Herpes

Herpes is a common and incurable sexually transmitted disease (STD). It is caused by the herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). A majority of oral herpes cases are caused by HSV-1 and a majority of genital herpes cases are caused by HSV-2. Many people may be unaware they are infected, because symptoms can often be mild or confused with other conditions. Once the symptoms have gone away, they can reoccur in episodes through out an infected person’s life. Unlike other common viral infections, once HSV-1 or HSV enters the body, it lives there forever.

Reporting

Genital herpes infections are very common in the United States. According to the Center for Disease and Control (CDC), there are at least 45 million people ages 12 and older who have had a genital herpes simplex virus (HSV) infection. That is one out of every five people. (source)

Herpes simplex virus type 2 (HSV-2) infections of the genitals are more common in women (about one out of four) than men (about one out of five), because male to female transmission has a higher chance of infection than female to male transmission.

Oral herpes infections are even more common, infecting 50% to 80% of all adults in the United States.
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Transmission

Most cases of genital herpes are caused by having vaginal or anal sex. Transmission occurs when the mucous membranes (the moist layer of tissue lining the respiratory, digestive, urinary, and reproductive tracts) primarily of the mouth and genitals or a cut or abrasion in the skin comes into contact with a contagious area. Contagious areas can have sores or lesions caused by the virus on them or have no visible symptoms.

Genital herpes can be transmitted to the mouth during oral sex, although this is not likely, because most genital herpes infections are caused by the herpes simplex virus type 2 (HSV-2) and HSV-2 rarely affects the mouth. Reversely, oral herpes (cold sores or fever blisters) can be transmitted to the genitals during oral sex, although it is also not likely, because most oral herpes infections are caused by the herpes simplex virus type 1 (HSV-1) and HSV-1 rarely affects the genital area. Oral herpes can also be transmitted during kissing.
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Symptoms

Symptoms are different for genital herpes and oral herpes.

Most people who have genital herpes will be unaware they are infected, because they might not have any symptoms, symptoms could be mild, or they could be mistaken for another condition. When symptoms do occur, they come in episodes (also called outbreaks or attacks).

The first episode usually occurs within two weeks after being infected, although it can take weeks, months, or years. This episode will usually be a lot worse than later ones. Symptoms of it can be sores or lesions around the genital areas (penis, vagina, thigh, anus, or buttocks) that look like little pimples or blisters. They will scab over and take two to four weeks to fully heal. Some people can experience more sores or lesions during this time. If these sores or lesions are mild, they could be mistaken for abrasions, yeast infections, insect bites, jock itch, or other conditions. Other symptoms include a flu like illness or a feeling of being unwell, backache, headache, fever, pain when passing urine, and swelling of the glands, particularly near the lymph nodes in the groin area. These other symptoms usually only occur during the first episode.

Once the first episode has cleared up, reoccurring episodes can occur. Herpes simplex virus type 2 (HSV-2) infections of the genitals usually cause four to five episodes a year. Herpes simplex virus type 1 (HSV-1) infections of the genitals usually cause less than one episode a year. More episodes tend to occur in the first year and some people will find their episodes become less severe and frequent over time.

An itching, tingling, or painful feeling will often come before a reoccurring episode of genital herpes. One to two days after the feeling, sores or lesions appear. They can be milder and resemble razor burn, insect bites, a pimple, hemorrhoids, an ingrown hair, or a red dot.

Most people who have oral herpes will also be unaware they are infected, because they might not have any symptoms, the symptoms could be mild, or the symptoms could be mistaken for another condition. When symptoms do occur, they also come in episodes (also called outbreaks or attacks).

As with genital herpes, the first episode of oral herpes is usually the worst. Symptoms of the first episode can be sores or lesions (usually forming as small fluid filled blisters) occurring as a single blister or a cluster of them on the lips, inside the mouth, on the tongue, or on the back of the throat. They can also occur inside the nose, on the chin, or on the cheek (called oral-facial herpes when this happens). If these sores or lesions are mild, they could be mistaken for bug bites, chapped lips, a crack or cut in the skin, or a pimple. Another symptom that usually only occurs during the first episode is swelling of the lymph nodes in the neck.

An itching, tingling, or painful feeling will often come before a reoccurring episode of oral herpes. One to two days after the feeling, sores or lesions will occur as a blister or cluster of blisters. As with the first episode, the blisters can be mild and mistaken for bug bites, chapped lips, a crack or cut in the skin, or a pimple. The frequency of the reoccurring episodes varies from person to person, but tends to decrease over time.
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Testing / Diagnosis

Laboratory tests are used to diagnose herpes. Testing is done on a culture taken with a swab from a sore or lesion or blood sample. It may be helpful to speak to a health care provider to find out what testing options are available.
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Treatment

Herpes can not be cured. However, the anti-viral drugs Zovirax® (acyclovir), Valtrex® (valacyclovir), and Famvir® (famciclovir) can help reduce the frequency of reoccurring episodes of genital and oral herpes. They can also help speed the healing process when an episode does reoccur. There are also ointments that can help treat the symptoms of an episode. A health care provider can recommend which of these treatment options is best.

Other forms of treatment that could help include taking a painkiller (aspirin or paracetamol) if an episode causes pain, wearing loose fitting clothing so air can get to areas with sores and lesions, bathing sores and lesions in a salt solution twice a day to sooth and dry them out faster, placing an ice-pack on the affected areas, passing urine in a warm bath if it is painful to do otherwise, drinking plenty of fluids, and getting plenty of rest.
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Complications

Most people with herpes will not have any major complications. The worst that usually occurs are the painful sores and lesions that come during a reoccurring episode, although people with weakened immune systems can experience more severe symptoms from the episodes. However, regardless of how severe the symptoms are, many people with herpes will suffer from psychological distress. Seeking out a qualified therapist or support group can help in dealing with this distress.

Besides psychological distress, herpes makes acquiring Human Immunodeficiency Virus (HIV) more likely. People with open sores or lesions are more likely to acquire HIV if exposed to HIV during sexual activity. People with herpes and HIV are also more likely to transmit both diseases during sexual activity because the open sores and lesions have an increased amount of the virus in them.

A pregnant woman who is infected and experiencing her first episode of genital herpes could transmit the virus to her baby during birth, causing neonatal herpes. Neonatal herpes can cause lasting damage to a baby’s central nervous system, mental retardation, or death. If drugs are given early enough, they can help reduce or prevent lasting damage, but the infection can still have serious consequences. Fortunately, the chances of the virus actually being transmitted to the baby are very low.
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Prevention

Abstaining from sexual contact can prevent the transmission of herpes. A mutual monogamous relationship with a trusted partner known to be tested and uninfected is another way.

Correctly using latex condoms during vaginal or anal sex can reduce the risk of transmission. Correctly using a condom can also reduce the risk of transmission during oral sex (mouth to penis). For other forms of oral sex (mouth to vulva, the outer female genital area, or oral to anal, also known as rimming) using a dental dam, plastic wrap, or a latex condom cut up and opened flat are also risk reducers. However, a condom or other form of protection may not cover all lesions or sores and the virus could still be transmitted. It is also important to remember that herpes can be transmitted when there are no sores or lesions visible.

People who share sex toys should place condoms on them, switching to a new condom when the toy goes from one person to another. People should also wash their hands after handling the sex toys or if their hands come in contact with a sore or lesion.

Those who are infected and experiencing an episode should tell their sexual partner(s) and refrain from any sexual activity until the episode has healed.
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