Genital Herpes; An Open Discussion

Herpes is a sexually transmitted disease. It’s something that no one wants to catch or transmit. Here you'll learn what you need to know to prevent that from happening, and what you need to do if you do indeed get it and are diagnosed with it.

Herpes is a viral infection that can be transmitted in several ways. It can be transmitted sexually and it can cause a whole range of illnesses, but the one that people generally consider herpes infections are genital herpes -- infections of the vaginal area or penis and anus area -- as well as oral infections of the mouth, cold sores and skin above and around the mouth.

Q. What's the difference between herpes 1 and 2?
The difference is that herpes simplex 1 is generally what causes the oral lesions, and the lip lesions, where herpes 2 -- HSV-2 -- is generally the one that causes genital lesions. However, there is a significant overlap between the two, so you can have herpes 2 that infects and causes lesions in your mouth and you can have herpes 1 that causes lesions on sexual organs.

What's the breakdown between someone who has herpes simplex 1, herpes simplex 2, if they have both -- is one more prevalent?
Herpes simplex 1 is more prevalent but, many people may be infected with both. Many people may be infected with one or the other and never develop any symptoms from it. Herpes simplex 1 may cause genital infections and herpes simplex 2 may cause oral infections. We don't always make that much of a distinction between the two anymore because there is such a large overlap.

What are the symptoms?
The symptoms -- at least at the start, after you've encountered this virus -- generally all sorts of lesions start with a blister type rash in general -- and this is talking about in the genital area. It usually begins with a blister type rash that is itchy, tingling, and or painful. It may progress when the blisters break into an ulcerative type of rash that if not treated may continue to persist for a week or two. Some people get a fever from it, some do not.

After the lesions have ruptured, you will see that there are ulcers that are generally very, very painful and then they are very contagious, so is the fluid that they contain, if they are that big. They may persist for a week or two if the person doesn't seek treatment, and in some cases may persist significantly longer than that and may actually progress and spread.

Herpes can also cause what's called a 'whitlow', which causes herpetic type lesions on the fingers. If you have contact with these lesions, you can get this infection in other parts of your body. You can get it on your finger, and then you can get it in other areas -- usually mucus membranes. This can be transmitted if you have oral-genital contact, so you may end up with oral sores. In some people it can continue to progress, but, you may have herpes and not have symptoms.

How come some people don’t get any symptoms?
We don't know completely why some people never develop any symptoms, and yet, they are infected. The concern with all of these sort of infections with herpes -- people who are symptomatic or asymptomatic -- is the risk of spread, and in fact the majority of the spread of herpes comes when people are actually asymptomatic. Even those who do develop intermittent symptoms continue to shed virus even when they do not have any sores or lesions. In those situations they may spread it to noninfected partners, and that's a very common scenario. If you just look at someone and you don't see lesions, that doesn't mean they do not carry or 'shed the virus'.

It has become a common situation in that 30 to 50 percent of college-age young people these days have herpes and have been infected with it. Probably 25 percent or so would never have any symptoms, but probably 75 percent would have intermittent symptoms. That is, they may have a lesion that lasts a week or two but then goes away, and then, depending upon the person -- some people have a lesion every few weeks or so, and those can be brought on with things such as stress, fatigue or menstruation. Other people may go a year or two, or longer, without having a repeat of their lesions. So it's very variable how frequently you get may get lesions. Some people never get it. Other people get it with varying periods of time in between.

Q. If you don't have any lesions it can still be spread?
AND how common is that, and how could you ever have not risked spreading it? Do people with lesions when they're in remission think, "Okay, now it is safer to have sex." Are they less likely to spread it at that point because they had such a symptom before as opposed to somebody who never has symptoms?

We know about this infection is that it is definitely more contagious and infectious when people have lesions, but it is definitely contagious when people have no lesions. We now believe the majority of these infections, when they're spread from individuals who have herpes infections, are spread during the time when they are not having any symptoms and not having any lesions.

