Getting a Handle on Herpes
The seriousness of the herpes virus has been overshadowed by the HIV/AIDS virus. But 500,000 Americans contract herpes every year, adding to the estimated 40 million Americans who already have it, and many of them don't even know it.
Contrary to popular belief, herpes doesn't always cause major symptoms, in some cases it may not cause any symptoms at all, according to Marshall Glover, director of the National STD (sexually transmitted disease) Hotline at the American Social Health Association (ASHA).
"People think that if you have herpes you are broken out all the time. In reality, the body's immune system does a good job at handling the infection."
What Is Herpes?
Herpes is caused by the herpes simplex virus (HSV). The first symptom that people with herpes are likely to notice is a cold sore-like lesion. If the lesion is on the mouth, lips, or face, the culprit is more likely to be herpes simplex Type 1 (HSV-1). If the lesions are in the genital or anal area, the culprit is likely herpes simplex Type 2 (HSV-2). While there is some crossover between HSV-1 and HSV-2 due to oral-genital sex, HSV-2 is usually the more uncontrollable and painful of the two viruses.
The virus lives in nerve cells and "creeps" along the course of the nerves to reach the skin surface, once in a while causing the characteristic sores and blisters. In fact, the word herpes is derived from the Greek word for "creeping." The main difference between HSV and many other common viruses is that HSV establishes a permanent presence in the body. This means that the virus can cause symptoms even if it remains dormant for long periods of time. Recurrent attacks may either be rare, occurring only once a year, or so frequent that they seem continuous. Recurrence can be triggered by many things, including irritation, menstruation, fatigue, and sunburn, and are usually milder and of shorter duration than the initial infection.
Laboratory tests can determine whether an infection is indeed herpes: a skin culture taken from an active sore is the most direct and accurate test. Alternatively, a blood test can detect the presence of antibodies to HSV-2. Such antibodies are evidence of previous exposure, but they do not establish that current symptoms are due to the HSV-2 organism. Like other viruses, there is no cure. However, there are medications to ease the symptoms, and a herpes vaccine may be available soon.
The first symptom of HSV-2 infection is a tingling or itching sensation in the genital area (called the prodromal phase), which may then be followed by sore red bumps that turn into blisters. In women, the sores usually occur on the vulva or around the anus, and in men on the head and shaft of the penis. Without treatment, the sores form scabs and heal in a few days. In addition to having a cold sore-like lesion some patients may experience painful and enlarged lymph nodes, headaches, and fever.
How Is It Treated?
There are medications for treating herpes that alleviate symptoms and keep the virus under control. Acyclovir (Zovirax), which has been available since 1982, can be taken orally or topically, and is usually well-tolerated. Two additional drugs, valacyclovir (Valtrex) and famciclovir (Famvir,) have also been used and have been found effective. These medications are also used for treatment of recurrent episodes, either episodically (ie, at the time of appearance of the lesions) or continuously as suppressive therapy. Medications are most effective when started within the first 24 hours. If given as suppressive therapy, medications reduce the rate of reactivation and decrease transmission to uninfected partners.
There have been reports that the amino acid, lysine, helps reduce early herpes symptoms. Lysine counteracts the effects of arginine, an amino acid found in foods such as nuts (especially peanuts), chocolate, and cola, which may stimulate herpes. It is perhaps wise to avoid arginine-rich foods during herpes episodes, though little evidence supports this recommendation or the use of lysine.
The sores heal best when kept dry and exposed to air; using any creams—particularly oil-based ones—will aggravate the symptoms. You can alleviate itching with compresses made of black tea and baking soda baths.
In general, the best defense against herpes outbreaks is a strong immune system. You can keep your immune system healthy by eating a balanced diet and getting enough rest. Vitamin C, zinc, and the herb echinacea are thought to also strengthen the immune system.
How Is Herpes Transmitted, and Can I Prevent it?
Herpes is spread by direct skin-to-skin contact during vaginal, anal, or oral sex. If you have a cold sore on your mouth and have oral sex, you can give your partner genital herpes.
Herpes is most contagious during outbreaks, so you should abstain from sex when symptoms are present. The virus can also be transmitted when symptoms are not present, so it is advisable to use condoms between episodes. While over 90% effective in some studies, condoms don't provide 100% protection since they may not cover all lesions and occasionally they break. Using spermicides, which have been shown to neutralize HSV and do prevent infection in mice, along with a condom should provide added protection. As noted above, taking daily medication (typically valacilovir or a similar drug) can significantly reduce risk of transmission.
Some people contract herpes from partners whose symptoms are very mild or completely absent, so they don't know they have it. Others catch it from people who don't tell them of their condition. As with any STD, the best prevention is getting to know and trust your partner before having sex so that you can comfortably communicate about STDs.
"You practically have to fill out a questionnaire on the first date. But taking precautions can save your life," says Boston sex therapist Alexandra Myles. While this may limit spontaneity, sex is usually most rewarding in a caring relationship without the risk of STDs. This becomes particularly important if you do contract herpes.
It is important to note that not everyone with a herpes-infected partner catches the virus—some people in long-term relationships with an infected partner never do.
The Emotional Aspect of Herpes
For many people, the hardest part of getting herpes is dealing with the social stigma.
"People aren't traumatized by having a cold sore on their mouths, but society views genital herpes very differently," says Glover.
According to an ASHA survey, many readers of the organization's newsletter, The Helper, report experiencing a loss of self-esteem and fear of revealing their condition to a partner, particularly in the first year following diagnosis. Herpes support groups have been established nationwide to help people share their emotions and feel less alone.
Over time, most herpes sufferers are able to have a normal sex life.
"I've found that my clients have been able to maintain relationships. The positive side has been that they become more discriminating and don't just jump into bed," says Myles.
As Brett, an ASHA reader, said in a recent article in The Helper, "I've been lucky in that I've never been rejected because of herpes. To the contrary, I have a normal fulfilling life in every way."
Herpes and Pregnancy
Herpes can also be an issue when a woman becomes pregnant. While less than 0.1% of babies contract HSV and most herpes-infected mothers have normal deliveries, it is important to take precautions. If you have herpes, you should inform your healthcare provider. If your partner has been infected with herpes, ACOG recommends that intercourse should be avoided in the third trimester. When intercourse is performed in the first or second trimester, condoms should be used, although they do not provide absolute protection..
If a mother gets infected in late pregnancy, babies may contract neonatal herpes, a rare but life-threatening disease. In the United States, mothers with herpes who have an outbreak at the time of delivery are commonly advised to have Cesarean sections. This approach has not been adopted in all countries, and the safest technique to prevent neonatal herpes has yet to be determined.
The facts about herpes dispel the "scarlet H" image. While herpes isn't fatal, it is uncomfortable and puts great stress on personal relationships. This is an example of a condition in which knowledge is your best treatment and prevention through consistent use of condoms is your best policy.
American College of Obstetricians and Gynecologists
American Social Health Association (ASHA)
The National Institute of Allergy and Infectious Diseases (NIAID)
BC Health Guide
Sex Information and Education Council of Canada
American Social Health Association (ASHA) website. Available at: http://www.ashastd.org.
FAMVIR website. Available at: http://www.genitalherpes.com/index.jsp.
Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med. 2004; 350:1970.
The National Institute of Allergy and Infectious Diseases (NIAID) website. Available at: http://www.niaid.nih.gov/factsheets/stdherp.htm.
Wald A, Krantz E, Selke S, et al. Knowledge of partners'genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis. 2006; 194:42.
Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006; 296:964.
Last reviewed May 2008 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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