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Herpes Simplex Virus

The herpes simplex virus (HSV) can cause blisters and sores almost anywhere on the skin. These sores usually occur either around the mouth and nose, or on the genitals and buttocks.

HSV infections can be very annoying because they can periodically reappear. The sores may be painful and unsightly. For chronically ill people and newborn babies, the viral infection can be serious, but rarely fatal.

How is a cold sore different from genital herpes?

These are both caused by the HSV virus. There are two types of this virus: type 1 and type 2. HSV type 1 commonly causes fever blisters or cold sores. Most people get Type 1 infections during infancy or childhood from close contact with family members or friends who carry the virus. It can be transmitted by kissing, sharing eating utensils, or by sharing towels. The sores most commonly affect the lips, mouth, nose, chin or cheeks and occur shortly after exposure. Patients may barely notice any symptoms or need medical attention for relief of pain. The Type 2 virus typically causes genital sores. Most people get Type 2 infections following sexual contact with an infected person. The virus affects anywhere between 5 and 20 million people, or up to 20 percent of all sexually active adults in the United States. With either type of herpes simplex, you can spread lesions by touching an unaffected part of the body after touching a herpes lesion. For example, touching a cold sore and having intimate relations following can result in the HSV type 1 virus causing a rash in the genital area.

What does the rash look like and how long will it last?

Both type 1 and type 2 infections present with tiny, clear, fluid-filled blisters. The number of blisters varies from one to a group of blisters. Before the blisters appear, the skin may itch or become very sensitive. The blisters can break as a result of minor injury, allowing the fluid inside the blisters to ooze and crust. Eventually, crusts fall off, leaving slightly red healing skin. The sores from the primary infection heal completely and rarely leave a scar. With the genital herpes, one might have burning with urination, itching and pain at the site of the lesions. Fever and muscle aches can occur with both types of herpes during an outbreak.

For both genital and cold sores, there are two kinds of infections – primary and recurrent. Although most people exposed to the virus get infected, only 10% will actually develop sores or cold blisters when this infection occurs. The sores of a primary infection appear two to twenty days after contact with an infected person and can last from seven to ten days. However, the virus that caused the infection remains in the body. It moves to nerve cells where it remains in a resting state. Many people will not have a recurrence. Others will have a recurrence either in the same location as the first infection or in a nearby site. The infections may recur every few weeks or less frequently. Recurrent infections tend to be milder than primary infections. They can be set off by a variety of factors including fever, sun exposure, and a menstrual period. However, for many, the recurrence is unpredictable and has no recognizable cause.

How Are the HSV Infections Diagnosed?

The appearance of HSV is often so typical that no further testing is necessary to confirm an HSV infection. However, if the diagnosis is uncertain, as it may be in the genital or cervical areas, a swab from the infected skin (culture) may be taken and sent to the laboratory for analysis. Other laboratory tests available for diagnosis include specially treated scrapings that are examined under the microscope and blood tests for antibodies.

How are Herpes Infections Treated and is there a Cure?

There is no vaccine that prevents this disease from occurring. Oral anti-viral medications such as acyclovir, famciclovir, or valacyclovir have been developed to treat herpes infections. These medications can be used to treat an outbreak or can be used for suppressing herpes.

While there are no known cures for herpes, clinical studies are now ongoing to attempt to reduce or possibly eliminate outbreaks.

How Do You Prevent Transmission?

Between 200,000 and 500,000 people “catch” genital herpes each year and the number of Type 1 or cold sore infections is many times higher. Prevention of this disease, which is contagious before and during an outbreak, is important. If tingling, burning, itching, or tenderness (signs of a recurrence) occur in an area of the body where you had a herpes infection, that area should not contact other people. With mouth herpes, one should avoid kissing and sharing cups or lip balms. For persons with genital herpes, this means avoiding sexual relations, including oral/genital contact during the period of symptoms or active lesions. Condoms can help prevent transmission of genital herpes to your sexual partner.

Can Herpes be Spread if there is No Visible Sore?

Not only can herpes be spread if there is no sore, MOST herpes is transmitted in the absence of lesions! It is now estimated that over 80% of all genital herpes is transmitted when there isn’t anything on the skin and no symptoms. Patients have been aware for many years that if they kissed someone while having a fever blister or had sex with their partner while having an outbreak of genital herpes that they were likely to transmit the virus. Despite this knowledge, however, a 30% increase in the prevalence of HSV 2 infections was documented in the 1980s and 1990s. This increase is most likely due to the presence of HSV on the genital skin in the absence of lesions or symptoms. This phenomenon is known as “asymptomatic viral shedding” and has been demonstrated in well-controlled clinical investigations. Most recently, persons who never recall having had an outbreak of genital herpes, but who have had positive blood tests for antibodies to herpes, also have been demonstrated to “shed” the virus occasionally from lips or genital skin.

It has been demonstrated that persons who take acyclovir daily have reduced amounts of the virus in the absence of symptoms or lesions. The same is probably true of the newer drugs, famciclovir and valacyclovir.