Why is Herpes So Confusing?

In the last 2 ½ years of my career as an OB/GYN, one thing has become particularly apparent… I diagnose genital herpes far more frequently than I ever thought I would.  Each time I do, there is often the need to explain the dynamics of herpes so that my patients (and/or their partners) don’t start second guessing the sanctity of their relationships.  I thought it would be interesting to blog a little about the basics of herpes to hopefully clear the air for many people. 

Herpes simplex virus, or HSV, or simply “herpes” to most people, is VERY common.  There are two flavors; creatively named Type-1 and Type-2.  Many also refer to these as oral and genital, respectively.  This nomenclature can be a bit confusing because genital herpes, while most often caused by the Type-2 virus, can also be a result of an infection with the Type-1 variety.  I recently read that AT LEAST 50 million Americans have had recognized genital herpes and that there are millions and millions more who have the virus (and can spread it), but have never had symptoms.  It is estimated that about 16% of adults in the United States carry HSV-2.  Studies have also shown that approximately 50% of adults also are positive for the HSV-1, which usually causes the common cold sore or fever blister.  If a person has a history of oral HSV-1 (or cold sores), this HSV infection can be passed to their partner’s genital area during oral sex.  The take home point here is that genital herpes is very, very, very (did I say very?) common.

Let’s break down the different types of genital herpes symptoms.  Herpes can be totally asymptomatic or it can be one of the most painful and worst genital infections out there.  It sometimes depends on whether this is truly your first outbreak, or is this just a recurrence of a previously asymptomatic infection.  Classic genital herpes presents with painful vesicular lesions, or small ulcers, on the genitals.  Sometimes you can get “viral” illness such as fevers, chills, etc.  If it is really severe , women can have very painful burning with urination.  If you think you have herpes, you should come into the office for us to verify the diagnosis (both by exam and cultures) and to initiate treatment.

Ok, so you have been diagnosed with genital herpes, and the questions start coming…

• Who gave me this? 
• How long have I had it?
• Can I pass it on?
• If I get pregnant can I have a vaginal birth or will I give it to my kid?

It is nearly impossible to know who gave someone herpes and when it happened.  And just because you get this for the first time (and let’s assume you are in a monogamous relationship and have been for some time), it DOES NOT mean that either of you were unfaithful.  You could have been asymptomatic for years even, and finally the virus decided to make an appearance.  Your partner could have been a carrier for YEARS and never known it, and may still have never had an outbreak, but could have spread the virus to you.  There is a chance that you passed it to your partner.  There are some blood tests which can determine if your immune system is responding to HSV 1 or 2 for the 1st time, but this still cannot determine exactly when you were exposed to the virus, and these results are often confusing.

Fortunately, if you get an outbreak, it is pretty easy to treat.  So let’s say you’ve been treated and now you and your partner are afraid to have unprotected sex because your partner does not want to risk getting herpes.  As I mentioned above, your partner may already have it and may have been the person who gave it to you.  Your partner may have blood work done, as mentioned above, to see if their immune system shows prior exposure to the same HSV (1 or 2) that has affected you.  If you both test positive for the same type of HSV, then there shouldn’t be any concern of “infecting” the other partner.  If neither of these are true, then there is a chance, that over time, you shed virus and your partner gets an infection.  The frequency of this viral shedding depends on the type of virus you have and also how close you are to an outbreak.  It is difficult to quantify this as a “percentage chance” for you.

If you are pregnant, or plan to become pregnant, and have had genital herpes, you can still have a vaginal birth.  The only situation that would disqualify you from this opportunity is an active outbreak at the time of labor.  An active genital HSV outbreak at the time of labor puts the baby at highest risk for contracting a dangerous systemic HSV infection.   We routinely prescribe HSV prophylaxis (meaning we give you a daily treatment of Valtrex to prevent an outbreak near delivery) beginning at 36 weeks gestation to those with a history of genital herpes.

