People shamefacedly whispered questions about it in locker rooms 25 years ago; nowadays, ads for herpes medication showcase happy people riding bicycles into the sunset. What’s changed? Knowledge, new medications, and promise of even better therapies in the future. Here’s what you need to know.
What is Herpes?
Herpes is a virus, causing sores in whichever part of the body it infects. There are several viruses in the herpes group, including one best known as the cause of chicken pox and shingles, Herpes Zoster. Genital herpes comes from the Herpes Simplex virus. There are two types of Herpes Simplex, 1 and 2.Type 1 is usually the “above-the-waist” type, causing blisters and sores around the mouth. This type is very common; better known as “fever blisters” or “cold sores,” it is spread through saliva. More than half of the U.S. population is infected as children, and many never have any symptoms. For most people, it isn’t a sexually transmitted disease. When type 1 is sexually transmitted, the symptoms are generally milder than type 2, and recurrences are less likely.Type 2 is the “below-the-waist” culprit, generally responsible for genital symptoms (see How do I know if I have it? below). This type is generally more severe, and also more likely to recur. Although the type 1 “above” and type 2 “below” the waist pattern is the most common, it isn’t quite that simple; either type can affect either location.
How does Herpes spread?
Despite popular myths, herpes isn’t spread through contaminated toilet seats or towels. The virus spreads with skin-to-skin contact, and sexual contact causes the overwhelming majority of genital cases. Someone with herpes can infect others most easily during the early part of an outbreak; but he or she may also pass along herpes when there are no symptoms or visible sores.Even after apparent healing, herpes hides in nerve cells close to the infected body part and periodically comes to the skin surface. This is called asymptomatic viral shedding, and is more common in the first six months after initial infection. After six months, asymptomatic shedding occurs on 5 to 20 percent of days.Herpes has spread widely because of this asymptomatic shedding, and because many infected people are symptom-free and don’t realize they are infected and contagious.
How can I tell if I have Herpes?
Herpes generally starts as small red bumps, often with a clear head like a small bubble or blister. The blisters later burst, leaving small, and usually very painful, open sores. Eventually the sores crust over and heal without leaving scars. Many people have pain, burning, or itching in the area, which can start before the sores appear.Two important points to remember:
A large number of those with herpes either have no symptoms, or such mild symptoms that they never know they are infected.
There are other diseases, some of which are sexually transmitted, that can also cause small sores.
The best way to tell if you have herpes is to get tested within the first 48 hours of any suspicious rash or bumps. Simple medical examination can diagnose herpes when the appearance is classic, but all herpes infections don’t look the same. This means examination isn’t always reliable. Not all sores are herpes, but you won’t know until you’re tested - so if you have sores, get them checked! Go early, preferably within 48 hours; once the sores are open the virus starts to die, so tests may not be accurate.Right now there is no perfect test for herpes. There are several tests available; each has advantages and disadvantages.
Testing from swabs of the sores:
Viral cultures are very accurate when they are positive for herpes, but at times they will falsely say that herpes is not present. Cultures are most accurate early in the outbreak, while the sores still look like small blisters. Cultures take seven to ten days for results.
The FA or fluorescent antibody test is slightly less accurate at finding positive results, and has the same problem as a culture with false negatives. It is faster than a culture, giving a result within 2 or 3 days. Like cultures, this test is most accurate early in the outbreak.
Another test, PCR, is extremely accurate but also extremely expensive. Currently, doctors use this test in the rare cases of life threatening infections that could be caused by herpes. This type of severe infection mainly happens in people with damaged immune systems, such as those undergoing cancer chemotherapy.
Blood tests
There are two kinds, type specific, and nonspecific. A nonspecific test isn’t very helpful, since it will show positive for either type: HSV-1, a common infection from childhood, and HSV-2. Type-specific tests report which type of HSV is present. Most newer tests are type specific. Blood tests are very accurate, but only after 12 to16 weeks of infection.
What Happens When Someone Is Infected?
The first episode after contracting herpes is called the primary infection. This usually lasts longer and causes more intense symptoms than do recurrences. Despite this, about three quarters of the time infected people don’t know they have herpes because the symptoms are so mild. In general, women experience more severe symptoms than men.Infected people may notice symptoms in the genital area: the penis and scrotum in men; the vaginal lips (labia) in women; and, for both sexes, the thighs, around the anus, and on the buttocks. Herpes may cause intense pain even before sores develop; some people feel itching or burning rather than pain. On average, sores appear from two days to two weeks after initial infection. There may also be vaginal or penile discharge, and swollen glands (lymph nodes) in the groin. Occasionally both men and women may have painful urination. A person with primary herpes infection may also notice more general symptoms such as fever, body aches, headache, nausea, and fatigue. The sores of primary infection last about two weeks.Repeated episodes of herpes, called recurrences, are most frequent during the first three months after the primary infection. Some people do not have recurrences; for others, recurrences may grow less frequent and less severe with time. For many, recurrence means sores with pain and itching that are similar to, though milder than, the primary infection. Most recurrences don’t involve the more general symptoms of fever, body aches, and nausea common with the first episode. Recurrences can be triggered by such diverse factors as fever, trauma, emotional stress, sunlight, and menstruation, and last nine days on average.
