Herpes: the Facts Amid the Myths

             Herpes simplex virus is a common contagious viral infection and is classified into two categories: herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). Under a microscope, the two viruses are almost identical as they share about 50 percent of their DNA. Both strains of the herpes virus infect human mucosal surfaces before establishing latency, which is the period between infection with a virus and the onset of symptoms, in the nervous system. Basically, the virus lies in wait in a person’s nerves until the time is right for an outbreak of herpes. The HSV-1 virus prefers to establish latency in the trigeminal ganglion, a collection of nerve cells near the ear, and from there can recur on the lower face or lip. The HSV-2 virus prefers to establish latency in the sacral ganglion at the base of the spine and recurs in the genital area. Thus why HSV-1 is often referred to as oral herpes and HSV-2 as genital herpes. About two-thirds of people infected with herpes, regardless of the type, are asymptomatic, or without symptoms, or they experience symptoms too mild to notice. Both types of herpes viruses can recur and spread even when no symptoms are present.

             HSV-1 causes oral herpes on the lips, mouth, gums, and/or face. These small, usually painful blisters are often referred to as cold sores and like to form in the soft moist skin that lines the lips, mouth and nose. Cold sores can form on ordinary skin if there is a break in the skin that allows the virus to enter the body. A cold sore on the lips can reappear anywhere else on the infected person’s face. The immune system will confine the virus to the facial area and will prevent the virus from catching anywhere else on that person’s body.

             Cold sores are only passed from direct skin to skin contact, for example when a person with an active cold sore or a cold sore that is forming kisses a person who is not infected. The majority of people who are infected with HSV-1 were infected as young children via social kissing from an infected adult relative. Children have no immunity against HSV-1. People who are infected with herpes will have antibodies (substances produced by the immune system to fight off infections) for either HSV-1 or HSV-2 in their blood, depending on the type of infection an individual has contracted.

             According to herpes.com, “By the time they’re teenagers or young adults, about 50 percent of Americans have HSV-1 antibodies in their blood. By the time they are over age 50, some 80-90 percent of Americans have HSV-1 antibodies.” Once a person gets a cold sore, the HSV-1 virus stays inside his or her body and hides within nerve sheaths and can reactivate any time during the infected person’s life. Because the virus can lie dormant within the human body and not cause any visible symptoms, some people infected with HSV-1 are not aware they have been infected with the virus and can unknowingly spread the virus to others.

             A common myth about HSV-1 virus is that it is not transmittable to the genital area. When a person infected with HSV-1 has an active or forming cold sore, that person can infect anyone he or she has direct skin to skin contact with. This means if the infected person performs oral sex on someone, the HSV-1 virus can infect the genital area. The opposite is true as well. A person with HSV-2 on his or her genitals can give an uninfected person who performs oral sex the HSV-2 virus on that person’s face. This dispels the myth that HSV-1 is always confined to the face and HSV-2 is always confined to the genital area. Both types of herpes can appear anywhere on the human body.

             While usually mild and forming cold cores on the lips, mouth, gums, and face, HSV-1 can be aggressive in rare cases. HSV-1 can recur spontaneously in the eye, causing a potentially serious infection called ocular herpes which can lead to blindness. In very rare cases, HSV-1 spreads spontaneously to the brain, causing a dangerous infection called herpes encephalitis which can result in death. Herpes whitlow, an infection of the finger, and herpes gladiatorum (also known as “wrestler’s herpes”), an infection on the chest or face, are caused by HSV-1 as well. The HSV-1 virus causes one-third of neonatal herpes, a rare but dangerous infection in newborns. The range and severity of HSV-1 infections have lead some health and science experts to view this virus as more risky than normally perceived.

             The HSV-2 virus “infects about 22 percent of adult Americans from all backgrounds, income levels, and ethnic groups,” according to herpes.com. This number translates to the statistic that roughly 40 million American adults are infected with HSV-2 virus. According to the Centers for Disease Control and Prevention (CDC), about one out of every six Americans aged 14 to 49 years in age have genital herpes. Yes, this math does not really match up because the CDC compiles genital herpes into one category regardless of type of infection while herpes.com is giving a statistic for just the HSV-2 virus itself. In addition, the CDC is giving data in an age range while herpes.com is reporting figures for all adults ages 18 and above. (Note: I wanted to show these math examples to educate readers on how to interpret statistics and compare them with other data available for times when one source states one number and a second source gives a different number altogether.)