I hope I cleared this up a little… but it is still super confusing huh?  Here are the take home points:

• Genital herpes can be caused by Type-1 or Type-2 HSV
• If you get painful little ulcers on your vagina, come in and see us to get proper diagnosis and treatment.
• Most likely neither you nor your partner were unfaithful if one of you gets an outbreak, as either of you could have been a carrier for many, many years.
• If you get pregnant and have had herpes, you can have a vaginal birth as long as there is not an ongoing outbreak.

http://www.kmobgyn.com/blog/entryid/246/why-is-herpes-so-confusing

Herpes simplex: Signs and symptoms

    Herpes simplex: If a person has HSV-1, a bad sunburn can trigger a herpes simplex outbreak.

         Herpes simplex: Outbreaks usually develop around the mouth or on the genitals, but the sores can appear almost anywhere on the skin.

Many people who get the virus that causes herpes never see or feel anything. If signs (what you see) or symptoms (what you feel) occur, a person may experience:

• Tingling, itching, or burning: Before the blisters appear, the skin may tingle, itch, or burn for a day or so.


• Sores: One or more painful, fluid-filled blisters may appear. Blisters break open and often ooze fluid and form a crust, before healing. The first time sores appear, they will show up between 2 and 20 days after a person has contact with an infected person. The sores can last from 7 to 10 days. Where the sores appear often varies with type:
  
  
  • Oral herpes (HSV-1): Most blisters appear on the lips or around the mouth. Sometimes blisters form on the face or on the tongue. Although these are the most common places to find oral herpes, the sores can appear anywhere on the skin.
  • Genital herpes (HSV-2): Sores typically occur on the penis, vagina, buttocks, or anus. Women can have sores inside the vagina. Like oral herpes, these sores can appear anywhere on the skin.
• Flu-like symptoms. Fever, muscle aches, or swollen lymph nodes (glands) in the neck (oral herpes) or groin (genital herpes) are possible.
• Problems urinating. People (most often women) with genital herpes may have trouble urinating or have a burning feeling while urinating.
• An eye infection (herpes keratitis). Sometimes the herpes simplex virus can spread to one or both eyes. If this happens, you can have pain, light sensitivity, discharge, and a gritty feeling in the eye. Without prompt treatment, scarring of the eye may result. Scarring can lead to cloudy vision and even loss of vision.
  
  If you develop signs and symptoms of herpes simplex, you can expect to have these for as long as listed below:
  
  
  • Oral (mouth) herpes: 2 to 3 weeks
  • Genital herpes: 2 to 6 weeks (the first outbreak)

Learn more about herpes simplex:

• Herpes simplex
• Herpes simplex: Who gets and causes
• Herpes simplex: Diagnosis, treatment, and outcome
• Herpes simplex: Tips for managing

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides. 

http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/herpes-simplex/signs-symptoms

Genital Herpes

Source: http://www.medicinenet.com/

What causes genital herpes?

The herpes viruses enter the skin or mucous membrane through tiny, even microscopic, breaks in the tissue. Because an infected person may transmit the disease even when he or she does not have signs or symptoms of herpes, avoiding sexual contact with someone with active blisters does not guarantee protection against the infection.

Individual outbreaks of herpes vary among affected people in terms of their frequency and severity. Outbreaks can be related to the function of the immune system and are typically worse in cases in which the immune system is suppressed; for example, at times of physical or emotional stress, during illness, or when you are taking certain medications.

How is genital herpes transmitted?

HSV infection is transmitted by direct person-to-person contact. Genital herpes is acquired through sexual contact of any type that involves contact with the genital areas. Genital herpes can also be caused by mouth to genital contact with a person who has cold sores or herpes infection of the mouth. Transmission from an infected male to a female partner is more likely than transmission from an infected woman to a male partner.

What are the signs and symptoms of genital herpes?

In women, genital herpes usually causes blistering lesions on the vulva and around the vaginal opening that progress to ulcer formation. The infection spreads to involve the cervix in most cases, leading to cervicitis (inflammation of the cervix). In some women, cervicitis may be the only sign of genital herpes infection. Infection and inflammation of the urethra accompanies the infection in some women, leading to pain on urination.Many people infected with genital herpes have mild symptoms or symptoms that are mistaken for another condition. It is also possible to be infected and have no symptoms, so not everyone who is infected may be aware of the infection. When symptoms are present, they consist of typically painful blisters around the genital or rectal area. The blisters break open, form ulcers, and take 2 to 4 weeks to heal. With the first outbreak of genital herpes, a person may also experience flu-like symptoms including fever, body aches, and swollen lymph nodes. Immediately prior to an outbreak, there may be an itching, burning, or tingling sensation of the skin.

