Herpes
Facts
The Herpes Virus Family
There are eight herpes viruses currently known to infect humans.
The most common are herpes simplex virus type-1 (HSV type-1) commonly
associated with cold sores or fever blisters and occasionally genital
herpes, and herpes simplex virus type-2 (HSV type-2), most commonly
associated with genital herpes and occasionally oral infection.
Herpes simplex viruses are contagious and are transmitted through
physical contact. Herpes is not a life-threatening disease, but
it is a lifelong disease and symptoms can recur at any time.
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Genital Herpes Symptoms
Most people with genital herpes are unaware that they have the
disease because they never have symptoms or do not recognize them.
When they do occur, the severity of the symptoms vary from person
to person. First episode symptoms of genital herpes can appear
within 2 to 10 days of infection and last an average of 2 to 3
weeks. In many people, the first infection may be so mild that
it goes unnoticed. In other people, painful sores may appear at
the site of infection. Other symptoms can include tingling, an
itching or burning sensation; pain in the thighs, buttocks, or
genital area; vaginal discharge; a feeling of pressure in the abdominal
area; flu-like symptoms (which may include swollen glands, headache,
muscle ache or fever;) and painful or difficult urination. Genital
herpes symptoms are sometimes mistaken for simple skin irritation,
jock itch, razor burn, or a yeast infection.
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Transmission
Herpes simplex viruses are transmitted through physical contact.
Avoid sexual contact (vaginal, anal or oral) or kissing when lesions
are present. Avoid touching lesions, as herpes infection may be
transferred from one area of the body to another in this way. If
you do touch them, wash your hands thoroughly afterwards. Genital
herpes infection can be spread even when there are no visible signs
of outbreak. Small amounts of virus can be shed even when a person
has no symptoms. This is called asymptomatic viral shedding. About
70% of people get herpes from a partner that does not have symptoms
at the time they transmit the disease. Using condoms during sexual
intercourse may help prevent the spread of infection. Medication
is available that may shorten the length of outbreaks and also
suppress the virus’ ability to reproduce, and may also reduce
the risk of transmission.
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Pregnancy
Women with herpes can have healthy babies. However, a woman who
develops a first episode of genital herpes during pregnancy or
has an active outbreak at the time of delivery can pass on the
infection to her newborn. The risk of passing herpes on to your
baby is greatest if you acquire HSV near or at the time of labor
or have an outbreak at the time of delivery. Cesarean section
can be done to reduce the possibility of transmission of infection
to the baby during birth. It is important to take precautions to
prevent becoming infected with herpes during pregnancy. If you
are pregnant and your partner has known or suspected genital herpes,
you may already be infected and not know it. You may want to request
a HSV type-specific blood test from your healthcare provider to
determine if you have been exposed to genital herpes. You can discuss
ways to minimize the risk of transmission to your baby with your
healthcare provider.
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Recurrences
After the initial infection, the herpes virus remains inside nerve
cells in an inactive, latent state. In most people, the virus reactivates
from time to time and can cause new lesions to appear near the
site of the original outbreak. The virus can also reactivate without
causing any visible symptoms. During this time, small amounts of
virus can be shed and can infect a partner (asymptomatic viral
shedding.) Symptoms of recurrent episodes are usually milder than
initial outbreaks and usually of shorter duration. The frequency
and severity of recurrences vary greatly.
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Relationship to HIV
To date, over 30 studies have determined that the risk for HIV
acquisition among persons with HSV type-2 is fairly high – as
much as double that of a non-HSV type-2 infected individual. HSV type-2 has
a different natural history among HIV-infected persons. Those individuals
that have both infections have more frequent HSV type-2 activations,
at much higher rates of shedding. Finally, there are some data
that HSV type-2 is associated with increased HIV plasma levels in people
who have both infections.
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Key Herpes Facts and Statistics
Transmission of the disease:
- 1 in 6 people worldwide have genital herpes caused by HSV type-2.
- HSV type-2 infects more than 1 of every 5 people in the US
- About 70% of people contracting herpes get it from a partner
who is unaware they have it at the time they transmit the disease.
- Both HSV type-1 and HSV type-2 can cause genital infection.
- Genital herpes can be transmitted by genital or oral sex (cold
sores).
- Viral shedding in the absence of symptoms can transmit infection.
- Transmission of herpes can occur within committed long-term
relationships and in people who have never had penetrative sex
through close genital contact or oral-genital contact.
- Condoms reduce the risk of transmission, but it is also advisable
to avoid skin to skin contact when lesions are present.
- HSV type-2 infection increases the risk of HIV infection.
Diagnosis:
- Up to 90% of all HSV type-2 infections go unnoticed or undiagnosed
because of mild or absent symptoms.
- Up to 20% of first episodes are actually reactivation of previously
latent infection rather than recently acquired primary
infection.
- HSV culture can frequently give false negative results.
- Accurate, type-specific serology tests can detect asymptomatic
infection.
Recurrences:
- People who experience a first episode will get better. Lesions
will heal and recurrences will usually be less severe.
- HSV type-2 may reactivate more frequently than HSV type-1.
- Antiviral treatment can minimize and/or prevent HSV outbreak.
Pregnancy:
- Genital herpes does not cause cervical cancer or affect fertility.
- First episode genital maternal HSV infection poses a threat
to the baby.
- Neonatal herpes is serious but rare.
- Women with genital herpes can have a safe pregnancy and vaginal
delivery.
- New infections need close medical follow-up.
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