             HSV-2, just like its HSV-1 counterpart, is usually mild. Nearly two-thirds of the people infected with HSV-2 don’t even know they have the virus due to being asymptomatic or having very mild symptoms that go unnoticed. HSV-2 rarely causes complications and rarely spreads outside the genital area to other parts of the body. Fluids found in genital herpes sores carry the herpes virus and contact with those fluids can cause infection. Genital herpes infections, regardless of virus type, are spread via vaginal, anal or oral sex with an infected person. An infected person sheds the herpes virus through the skin, which is how an infected person without visible sores can infect another person. Condoms do not always prevent the spread of herpes because they do not always cover the areas where the infection is active. HSV-2 causes the majority of neonatal herpes infections, which can be fatal to the newborn if left untreated.

             How much of a physical problem a herpes infection is to an infected person depends on three factors: how well the person’s immune system can control the herpes infection; how long a person has had the herpes infection; and whether the virus is established in its preferred location. For example, an HSV-1 infection on the genitals will be a milder infection than an infection on the face because the virus is away from its “home” territory. The virus simply loses its strength once it establishes outside its theoretically preferred area.

             For both types of herpes infections, the first outbreaks seem to the worst. For example, in the first year of HSV-2 infection, those with reoccurring outbreaks experience an average of four to six episodes, according to herpes.com. Both HSV-1 and HSV-2 outbreaks diminish in frequency over time, although the exact reason for this phenomena is still unknown.

             When an infected person has a recurrence of herpes, the immune system defends the body from the herpes virus, which can then cause the body to be more perceptible to catching other viruses due to a weakened immune system. These secondary infections are referred to as opportunistic infections. Avoiding additional infection is the main reason a herpes patient needs to keep the herpes virus under control at all times. Both HSV-1 and HSV-2 pose the greatest health risks to infants because of their limited immune response and to those with compromised immune systems, including people with cancer, AIDS, severe burns and people taking immunosuppressant drugs. Herpes simplex is one of the opportunistic infections in HIV patients that can lead to the diagnosis of AIDS.

              The herpes virus can be treated, but not cured. Oral antivirals called nucleosides or nucleoside analogues are the most common drugs used to treat genital herpes. These drugs limit herpes viral replication and its spread to other cells and include acyclovir (Zovirax is the brand name), valacyclovir (Valtrex), and famiciclovir (Famvir). These medications are initially used to treat a first attack of herpes, which lasts an average of seven to ten days, and then taken afterward for one to five days to treat recurrent outbreaks. To suppress outbreaks, medications must be taken on a daily, long-term basis. Suppressive treatment can reduce outbreaks by 70-80 percent. Outbreaks of cold sores can be treated with the same oral antiviral medications used to treat genital herpes as well as the topical antivirals penciclovir (Denavir) and acyclovir.

             Society brands HSV-1 as the “good” herpes and HSV-2 as the “bad” herpes because of how the each virus is spread. There appears to be less social stigma associated with infections that are spread through something perceived as innocent, such as kissing, as opposed to an infection spread through sexual acts. This perception is one reason people may not understand that herpes is still herpes, regardless of the type of virus a person has, and, therefore, may not take HSV-1 infections as seriously as they should. The safest approach is to assume everyone can be a carrier of either herpes virus because the virus is usually asymptomatic or very mild in severity of symptoms. Ask potential sexual partners about their HSV-1 and HSV-2 status in order to make a more informed decision about present and future sexual behavior with those partners.

             The only way to truly know if someone is infected with either HSV-1 or HSV-2 is to test the person’s blood using a blood test called Type Specific IgG, which is the only reliable and commercially available test for herpes infections. Type Specific IgG can distinguish between the types of the herpes virus, but cannot determine if HSV-1 is causing genital herpes or cold sores and vice versa for HSV-2. Dr. Jen Gunter wrote a very informative blog that breaks down how the test works and gives readers much to think about.

             In the world of infections, the herpes virus is not as dangerous in symptoms and as high in morbidity rates as the Ebola virus, which can be spread sexually via vaginal or anal intercourse. The Ebola virus can be detected in the sperm of an infected man for up to seven weeks after his exposure to the virus. The CDC ranks HSV-2 as the fifth most common type of sexually transmitted infection (STI) in the U.S. out of eight types of STI’s. Hands down, human papillomavirus (HPV) tops the charts, and there is no cure for HPV. While the Gardasil vaccine, when taken on the schedule recommended by the manufacturer, does prevent four types of the HPV virus from forming in boys and girls vaccinated prior to start of sexual intercourse of any kind, there are over 100 strains of HPV and nearly all strains produce no symptoms.

             When used properly, condoms can provide protection from STI’s. The degree of protection varies from infection to infection, but something is better than nothing when experimenting sexually outside of a strictly monogamous relationship. Your Sexy Librarian understands that monogamy depends on both partners being completely honest with one another, which does not always happen. When in doubt, seek treatment from a medical health professional for any possible infections and use condoms for protection and peace of mind as well.

             For a much more in-depth educational look at herpes and its two viruses, please visit the website www.herpes.com.