Continuing the previous blog's discussion of herpes testing, I wanted to call your attention to another study of asymptomatic herpes... sort of. The study found that only 40 percent of people who had herpes knew they were infected, but another 30 percent of people had herpes symptoms when questioned at their next doctors visit - they just didn't realize that's what the recurring genital blisters were.

Once again, we end up looking at two facts - herpes is incredibly common and a lot of people don't realize they have it. So what do we do? Do we test widely, and accept the possibility of some false positives and the stigma that goes along with them? Do we say that since it's not life threatening, herpes isn't that big a deal - even though it can have serious psychological consequences and sometimes cause severe pain? Or do we educate people as best we can about asymptomatic transmission and hope that it motivates them to at least be more consistent about practicing safer sex?

I don't think there are any easy answers here. There are benefits to each option, and since in many cases a herpes diagnosis has more psychological implications than physical ones it is necessary for policy makers to take that into consideration at well. What would you do? Discuss your thoughts in the Herpes Forum or in the comments of this post.

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A paper that appeared in the April 13 issue of JAMA confirmed, once again, that people can spread genital herpes even when they don't have any symptoms.. The study, which had 498 individuals with HSV-2 do daily swabs of their genitals, found that on average people with symptomatic herpes had virus in their samples once every five days and people with asymptomatic herpes shed virus once every ten. Furthermore 68 percent of the individuals who had symptoms shed detectable amounts of virus at least once over the two month study period.

It's an important study, but the fact that asymptomatic people can transmit herpes shouldn't be news. It is news, though, because a large number of people (and doctors - who are similar to people only theoretically more informed) still don't know that herpes can be transmitted in the absence of symptoms. That's one of the reasons it's so common. On the other hand, what should be news about this study is that the authors are obliquely recommending a discussion of whether it's worth doing more wide-spread herpes testing so that more people are aware of their status. That's a big sea change, but one that I think has my support. Encouraging condom use and suppresive therapy to reduce transmission is all well and good, but it would work a heck of a lot better if the encouragement was reaching a larger number of infected people.

• Genital Herpes
• Asymptomatic Transmission.
• Asymptomatic STDs: The Hidden Epidemic
• Herpes Testing Accuracy
• Condoms and Herpes
• Suppresive Therapy and Transmission

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A recent article in the New York Times brings up the question of whether HIV positive individuals should be able to receive organs from infected donors - something which is currently illegal in the U.S. The debate is fueled by the ongoing shortage of donor organs, which could be significantly relieved by allowing transplants from HIV infected donors. Doing so would probably also help HIV infected recipients move up on the transplant list.

At least one state, Illinois, is willing to give the idea a go, although they are currently prohibited by federal law. That said, the idea of transplanting a chronically infected organ is not completely new. Individuals with hepatitis C can already donate their livers to recipients who also have the virus. Still, some concerns about the process include infection with more robust strains of HIV, problems with the immuno-suppressant drugs required after transplantation, and the possible release of infected organs into the general transplant pool.

The CDC is about to release guidelines encouraging research on the topic of HIV infected organ transplants, and it will be interesting to see if more robust studies confirm preliminary results that they may work relatively well. That said, I understand why the idea is a little hard for some people to wrap their brains around. As someone who grew up during the early years of the AIDS epidemic, it's sometimes difficult to remember that HIV is becoming a chronic disease that people can live long, healthy lives with.

On the other hand, it's impossible for me to not be aware of how many people die each year from a lack of available organs. That's why the endgame for this process may turn out to be bigger than donating HIV infected organs to people who are already HIV positive. It may involve profound legal and ethical questions about the costs and benefits of choosing to live with HIV rather than die of organ failure.

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Although talking about polyisoprene condoms always leads to my going off on long tangents about how most people with latex allergies aren't actually allergic to latex, I do think they are quite a useful addition to the safer sex arsenal. Some people find that polyurethane condoms - both male and female - are too baggy for comfort, and so it has been exciting to have a stretchy, snug fitting alternative for the latex-allergic population that wants more choices for practicing safe sex.

The option pool has now expanded once again with the release of Lifestyles SKYN Large condoms - a plus-sized variant of their SKYN brand. I haven't gotten my hands on one of them yet, but I like the original SKYN condoms a lot - they're a slightly different texture than most latex condoms, and I suspect these will be similar. Whether or not you're latex allergic, if you're looking for larger size condom options, they may be worth checking out. Condoms are quite stretchy, but some people definitely find it more comfortable to use larger or smaller sizes as well as particular brands.

• Users Review Their Favorite Condoms
• Condom Profile: Polyisoprene Condoms
• Condom Profile: Polyurethane Condoms
• Condom Profile: Female Condoms
• Condom Size Chart

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