What is herpes and how is it transmitted?

Herpes simplex virus, or HSV, is an extremely common and usually mild viral infection. One in five adults in the US is believed to be infected with genital herpes. HSV causes cold sores or fever blisters (oral herpes), and it also causes genital sores (genital herpes). Even if the HSV infection is not currently causing signs and symptoms, it may cause symptoms later. Herpes can be a recurring and upsetting disease but is rarely dangerous. However, it can cause recurrent painful sores and can be severe for people with suppressed immune systems. HSV frequently causes psychological distress and may play a major role in the spread of HIV (HSV causes people to be more susceptible to HIV). Although there is not yet a cure for herpes, appropriate treatment is effective in helping to control the disease.

There are two primary herpes simplex viruses: herpes simplex type one (HSV-1) and herpes simplex type two (HSV-2). Most commonly HSV-1 occurs above the waist, usually as cold sores or lesions in the mouth or on the lips and face (orofacial herpes); HSV-2 occurs below the waist, usually as genital sores (genital herpes). Occasionally sores can appear on other parts of the body where broken skin has come into contact with the virus.

HSV-1 and HSV-2 are spread by direct skin-to-skin contact, that is, directly from the site of infection to the site of contact. If you have a cold sore and kiss someone, you can transfer the virus from your mouth to your partner's. Similarly, if you have genital herpes and have vaginal or anal intercourse, you can transfer the virus from you genitals to your partner's. Also, if you have a cold sore and put your mouth on your partner's genitals (oral sex), you can give your partner genital herpes.

Transmission is most likely when a sore or other symptoms of infection are present. However, herpes can also be transmitted during "prodromal symptoms" (itching, tingling or other sensations on the skin before lesions appear) and sometimes when there are no obvious signs or symptoms. People who do not realize they're infected or are not aware that their infection is "active" often transmit herpes.

What does herpes look like and how would I know if I had it?

Symptoms of primary herpes (the first episode) usually develop within 2-14 days after the virus is transmitted. The infection usually develops quickly during the first episode and causes obvious symptoms because the immune response is not well developed. However, some people have a very mild first episode and may not notice symptoms until a later episode.

During the first episode, the virus starts to multiply within the skin cells and the skin becomes red and sensitive. Soon afterward, small red bumps appear and may develop into blisters or painful sores. Individuals may also experience flu-like symptoms including swollen glands, headache, muscle aches, or fever. Sometime the glands in the groin may enlarge and cause discomfort. In the following week or so, the blister-like sores break open, scab over, and heal without scarring. However, signs of herpes may be obvious like previously stated or may cause no discomfort and be undetectable.

What is a herpes infection recurrence and how often does it occur?

After the initial or primary infection, the virus retreats and lies dormant. From time to time, the virus can be reactivated and cause new sores to erupt. It can also reactivate without causing any visible sores. At these times small amounts of the virus may be shed at or near the sites of the original infection. The reasons why this occurs are unclear.

Over 50 percent of individuals infected with herpes have recurrent or secondary episodes. Some people have frequent recurrences while other people rarely have them. Research indicates that "outbreaks" are often influenced by whether you have HSV1 or HSV-2 infection and the length of time you've been infected. The average number of recurrences for HSV-2 is about four times per year; recurrences are most common during the first year. Approximately a third of the HSV-2 recurrences do not cause recognizable signs and symptoms. HSV-1 infection in the genital area usually causes a significant first episode, about one recurrence per year and a lower rate of unrecognized recurrences.

There are also a number of other factors thought (but not proven) to induce a recurrence such as illness, stress, fatigue, skin irritation, diet, menstruation, or vigorous sexual intercourse. Over time, individuals tend to discover the physical factors that appear to cause their HSV "outbreaks".

