What is Herpes?
Herpes Simplex Virus, or simply Herpes, is an incredibly common viral skin infection. About 20% of Americans over age 12 have Genital Herpes, of which 90% are undiagnosed. An additional 50-80% of the population is estimated to have the more common oral Herpes presentation.
What’s the difference between Oral and Genital Herpes?
Oral and Genital Herpes are both caused by the Herpes Simplex Virus, or HSV. However, there are two forms of the virus, one of which is more likely to cause genital herpes and one which it more likely to cause the oral.
Most commonly, HSV-1 (also known as Type 1) causes oral herpes presentation while HSV-2 (also known as Type 2) causes genital presentation. However type 1 can also be found on the genitals.
What are the symptoms of herpes?
The trademark symptom of either type 1 or type 2 is blistering lesions. With oral herpes the lesions appear around the mouth or nose and with genital herpes appearing in the genital and/or rectal area. When appearing on the mouth, these blisters are often referred to as “cold sores” or “fever blisters”.
Traditionally, it was assumed that HSV-1 strictly caused oral sores and blisters, whereas HSV-2 caused genital and/or rectal sores and blisters. However, the virus- or perhaps just our understanding of the virus itself- has evolved in such a way that doctors now recognize that either HSV-1 or HSV-2 can cause genital and/or rectal sores, albeit with HSV-2 causing the majority of sores in the genital or rectal areas.
How often will I get outbreaks?
In both forms, HSV lies dormant for a period of time and then flares up. The irregularity of symptoms can be of frustration to some, and relief to others.
HSV-2 lives in nerve tissues, but can travels to the surface of the skin causing the trademark sores and blisters during an active outbreak. While HSV-1 and HSV-2 are in a period of dormancy and inactivity, the affected individual is asymptomatic.
However, when the virus is active, a flare or outbreak will occur, with the individual again presenting with sores and blisters.
Is Herpes contagious?
Yes, and when the virus is active the affected individual is at their most contagious. At this point, the virus is active on the surface of the skin, where it is replicating, making copies of itself in a process known as shedding. These viral copies can rub off on another individual and infect them with the virus.
Unfortunately, the individual with herpes is most contagious the week before getting symptoms of an outbreak such as blisters. During this time of shedding the patient nor his/her partner will see any evidence of an outbreak.
After the period of viral activity and blistering, the virus will move back down the length of nervous tissue, where it will again lie dormant until the next outbreak.
Who gets Herpes and why? How does it spread?
As previously stated, Herpes is incredibly common in it’s Oral presentation, affecting roughly 50-80% of the population. While less common, Genital Herpes also presents with a fair degree of regularity, affecting roughly 20% of the population.
Women tend to be affected more commonly than men, although both sexes can become infected. One reason for the increased commonality in women is related to genital structure and form: the virus is slightly more likely to infect the tissues of the vagina more so than the penis, thanks to the unique anatomy of each organ.
Herpes also tends to become more common in age, thanks to increased sexual behaviors. In general, the more sexual partners someone has, the greater their chance of infection.
However, herpes can still present at any age, regardless of the number of sexual partners. It can also present in children, thanks to food and beverage sharing, poor hygiene, or early sexual behavior. Infants can also be infected at childbirth if the mother is infected.
HSV-1 is commonly spread by kissing, sharing food and/or beverages, sharing of toothbrushes or other hygiene materials (such as makeup brushes or cosmetics, chapstick, etc), and sharing of utensils.
HSV-1 can also be spread to the genitals of either an infected or uninfected individual during oral sex. If this occurs, this is secondary outbreak is now referred to as Genital Herpes, despite its original site at the mouth of the infected carrier.
HSV-2 is most typically spread during vaginal intercourse. However, just as is the case for HSV-1, HSV-2 can be passed from the genitals of an infected individual to the mouth of either an infected or uninfected person during oral sex, where it is then referred to as Oral Herpes, despite its original site at the genitals of the infected carrier.
How can I prevent getting HSV-1 or HSV-2, and how can I avoid spreading it to others?
HSV-2 cannot live long on hard surfaces, making shared toilet seats or other shared surfaces that genital areas may come in contact with a low risk for infection. However, HSV-1 can live on hard surfaces that the saliva of the infected person has come into contact with, such as a toothbrush or unsensitized utensil, for a short period of time.
There are also times throughout the year that the virus is still active without its usual blistering presentation. These periods are known as Asymptomatic Reactivation or Asymptomatic Shedding, and at these points the individual is very contagious.
For these reasons, beverage/food, utensil, and toothbrush or cosmetic sharing is not a good idea for an infected individual, even during what appears to be a period of viral inactivity.
