Hsv 1 on genitals

Herpes simplex virus

Infection with the herpes simplex virus, commonly known as herpes, can be due to either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital herpes). However, HSV-1 can also be transmitted to the genital area through oral-genital contact to cause genital herpes.

Both oral herpes infections and genital herpes infections are mostly asymptomatic but can cause mild symptoms or painful blisters or ulcers at the site of infection.

  • Herpes simplex virus – type 1 (HSV-1)
  • Herpes simplex virus – type 2 (HSV-2)

Herpes simplex virus type 1 (HSV-1)

HSV-1 is a highly contagious infection, which is common and endemic throughout the world. Most HSV-1 infections are acquired during childhood, and infection is lifelong. The vast majority of HSV-1 infections are oral herpes (infections in or around the mouth, sometimes called orolabial, oral-labial or oral-facial herpes), but a proportion of HSV-1 infections are genital herpes (infections in the genital or anal area).

Scope of the problem

In 2012, an estimated 3.7 billion people under the age of 50, or 67% of the population, had HSV-1 infection. Estimated prevalence of the infection was highest in Africa (87%) and lowest in the Americas (40-50%).

With respect to genital HSV-1 infection, 140 million people aged 15-49-years were estimated to have genital HSV-1 infection worldwide in 2012, but prevalence varied substantially by region. Most genital HSV-1 infections are estimated to occur in the Americas, Europe and Western Pacific, where HSV-1 continues to be acquired well into adulthood. In other regions, for example in Africa, most HSV-1 infections are acquired in childhood, before the age of sexual debut.

Signs and symptoms

Oral herpes infection is mostly asymptomatic, and the majority of people with HSV-1 infection are unaware they are infected. Symptoms of oral herpes include painful blisters or open sores called ulcers in or around the mouth. Sores on the lips are commonly referred to as “cold sores.” Infected persons will often experience a tingling, itching or burning sensation around their mouth, before the appearance of sores. After initial infection, the blisters or ulcers can periodically recur. The frequency of recurrences varies from person to person.

Genital herpes caused by HSV-1 can be asymptomatic or can have mild symptoms that go unrecognized. When symptoms do occur, genital herpes is characterised by 1 or more genital or anal blisters or ulcers. After an initial genital herpes episode, which may be severe, symptoms may recur, but genital herpes caused by HSV-1 often does not recur frequently.

Transmission

HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes infection, via contact with the HSV-1 virus in sores, saliva, and surfaces in or around the mouth. However, HSV-1 can also be transmitted to the genital area through oral-genital contact to cause genital herpes.

HSV-1 can be transmitted from oral or skin surfaces that appear normal and when there are no symptoms present. However, the greatest risk of transmission is when there are active sores.

Individuals who already have HSV-1 oral herpes infection are unlikely to be subsequently infected with HSV-1 in the genital area.

In rare circumstances, HSV-1 infection can be transmitted from a mother with genital HSV-1 infection to her infant during delivery.

Possible complications

Severe disease

In immunocompromised people, such as those with advanced HIV infection, HSV-1 can have more severe symptoms and more frequent recurrences. Rarely, HSV-1 infection can also lead to more severe complications such as encephalitis or keratitis (eye infection).

Neonatal herpes

Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

Psychosocial impact

Recurrent symptoms of oral herpes may be uncomfortable and can lead to some social stigma and psychological distress. With genital herpes, these factors can have an important impact on quality of life and sexual relationships. However, in time, most people with either kind of herpes adjust to living with the infection.

Treatment

Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are the most effective medications available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.

  • WHO guidelines for the treatment of Genital Herpes Simplex Virus

Prevention

HSV-1 is most contagious during an outbreak of symptomatic oral herpes, but can also be transmitted when no symptoms are felt or visible. People with active symptoms of oral herpes should avoid oral contact with others and sharing objects that have contact with saliva. They should also abstain from oral sex, to avoid transmitting herpes to the genitals of a sexual partner. Individuals with symptoms of genital herpes should abstain from sexual activity whilst experiencing any of the symptoms.