The viral shedding or recurrence usually occurs for one day and though infrequent, is sufficient to infect your sexual partner. Most people can tell when an attack is coming on because they feel a tingling or burning sensation where the sore will occur. Because the immune system develops antibodies and other weapons against the virus during the first episode, recurrences are usually milder and shorter. Some people never have a second outbreak.

If I had herpes but do not have signs and symptoms, can I still transmit it?

Herpes can be "active" even when it does not cause signs and symptoms. This is referred to as "asymptomatic shedding", "subclinical shedding" or "unrecognized" herpes. Herpes may be "unrecognized" because lesions are not found, they are mistaken for something else, or the lesions can't be seen. So there could be times when you won't be aware that the virus has reactivated but transmission could occur.

When should I see a health care provider?

If you experience itching or tingling or develop any rash or sores, see a health care provider while symptoms are still present. Diagnostic tests are most useful when the lesions are present.

How is herpes diagnosed?

Your health care provider can often diagnose herpes on the basis of your history and the examination of the sores. The health care provider may take a sample of fluid from the sore(s) to determine if the herpes virus is present and to determine if you have HSV-1 or HSV-2.

How is herpes treated?

At present there is no cure for herpes but appropriate treatment can relieve discomfort. Your health care provider might suggest a prescription drug called Acyclovir which may reduce your discomfort and the frequency and duration of outbreaks. Always check with your health care provider before using any over-the-counter medications or home remedies.

During an active recurrence, you can take several measures to decrease discomfort:

  • Keep the infected area as clean and dry as possible. After a shower avoid rubbing with a towel. Dry gently with a towel or with a hair dryer on low or cool setting.
  • Take warm baths to cleanse and soothe the infected area.
  • Wear 100% cotton underwear and avoid tight fitting pants or jeans which might cause irritation.

You may spread the virus by hand to other parts of your body (autoinoculation) or to other people. Therefore it is important to avoid contact with the infected area, especially during the first episode (outbreak). If you do touch the area, wash and dry your hands with soap and water.

Proper nutrition, plenty of exercise, and rest can keep your immune system healthy and may help control the virus. You may also find it helpful to participate in a herpes support group.

How can I avoid getting herpes?

  • Always use condoms because sometimes signs and symptoms of herpes infection are not recognized.
  • If you are free of herpes infection, you can reduce your risk by not having sex with anyone (abstinence) or by having sex only with a non-infected partner who has sex only with you (mutual monogamy).
  • If you have a sexual relationship with a person who has herpes, you should abstain from sex with your partner when signs or symptoms are present. If the sores are in the mouth or on the lips, you should avoid kissing during a recurrence.
  • Between outbreaks, use latex condoms. Condoms do not provide 100% protection because the condom may not cover all lesions.

Can herpes be transmitted to babies during childbirth?

In most cases, mothers can have a normal vaginal delivery. However, a cesarean section is performed if a woman has an active outbreak during delivery. It is important to inform your health care provider that you have herpes, even if it has been awhile since you had symptoms. If your partner has herpes but you don't, it is especially important to avoid contracting herpes during your pregnancy because there is an increase a risk of transmission during delivery if it is your first episode.

Where can I go for more information and support?

Support and information is available for those who have herpes.

  • You may talk to your health care provider at the UCSB Student Health Center at 896-3371.
  • Planned Parenthood provides herpes HELP Support Groups. Call 1 800 230 PLAN for more information.
  • American Social Health Association (ASHA) maintains the Herpes Resource Center which provides information and resources.
  • For more information on herpes, contact the National Herpes Hotline at (919) 361-8488.

Sources: JG McKenna, A McMilan., A Blakely., et al, "Cold Sores and Safer Sex, letter," Lancet 338(1991): 632. Joseph Apuzzio. "Genital Herpes," Medical Aspects of Human Sexuality, February (1990); Herpes Resource Center, Understanding Herpes (American Social Health Association, 1991); Tracking the Hidden Epidemics: Trends in STDs in the United States 2000, (CDC); review by OHP, SHC, Duke University, 2003.

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