HERPES

What is herpes?
 
Herpes simplex virus, or HSV, is an extremely common viral infection. One in four adults in the United States is believed to be
infected with the HSV. HSV causes cold sores or fever blisters (oral herpes), and it also causes genital sores (genital herpes).
Herpes can be a recurring and upsetting disease but is rarely dangerous compared to other STDs. Although there is not yet a
cure for herpes, appropriate treatment is effective in helping to control the disease.
 
There are two herpes simplex viruses: herpes simplex type one (HSV-1) and herpes simplex type two (HSV-2). Most
commonly HSV-1 occurs above the waist, usually as cold sores or lesions in the mouth or on the lips and face (orofacial
herpes); HSV-2 occurs below the waist, usually as genital sores (genital herpes). Occasionally sores can appear on other parts
of the body where broken skin has come into contact with the virus.
 
HSV-1 and HSV-2 are spread by direct skin-to-skin contact, that is, directly from the site of infection to the site of contact. If
you have a cold sore and kiss someone, you can transfer the virus from your mouth to your partner's. Similarly, if you have
active genital herpes and have vaginal or anal intercourse, you can transfer the virus from your genitals to your partner's. Also, if
you have a cold sore and put your mouth on your partners genitals (oral sex), you can give your partner genital herpes.
 
Transmission is most likely when sores or other symptoms of infection are present. However, herpes can also be transmitted
during "prodromal symptoms" (itching, tingling or other sensations on the skin before lesions appear) and sometimes even when
no signs or symptoms are present. Becoming familiar with your individual signs and symptoms of a recurrence is an important
step in determining when transmission to a sexual partner is most likely.
 
What does herpes look like and how would I know if I had it?
 
Symptoms of primary herpes (the first episode) usually develop within 2 to 10 days after contact with the virus, although some
people develop symptoms several months later. As the virus starts to multiply within the skin cells, the skin becomes red and
sensitive. Soon afterward small red bumps appear and may develop into blisters or painful sores. Individuals may also
experience flu-like symptoms including swollen glands, headache, muscle aches, or fever. Sometimes the glands in the groin
may enlarge and cause discomfort. In the next week or so the blister-like sores break open, scab over, and heal without
scarring.
 
What is a herpes infection recurrence?
 
After the initial or primary infection, the virus retreats and lies dormant in certain clusters of nerve cells near the spinal cord.
From time to time, the virus can be reactivated and cause new sores to erupt. It can also reactivate without causing any visible
sores. At these times small amounts of the virus may be shed at or near the sites of the original infection. The reasons why this
occurs are unclear.
 
A number of factors such as illness, stress, fatigue, skin irritation, diet, menstruation, or vigorous sexual intercourse are among
the factors thought (but not proven) to induce a recurrence. Over 50 percent of herpes patients have recurrent or secondary
episodes. Some people have frequent recurrences while other people have them rarely. The average number of recurrences for
genital herpes is about four times per year.
 
The viral shedding usually occurs for one day and though infrequent, it is sufficient to infect your sexual partner. Most people
can tell when an attack is coming on because they feel a tingling or burning sensation where the sores will occur. Because the
immune system develops antibodies and other weapons against the virus during the first episode, recurrences are usually milder
and shorter. Some people never have a second outbreak.
 
When should I see a health care provider?
 
If you experience itching or tingling or develop any rash or sores, see a health care provider while symptoms are still present.
Diagnostic tests are most useful when the lesions are present.
 
How is herpes diagnosed?
 
Your health care provider can often diagnose herpes on the basis of your history and the examination of the sores. The health
care provider may take a sample of fluid from the sore(s) to determine if the herpes virus is present.
 
How is herpes treated?
 
At present there is no cure for herpes but appropriate treatment can relieve discomfort. Your health care provider might suggest
a prescription drug called Acyclovir which may reduce your discomfort and the frequency and duration of outbreaks. Always
check with your health care provider before using any over-the-counter medications or home remedies.
During an active recurrence, you can take several measures to decrease discomfort:
 
Keep the infected area as clean and dry as possible. After a shower avoid rubbing with a towel. Dry gently with a towel
or with a hair dryer on low or cool setting.
Take warm baths to cleanse and soothe the infected area.
Wear 100% cotton underwear and avoid tight fitting pants or jeans which might cause irritation.
You may spread the virus by hand to other parts of your body (auto-inoculation) or to other people. Therefore it is important to
avoid contact with the infected area. If you do touch the area, wash and dry your hands thoroughly.
Proper nutrition, plenty of exercise, and rest can keep your immune system healthy and may help control the virus. You may
also find it helpful to participate in a herpes support group.
 
How can I avoid getting herpes?
 
If you are free of herpes infection, you can eliminate your risk entirely by not having sex with anyone (abstinence) or by
having sex only with a non-infected partner who has sex only with you (mutual monogamy).
If you have a sexual relationship with a person who has herpes, you must avoid direct contact (including cuddling or
rubbing together) with the affected area during your partner's recurrences. In other words, intercourse should be avoided
from the time the first prodromal symptoms appear (tingling, itching, burning of the skin) until the area is completely
healed and new skin has formed. If the sores are in the mouth or on the lips, you should avoid kissing during a
recurrence.
 
Between episodes of the herpes virus reactivation, use latex condoms and spermicidal foams for additional (but not
complete) protection.