People who already have HSV-1 infection are not at risk of getting it again, but they are still at risk of acquiring herpes simplex virus type 2 (HSV-2) genital infection (see below).

The consistent and correct use of condoms can help to prevent the spread of genital herpes. However, condoms can only reduce the risk of infection, as outbreaks of genital herpes can occur in areas not covered by a condom.

Pregnant women with symptoms of genital herpes should inform their health care providers. Preventing acquisition of a new genital herpes infection is particularly important for women in late pregnancy, as this is when the risk for neonatal herpes is greatest.

Additional research is underway to develop more effective prevention methods against HSV infection, such as vaccines. Several candidate HSV vaccines are currently being studied.

Herpes simplex virus type 2 (HSV-2)

HSV-2 infection is widespread throughout the world and is almost exclusively sexually transmitted, causing genital herpes. HSV-2 is the main cause of genital herpes, which can also be caused by herpes simplex virus type 1 (HSV-1). Infection with HSV-2 is lifelong and incurable.

Scope of the problem

Genital herpes caused by HSV-2 is a global issue, and an estimated 417 million people worldwide were living with the infection in 2012. Prevalence of HSV-2 infection was estimated to be highest in Africa (31.5%), followed by the Americas (14.4%). It was also shown to increase with age, though the highest numbers of people newly-infected were adolescents.

More women are infected with HSV-2 than men; in 2012 it was estimated that 267 million women and 150 million men were living with the infection. This is because sexual transmission of HSV is more efficient from men to women than from women to men.

Genital herpes infections often have no symptoms, or mild symptoms that go unrecognised. Most infected people are unaware that they have the infection. Typically, about 10-20% of people with HSV-2 infection report a prior diagnosis of genital herpes.

When symptoms do occur, genital herpes is characterised by one or more genital or anal blisters or open sores called ulcers. In addition to genital ulcers, symptoms of new genital herpes infections often include fever, body aches, and swollen lymph nodes.

After an initial genital herpes infection with HSV-2, recurrent symptoms are common but often less severe than the first outbreak. The frequency of outbreaks tends to decrease over time. People infected with HSV-2 may experience sensations of mild tingling or shooting pain in the legs, hips, and buttocks before the occurrence of genital ulcers.

HSV-2 is mainly transmitted during sex, through contact with genital surfaces, skin, sores or fluids of someone infected with the virus. HSV-2 can be transmitted from skin in the genital or anal area that looks normal and is often transmitted in the absence of symptoms.

In rare circumstances, HSV-2 infection can be transmitted from a mother to her infant during delivery.

HSV-2 and HIV

HSV-2 and HIV have been shown to influence each other. HSV-2 infection increases the risk of acquiring a new HIV infection by approximately three-fold. In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others. HSV-2 is amongst the most common infections in people living with HIV, occurring in 60-90% of HIV-infected persons.

Infection with HSV-2 in people living with HIV (and other immunocompromised individuals) often has a more severe presentation and more frequent recurrences. In advanced HIV disease, HSV-2 can lead to more serious, but rare, complications such as meningoencephalitis, esophagitis, hepatitis, pneumonitis, retinal necrosis, or disseminated infection.

Neonatal herpes

Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

Psychosocial impact

Recurrent symptoms of genital herpes may be painful and the infection can lead to social stigma and psychological distress. These factors can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

Antivirals, such as acyclovir, famciclovir, and valacyclovir are the most effective medications available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.

  • WHO guidelines for the treatment of Genital Herpes Simplex Virus

Individuals with genital HSV infection should abstain from sexual activity whilst experiencing symptoms of genital herpes. HSV-2 is most contagious during an outbreak of sores, but can also be transmitted when no symptoms are felt or visible.

The consistent and correct use of condoms can help reduce the risk of spreading genital herpes. However, condoms only provide partial protection, as HSV can be found in areas not covered by a condom. Medical male circumcision can provide men life-long partial protection against HSV-2, in addition to HIV and human papillomavirus (HPV).