Both HSV-1 and HSV-2 are most commonly spread during a period of viral activity with typical presentation. In other words, the majority of HSV-1 and HSV-2 transmission occurs during a period when the virus is A) Active, and B) Presenting with sores or blisters.
During these periods, it is especially important to abstain from kissing and any form of physical contact with the blistering area, saliva, or sexual discharge. If you are infected, be sure to wash your hands after touching an infected area on either the oral or genital regions. Herpes medications can also help reduce your risk of transmitting the virus to another individual.
It’s generally best to abstain from sexual intercourse in order to lower odds of transmission to their lowest during an outbreak. While using condoms, dental dams, or other skin-protective sexual barriers can help reduce the overall risk of transmission, they are by no means foolproof.
Is Herpes dangerous? Is there a cure for Herpes?
There is no cure for HSV-1 or HSV-2. In general, however, Herpes is not terribly dangerous. There are a few caveats to this rule: for pregnant women, those who are immunosuppressed, and those at an increased risk for HIV/AIDS, the risk of HSV infection is slightly more concerning.
For pregnant women, HSV can be passed to the infant during birth. This occurs when the virus is present in the genital area or vaginal cavity during birth, where it is then potentially passed to the infant. In turn, this causes a condition known as Neonatal Herpes, which can be life-threatening.
In infants for whom the condition is quickly diagnosed and controlled by antiviral medication, prognosis is good. However, in untreated and undiagnosed infants, the virus can attack the body’s organs systems, causing serious and potentially life-threatening complications, including seizures and Encephalitis, which can cause brain and/or spinal damage.
To avoid the risk of birth transmission, it’s crucial that pregnant women discuss their HSV infection with a doctor prior to delivery. This provides adequate time to establish a birthing plan to reduce the odds of transmission to the infant.
Oftentimes, medications are given to reduce viral activity. In other cases, a cesarean delivery (or as it is more commonly known, a C-Section) is used to avoid the infant’s contact with the birth canal, thereby reducing the likelihood of infant infection.
For those who are immunosuppressed (those with weakened immune systems) and those at an increased risk for HIV/AIDS, the presentation of genital herpes is especially concerning, as it increases the likelihood of an HIV infection.
How is Herpes treated?
There are home remedies, prescription, and over the counter treatments available to treat both HSV-1 and HSV-2 infections and outbreaks. Generally, a mixture of all three are used to control the infection and the number of outbreaks.
Common home remedies include the use of painkillers, such as acetaminophen and ibuprofen, to control pain associated with blistering sores and outbreak, as well as application of petroleum jelly or lidocaine cream to affected areas.
Over the counter remedies include specialized ointments and creams, which help to soothe the sore or affected area.
Prescription antiviral medications are also commonly used to reduce the duration, severity, and incidence of outbreak. These medications include (but are not limited to) valacyclovir, acyclovir, and famciclovir. Remember that these medications will not cure HSV-1 or HSV-2. Instead, they will help reduce the amount of time the outbreak is present, and help control the severity of symptoms.
Remember that during an outbreak the virus is at is most active and the chances of transmission are at its highest. During this period, it’s especially important to consider sharing behaviors for HSV-1, and sexual behaviors for HSV2. By avoiding sexual and/or oral contact, the risk of oral or genital transmission is at its lowest.
Do not share toothbrushes, cosmetic brushes, food, beverages, or unwashed, unsanitized utensils during this time, and abstain from sexual contact if possible.
If abstinence is not possible, using a sexual barrier (such as a condom or dental dam) can reduce the likelihood of transmission, although there is still a risk that these methods will not be sufficient to prevent the spread of the virus. It’s also a good idea to keep a visual reminder of your infection at hand to avoid any accidental food or beverage sharing.
Consider designating a special, brightly colored bracelet or visual designator that you will wear only during active viral periods: this will serve as a visual cue, reminding you each time that you eat or drink that food and/or beverage sharing is not an option during this time: this subtle cue will remind you to not engage in a high-risk behavior during an active viral period.
Additionally, it’s important to inform any sexual partners and/or family members of your condition, including how to avoid their own infection during a period of active infection. Otherwise, an unsuspecting family member might take a sip of your beverage, or a significant other might swoop in for a kiss before you have adequate time to stop them.
If you think you have or have been exposed to herpes you should see your primary care provider for follow up, screening, and possible treatment. Many providers today will not test unless you have symptoms of an outbreak, as often tests come back as false positive and the CDC has concluded that false positives cause psychological trauma to those tested. There is much debate on if you should test without symptoms or not, others say it is unethical to not be aware of your current STD status and risk infecting other people.