the CDC. 1 Once HSV-2 infection occurs, the virus establishes latency in nerve ganglia and cannot be eradicated by the immune system or current antiviral medications. 1
Key Evidence Supporting Permanent Infection
Antiviral medications neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after discontinuation. 1 This fundamental limitation applies to all available therapies including acyclovir, valacyclovir, and famciclovir. 1
Viral shedding persists indefinitely, even in asymptomatic periods. HSV-2-infected persons shed virus intermittently in the genital tract throughout their lifetime, regardless of whether they experience clinical symptoms. 1
Suppressive therapy reduces but does not eliminate viral shedding. Even with continuous daily antiviral therapy, subclinical viral shedding continues, demonstrating that the virus cannot be cleared. 1
Clinical Manifestations Across the Disease Spectrum
Symptomatic vs. Asymptomatic Infection
Most HSV-2-infected persons (over 90%) have unrecognized infections and have never received a diagnosis of genital herpes, yet they remain infected and capable of transmission. 1
Among newly acquired HSV-2 infections, only 37% are symptomatic at seroconversion, but the remaining 63% with asymptomatic seroconversion still harbor permanent infection. 2
Persons with asymptomatic HSV-2 infection shed virus on 10.2% of days, compared to 20.1% in symptomatic individuals, but both groups maintain lifelong infection. 3
Viral Shedding Dynamics
Subclinical shedding occurs on 13.1% of days in symptomatic patients and 8.8% of days in asymptomatic patients, with similar viral loads during these episodes (median 4.3 vs 4.2 log₁₀ copies). 3
The immune system can clear individual shedding episodes but not the underlying infection. Late viral decay rates are similar on and off antiviral therapy (-6.0 vs -5.8 HSV DNA logs/day), indicating that local immune response clears episodes but cannot eliminate latent virus. 4
Critical Clinical Implications
Counseling Patients
All HSV-2-infected patients must be counseled that:
- The infection is lifelong and cannot be cured 1
- Transmission can occur during asymptomatic periods without visible lesions 1
- Recurrent episodes may occur unpredictably throughout life 1
- Antiviral therapy only provides symptomatic control, not cure 1
Common Pitfalls to Avoid
Do not suggest that absence of symptoms means the infection has resolved. Even persons who "have symptoms shortly after infection and then never again" remain infected and capable of transmission. 1
Do not confuse episode clearance with viral clearance. While individual outbreaks resolve, the latent virus persists in nerve ganglia indefinitely. 1
Do not assume that HSV-1 immunity prevents HSV-2 infection. Previous HSV-1 infection does not reduce HSV-2 acquisition rates, though it may increase the likelihood of asymptomatic presentation. 2
Impact on Quality of Life and Transmission
Over 45 million persons in the United States have genital HSV-2 infection based on serologic studies, representing a permanent reservoir for ongoing transmission. 1
Most transmission occurs from persons unaware of their infection or during asymptomatic periods, underscoring that natural clearance does not occur even in those without recognized symptoms. 1