Q: Is that because there's a tendency to get relaxed and say, "Well, I don't need a condom," etc.?
A: That's part of the tendency and problem, and many people think that if they don't have lesions, they can't spread it. The other point is that, there may be a period of months, years, or even never when people have a recurrence of their first infection, so the time course there when they have no lesions is much, much greater than the time course when they do have lesions, and that is one of the reasons that the spread occurs, much of the time, when there are no lesions or any symptoms at all.

Another problem is that when there are lesions present in some women, it does not affects the vulva and external vagina, but it may affect the vaginal walls and the cervix; so people may think they are NOT having an outbreak, when they indeed are, most of these are spread when someone does not have one of these lesions because when you do, you're probably unlikely to be having much sex.

Q: Just to continue with the spreading aspect, because of the simplex 1 and simplex 2 -- theoretically, somebody, say, has the lesions on their mouth. If they engage in oral sex, can that spread to the genitals of somebody else, or would it only be mouth-to-mouth and genital-to-genital?
A: Good point! It can definitely spread from mouth to genital area. We see that herpes simplex 1 more likely infects the mouth, and when it does it has more frequent outbreaks than when it infects the genital area, and vice versa for herpes simplex 2, but there is a great overlap and each can infect the sites that they're theoretically not supposed to infect.

Q. Since, there is no cure for Herpes, does a person constantly need to take medication?
A: We treat people, for the most part, with their recurrent infections for symptoms, because most patients will get better on their own, even without treatment. Treatment helps sores heal a lot faster and so people feel a bit better, but it doesn't seem to change very much the actual recurrent infections. We can use it to help prevent recurrences in people who develop frequent recurrences, and we use it for patients when they develop recurrences, both oral and genital, but sometimes the treatment is not that effective for those situations and for some people.

Q: If one partner of a couple shows symptoms, they're infected. Does this have anything to do with whether the other partner will be symptomatic or not? Not necessarily. One partner can be tremendously symptomatic -- and have many outbreaks and the other person can be relatively asymptomatic. This is probably related in some way to their underlying immune system or other factors that we don't completely understand.

Q: What is the best course to ensure your safety, and your partner's safety?
As with many other sexually transmitted diseases it's important that individuals wear condoms when they're having sex and that they don't engage in high-risk or unprotected or casual intercourse -- oral, vaginal, anal -- because it can be spread in all those ways.

Q. What about herpes simplex of the mouth. Is a couple supposed to abstain from kissing?

I don't think that's necessary, unless one of them is in pain from sores . Again, most couples have probably transmitted what they're going to transmit at one point or another during their relationship, so I don't think that by telling a couple not to kiss that you're going to prevent them from spreading something that they probably have already spread. As far as if the person has an open lesion or an open sore, yes, you probably ought to avoid contact with that. If somebody has an open mouth lesion, then yes, contact should be avoided. That is a particularly infectious time. But other than that, no, I don't think it's generally recommended.

Keep in mind that the main way genital herpes is spread is through genital contact, oral-genital contact. Herpes can certainly be spread if someone has an open lesion in their mouth or is asymptomatically shedding herpes in their mouth at that particular time. But that's less likely. The main gist of where this is going to occur is going to be through unprotected sex of some sort, not through kissing.

Treatment

There are a number of different medications now that can very effectively treat herpes and in some cases prevent it from occurring. Acyclovir, or Zovirax are what is most often prescribed. Some people take Valtrex and Famvir. These are great for relieving the symptoms and for many people prevent outbreaks. So, yes, there are effective treatments and they can shorten the duration as well as, in some cases, prevent recurrence. Prevent recurrence as frequently. In other words, you can't treat and make it go away, but in people who have frequent recurrences you can reduce those numbers of recurrences with treatment. There is also a cream you can put on the lesions that does help, this contains Acyclovir. Some people even benefit from Blistex for oral herpes.

* Check out: Genital Herpes: Suppression or Not?
* Herpes On The Rise

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How to Deal With An Outbreak

Use a CONDOM every time you have sexual intercourse. For condom help...