Herpes Simplex Is More Complex Than You Might Think

Herpes simplex virus (HSV) infections are common. It's estimated that between 50 percent and 80 percent of adults in the United States have oral herpes, which can present as cold sores and fever blisters in or around the mouth. There is no cure for this virus, as the infection is lifelong and its symptoms may recur for years.

"Herpes is a sexually transmitted infection or STI," explained Monty Swarup, M.D., FACOG, board-certified in OB/GYN in Chandler, Arizona and the founder of HPD Rx. "There are two types of herpes: HSV-1 and HSV-2. HSV-1 is oral herpes but can lead to HSV-2, known as genital herpes."

About 12 percent of people between the ages of 14 and 49 have an HSV-2 infection, according to the Centers for Disease Control and Prevention (CDC). Although the prevalence of HSV-1 has dipped in recent years, every age group may have become more susceptible to HSV-2 infections.

The two types differ in how they are spread. HSV-1 generally spreads through saliva or skin contact, while HSV-2 is passed on through sexual contact. HSV-1 is usually contracted during childhood and presents as fever blisters or cold sores.

Herpes risks and causes

Herpes generally doesn't cause serious medical concerns, according to Swarup, but genital herpes increases the chance of contracting HIV (human immunodeficiency virus). Other infections associated with HSV-1 include conjunctivitis (pink eye), keratitis (inflamed cornea) and herpetic whitlow (finger or thumb lesion), according to "Vaccines for the 21st Century: A Tool for Decisionmaking" a book published in 2000.

The CDC noted that the herpes virus is transmitted through contact with infected herpes lesions, mucosal surfaces, genital secretions or oral secretions.

"Contact with an infected person's skin causes herpes," Swarup explained. "The HSV then stays in the body, causing sores and blisters, and travels throughout the body through nerve cells."

There are many ways contact can happen. Receiving oral sex from someone with oral herpes can result in transferring the infection, but it will not turn into genital herpes.

The major risk of herpes is transferring it to someone else, which can often happen without the spreader knowing they have it, which means they cannot warn their partners. Since herpes spreads by direct contact with the skin, whether sexual or not, it spreads quickly.

"Herpes spreads by direct contact with another person with herpes sores, although it can be [spread from] skin with no sores," Swarup said. "HSV usually spreads by oral, vaginal or anal sex."

People most at risk for herpes complications are pregnant people, because a flare-up during pregnancy increases the risk of premature labor, according to Yale Medicine. The baby can also get an infection in the womb.

What does herpes look like?

Generally, herpes is an invisible infection. It can lie dormant in your body for years at a time. During a flare-up, the physical manifestation of herpes can present as white, yellow or red translucent sores or bumps. These bumps fill with a clear liquid and are usually uneven and not uniform in size or shape. Some genital herpes outbreaks present as internal sores, so while the outbreak isn't visible, it is present and painful.

Since the symptoms are usually brief or nonexistent, if you're concerned, seek a primary care physician or gynecologist to get tested.

What the research says

Herpes has been a topic of many studies over past decades, but recent research could be the most groundbreaking.

A herpes vaccine could be on the way soon

Currently, there are no authorized or approved herpes vaccines in the U.S., but that could change. The World Health Organization (WHO) and the National Institutes of Health (NIH) are working together with updated information on current herpes vaccine clinical trials and have viable vaccine candidates for HSV-1 and HSV-2.

Research on herpes vaccines has been around since the 1930s, but despite the long history of trials, none have made it to market. One of the main reasons is that the virus can be dormant in someone's body for years, which means it's hard to detect the origin point, a huge marker for developing a vaccine.

Looking for a cure

Herpes has one of the most complicated DNA sequences of any virus, a reason it's been difficult to develop a vaccine and more effective treatment options.

One of the teams leading genome research is the Jerome Lab at the Fred Hutchinson Cancer Center in Seattle. Its research focuses on creating a way to disable latent viral genomes via gene therapy, or in simpler terms, prevent the HSV virus from being able to replicate.

In 2020, the center announced successful steps toward destroying up to 95 percent of herpes virus in certain nerve clusters of mice.

"This is the first time that anybody has been able to go in and actually eliminate most of herpes in a body," said Keith Jerome, M.D., Ph.D., in a 2020 news release. "It is a completely different approach to herpes therapy than anybody's ever had before."

Cow mucus could be the key to preventing herpes transmission

Research by the KTH Royal Institute of Technology in Stockholm indicated that cow mucus may be the basis for a synthetic prophylactic gel to protect against herpes transmission.

The lubricant gel proved 70 percent effective in lab tests against HIV and 80 percent effective against herpes. The study also found that this gel doesn't run the same risk of resistance as other antivirals, meaning it could be a long-term option for herpes treatment.

The study explained that in the body, mucin molecules can bind to and trap virus particles, which are then cleared through active mucus turnover. The synthetic gel replicates this self-healing function.

Editor's note: This report is part 1 of a four-piece introduction and continuing update focusing on the herpes simplex virus. You can find other parts of this series coming this week:

1. Herpes Simplex Is More Complex Than You Might Think
2. Herpes: Symptoms, Diagnosis and Treatments
3. Herpes: Complications, Costs and Your Reproductive Health
4. Herpes: Living, Dating and Thriving