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: 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

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.