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The Facts About Herpes

Herpes is common and easily transmitted. Learn a few of the basics to stay safe and healthy.

Two mouths are kissing as one tongue is pushing into the other.

Overview

Herpes is a viral infection caused by the herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). The World Health Organization estimates 3.7 billion people younger than 50 years old are infected with HSV-1 globally, while 491 million people younger than 50 have HSV-2. Both viruses are abundant in infected individuals' bodily fluids, such as saliva, semen and vaginal secretions.

HSV-1, the more prevalent virus, is primarily transmitted orally and is most responsible for oral herpes, which manifests commonly as cold sores around the mouth. HSV-1 can also cause genital herpes when the virus is passed through oral-to-genital transmission during oral sex. However, genital herpes is more likely to be transmitted through HSV-2. HSV-2 is more likely to recur than HSV-1 and can be transmitted to others even without the presence of an open sore, and that makes it much more easily passed on as it's difficult to know if you're infectious or not.

HSV transmits more easily from men to women, which may be part of the answer as to why more women have herpes than men. Herpes is also more common among young people, potentially (but not definitely) because they have more partners and are less likely to use condoms. Immunosuppressed people are understandably more at risk for infection.

Symptoms

Many individuals infected with herpes transmit the virus even though they present no symptoms or outward signs of the disease. Once transmitted, the herpes simplex virus remains dormant in the nerve cells surrounding the point of infection. Eventually, an infected person will notice an outbreak of blisters or sores, which may be preceded by tingling, itching or burning sensations at the point of transmission, typically either the mouth or genitals.

Outbreaks are often triggered by any of the following conditions:

  • Physical or psychological stress
  • Immunosuppression
  • Severe illness
  • Physical trauma to the affected area

The initial outbreak varies in terms of duration and severity. Individuals may be prone to recurrent episodes if they are continuously exposed to the trigger factors above.

General and specific symptoms of herpes infection are manifold. Painful blisters or sores on the mouth or genitals are common. These blisters may appear alone or in groups on the lips, face, vagina, penis or around the anus. Sometimes the blisters burst open and release fluid laden with the herpes simplex virus.

Ulcers in the mouth or on the genitals can result from ruptured blisters or sores. You can take pain-relieving drugs like ibuprofen to reduce pain associated with an outbreak. Infected areas in the mouth must be kept dry to prevent bacterial infection.

Other symptoms include headaches and body aches, which can also be relieved by painkillers. Fever is a less common symptom, which can be managed using acetaminophen. Some sufferers will experience a burning sensation while urinating, which is caused by a genital ulcer, although this particular symptom is not universal.

Genital herpes

Genital herpes is caused largely by HSV-2, which is transmitted during unprotected sexual interactions with an infected person. While HSV-1 typically transmits from sores, HSV-2 can transmit regardless of what symptoms are present, so condoms are the best protection against genital herpes transmission. Genital herpes symptoms in men appear as blisters on the penis and around the scrotum; in women, genital herpes manifests as sores near the vagina or anus.

Some patients with genital herpes may reduce their sexual activity for fear of transmitting the virus. A 2017 study published in the International Journal of STD & AIDS revealed 80 percent of female patients abstained from sex when they were initially diagnosed with HSV infection. Also, some infected individuals may develop psychological feelings of depression, guilt or isolation. Professional counseling is recommended to help ease these feelings.

Diagnosis and treatment

While doctors are informed by the clinical signs and symptoms listed above, they can use two kinds of laboratory tests to confirm herpes simplex virus infection:

  • Blood tests detect antibodies specific to HSV-1 or HSV-2.
  • Fluids from sores are taken for analysis to identify the presence of HSV-1 or HSV-2.

Herpes infection is a protracted illness with no absolute remedy. Treatment requires multiple approaches in order to be effective, including lifestyle changes and the use of antiviral medications.

Prescription drugs such as acyclovir, taken daily, are commonly prescribed to reduce the duration of outbreaks and the amount of virus shed in open sores. Because acyclovir lowers the amount of virus shed in an affected area, it's often referred to as suppressive therapy.

Acyclovir isn't necessarily the only antiviral therapy available. Research is in progress to develop other therapeutic interventions for HSV infection. Molecular interventions like the suppression of HSV-1 replication via gene editing have shown effectiveness in treating infection. While these treatment methods may not be fully developed and require more research before they're available for widespread public use, they point to a trend toward more complete care options in the future. Talk to your doctor about the best plan for you.

Necessary lifestyle changes

Beyond pharmaceutical help, daily changes in personal behavior can prevent and treat herpes. The following are some of the more effective lifestyle changes:

  • Avoid unprotected sex with your partner once you have been given a positive diagnosis. Communicate with your partner(s) that you have contracted herpes so they can get their blood tested for the virus.
  • Condoms can only protect so much. A meta-study analyzing condom use and the acquisition of HSV-2 found using a condom reduced the chances of catching the virus by 30 percent. If you feel an outbreak coming on, it's best that you refrain from having sex, even if you were intending to use a condom.
  • Practice good hygiene by washing your hands with antiseptic solution whenever you contact fluids from sores. Handwashing reduces your risk of reinfecting another region of your body or transmitting the virus to your partner.
  • Pay close attention to symptoms like tingling or burning sensations in your genitals, which often signal imminent outbreaks either for initial or recurrent infection.
  • Wear loose clothes and use a designated towel to clean the affected parts of your body after bathing during outbreaks. This can prevent the infection from spreading to other areas of your body.

Having herpes puts you at higher risk of contracting HIV, or human immunodeficiency virus. Being a carrier of genital herpes (HSV-2) makes a person up to three times more likely to contract HIV. Researchers long hypothesized this was because herpes sores were present on the genitals, but even with drug treatment to suppress outbreaks, the elevated risk of HIV remained for people with HSV-1 as well. Even after the skin healed, elevated numbers of the type of cell-surface receptors HIV needs to enter a person's T-cells were present. HIV replicates three to five times more rapidly in lab cultures in cells cultured from healed HSV-2 sores.

There's no cure for herpes, but suppressive treatment and smart lifestyle choices can reduce the severity of symptoms and lower the risk of transmission.