If I Have Herpes, What Can I Do About It?
Until medical science comes up with a cure, the virus is forever. After the initial infection, herpes remains in nerve cells, and may periodically reactivate to cause an outbreak. It sounds bleak, but while there isn’t a cure, there are treatments that can prevent or shorten outbreaks and may make a big difference in your life. The mainstay of treatment is antiviral drugs. As of 2005, Acyclovir (Zovirax, generics), Valacyclovir (Valtrex), or Famcyclovir (Famvir) are FDA approved for genital herpes. These medications are all very similar and side effects are usually minor, if any.Acyclovir was the first drug developed for herpes. Since there are generics available, this is the least expensive choice. Initially, it was inconvenient, requiring five doses a day. Newer dosing schedules are more convenient, as are those of Famcyclovir and Valacyclovir. All three are used for treating episodes of herpes, or suppressive therapy.Suppressive therapy means taking the drug continuously to decrease or avoid outbreaks. Such therapy will reduce how often outbreaks occur by 70 to 80 percent. Infected individuals should make a decision about suppressive therapy with their doctor, based on how frequent the episodes are, how severe the episodes are, the person’s other health conditions, and whether the person’s partner is infected.Creams and ointments are not considered helpful for genital herpes, and medical authorities don’t recommend them.
Preventing Herpes
Someone with herpes can infect a partner even when no sores are visible, though it is much more likely to occur when sores are present. Using a latex condom helps, but there is still skin contact in areas the condom doesn’t cover. The only perfect prevention is to abstain from sex, or to know that your partner is negative for herpes, and then have sex only with that partner. If you are sexually active without a regular partner, there are still ways to lessen the risk of getting herpes. Similarly if you have herpes, there are ways to decrease the chances of passing it on to your partner. The first, and most important, step is communication with your partner. At the end of this article are some resources to help you plan your talk. If you are both informed, you can best choose strategies to lessen the risk.
Abstain during high-risk times
When someone has cold sores or fever blisters around the mouth (oral herpes), she or he should not perform oral sex until all sores are completely healed. (They are healed when the scab has fallen off and new skin has formed where the sore was.)
When someone has blisters or a rash that could be herpes around the genitals, he or she should not have sexual activity until all sores have completely healed.
If you have herpes you should avoid sexual contact from the time you first feel any symptoms until the sores are completely healed.
Condoms or barriers
When there are no symptoms present around the mouth, using a barrier or condom when performing oral sex can reduce the risk of contracting genital herpes.
When there are no symptoms present in the genital area, using latex condoms reduces the risk of getting herpes. Though smaller, the risk still exists since areas of the skin still touch.
Suppressive therapy
Taking medication for herpes outbreaks regularly, every day whether or not there are symptoms, decreases the number of recurrences. It’s also been shown to reduce the risk of herpes transmission by 50 percent.
It’s likely that a combination of suppressive medication and condoms provides greater protection than either method alone.
Preventing other problems:
Although it is rare, someone with herpes can spread it to other parts of the body, or to other people without sexual contact. To avoid this:
Keep the infected area clean and dry to prevent other infections from developing in the open sores.
Don’t touch the sores.
If you can’t avoid touching the sores, wash your hands immediately afterwards.
Wash your hands before physical contact with other people, especially young children, the elderly, or those with immune system problems.
Is Herpes Ever Dangerous?
Although herpes is annoying and painful, it rarely poses a danger to people in good health. However, when the immune system doesn’t respond normally or at all, herpes can be dangerous. This can occur with AIDS, cancer chemotherapy, certain medications, and some rare genetic disorders. Herpes is also a problem for pregnant women, since the infection can pass to the unborn baby. Primary infections pass to newborns at a much higher rate than recurrent infections, but either can kill newborns or leave them with damage to the nervous system (such as seizures and mental retardation). In less serious instances, babies may have an outbreak of herpes on the skin, but no other problem. If you are pregnant and know you have herpes, be sure to tell your obstetrician, as you will need careful monitoring. Medication or caesarean section delivery can reduce the chances of infecting the baby.
The Future of Herpes Treatment
The best answer to herpes is prevention, and the best widespread prevention is likely to be a vaccine. Researchers have several possible vaccines in development; none to date are 100 percent effective, but some are promising. Research continues on vaccines, and on new drugs for treatment.Remember, right now the best prevention is to know your partner and his or her status with respect to herpes. The best treatment plan involves your doctor and your partner. Communicate!
Some useful links :
Tips for telling your partner about herpes from
Herpesweb, University of California at Santa Barbara, Menstuff, and the Famvir site.General Information on Herpes from
National Institutes of Health and Center for Disease Control.