After the initial infection, a person typically has outbreaks later in life.

STD Symptoms In Men - Common Symptoms of STD's In Men

Herpes simplex: Who gets and causes

Source: nonprofitstdtesting.org

Who gets herpes simplex?

Most people get HSV-1 (herpes simplex type 1) as an infant or child. This virus can be spread by skin-to-skin contact with an adult who carries the virus. An adult does not have to have sores to spread the virus.

A child can get this virus from an infected adult. A kiss, eating from the same utensil, or sharing a towel can spread the virus.

A person usually gets HSV-2 (herpes simplex type 2) through sexual contact. About 20% of sexually active adults in the United States carry HSV-2. Some people are more likely to get HSV-2. These people:

• Are female.
• Have had many sex partners.
• Had sex for the first time at a young age.
• Have (or had) another sexually transmitted infection.
• Have a weakened immune system due to a disease or medicine.

What causes herpes simplex?

Herpes simplex viruses spread from person to person through close contact. You can get a herpes simplex virus from touching a herpes sore. Most people, however, get herpes simplex from an infected person who does not have sores. Doctors call this “asymptomatic viral shedding.”

How people get herpes around their mouthA person with HSV-1 (herpes simplex type 1) can pass it to someone else by:

• Kissing.
• Touching the person’s skin, such as pinching a child’s cheek.
• Sharing objects such as silverware, lip balm, or a razor.

How people get herpes on their genitalsYou can get genital herpes after coming into contact with HSV-1 or HSV-2. Most people get genital herpes from HSV-2, which they get during sex. If someone has a cold sore and performs oral sex, this can spread HSV-1 to the genitals — and cause herpes sores on the genitals. 

Mothers can give the herpes virus to their baby during childbirth. If the baby is born during the mother's first episode of genital herpes, the baby can have serious problems. 

What happens once you have HSV-1 or HSV-2?Once a person becomes infected with a herpes virus, the virus never leaves the body. After the first outbreak, the virus moves from the skin cells to nerve cells. The virus stays in the nerve cells forever. But it usually just stays there. In this stage, the virus is said to be dormant, or asleep. But it can become active again.

Some things that can trigger (wake up) the virus are:

• Stress.
• Illness.
• Fever.
• Sun exposure.
• Menstrual periods.
• Surgery.

Lean more about herpes simplex:

• Herpes simplex
• Herpes simplex: Signs and symptoms
• Herpes simplex: Diagnosis, treatment, and outcome
• Herpes simplex: Tips for managing

Top 10 Herpes Facts (Sex Health Guru Tip)

Herpes

Source: http://www.bodyandsoul.com.au/health

Herpes is a common contagious viral infection that is easily spread through kissing and sex.

Herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV) that cycle between periods of active disease – presenting as infectious blisters – that last 2–21 days, followed by a remission period, during which the sores disappear.

There are two types: HSV1 and HSV2. HSV1 is usually found around the lips and mouth and is commonly known as cold sores; HSV2 more typically infects the genital and anal areas although either HSV1 or HSV2 can occur on either the lips, mouth, genital or anal areas.

Herpes enters the body through the skin of the genitals, mouth and anus, or through tiny cuts and abrasions in the skin anywhere on the body and you can develop symptoms days, weeks or even months after infection or not at all.

When the blisters occur they become itchy then burst to become painful ulcers that then heal by themselves about a week after the outbreak. Some people may only ever have one outbreak of symptoms, while other people have outbreaks throughout the remainder of their lives.

A doctor will either diagnose you through observing the blisters or through a blood test.

There is no cure, you will have herpes for life, but there are anti-viral drugs and ointments that help reduce the severity of outbreaks. Keeping the area dry, bathing ulcers salt water and taking paracetamol for the pain helps too.