Pregnant women with symptoms of genital herpes should inform their health care providers. Preventing acquisition of a new genital herpes infection is particularly important for women in late pregnancy, as this is when the risk for neonatal herpes is greatest.

Additional research is underway to develop more effective prevention methods against HSV infection, such as vaccines or topical microbicides (compounds which can be applied inside the vagina or rectum to protect against sexually transmitted infections).

WHO response to herpes (HSV-1 and HSV-2)

WHO and partners are working to accelerate research to develop new strategies for prevention and control of genital and neonatal HSV-1 and HSV-2 infections. Such research includes the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.

Dr. Harold Fisher/Getty ImagesThe highest risk of transmitting the herpes virus is during an outbreak.

Can someone infected with herpes continue to have sex without giving it to their partner? Do cold sores, which are almost always caused by herpes simplex virus type 1 (HSV-1), protect against genital herpes caused by herpes simplex virus type 2? Can someone be infected with both types of herpes viruses?

Those are among the questions recently posed by readers of the Consults blog. Dr. Peter Leone, an expert on sexually transmitted diseases and associate professor at the University of North Carolina School of Medicine and Public Health, responds.

What’s My Risk of Spreading Herpes?

Q.

I found out that I have herpes simplex type 2 (HSV-2) about a month and a half ago. My primary partner, who is male, has been tested twice since then, and both results have been negative. We were fluid-bonded and had plenty of unprotected sex between my most recent negative result and last month’s positive one. What are the rates of transmission in a serologically discordant couple where the female partner has HSV-2?

I’ve read that it’s:

  • 4 percent in couples who don’t use barriers but avoid sex during outbreaks, and where the woman is not on antiviral suppressive therapy.
  • 2 percent in couples who use condoms and no antivirals.
  • 1 percent in couples who use both condoms and daily antivirals.

Is this accurate? It’s really hard to find comprehensive information on the Internet that gives hard scientific data on rates of transmission.
Stella, Chicago

A.

Dr. Peter Leone responds:

Transmission of HSV-2 to an uninfected partner depends on many different factors, and it is difficult to give precise figures. Studies involving discordant couples, in which one partner has HSV-2 and the other does not, introduce various biases. Discordant couples, for example, have not transmitted the virus between them and are encouraged to use condoms and take other preventive measures. Given these caveats, here’s what we can say:

  • Women are more likely to acquire HSV-2 from an infected male partner then men are from women. On average, the risk for women acquiring HSV-2 sexually from an infected partner is about 10 percent per year, though there is a large range — from 7 percent to 31 percent — in different studies.
  • For uninfected men, the risk of sexually acquiring HSV-2 from an infected woman is about 4 percent per year.
  • Having HSV-1 infection may lower the risk of acquiring HSV-2 sexually, but studies on this provide conflicting results.
  • Condoms reduce the risk of transmission by about 30 percent, and daily suppressive therapy reduces the risk of transmission by about 48 percent, studies show. Using condoms and taking daily suppressive therapy reduces the risk even further than either measure alone, though studies were not large enough to provide reliable numbers.
  • Unfortunately, there is no available data on the rate of transmission for same-sex couples.

HSV-2 transmission is more dependent on genitals than gender. What I mean by this is that contact by the penis with either the vagina or rectum is where the greatest risk of transmission occurs. Oral sex is more of an issue for HSV-1 transmission — from mouth to genitals, and indeed, HSV-1 is a fast-growing cause of genital herpes. Oral sex, though, is not much of a risk for HSV-2, since HSV-2 oral infection is rare and shedding of HSV-2 from the mouth is extremely low.

Can You Be Infected With Both Types of Herpes?

Q. A.

Dr. Peter Leone responds:

Yes. About 10 percent of adults in the United States have both HSV-1 and HSV-2. Of those with HSV-2, about 40 percent are co-infected with HSV-1.

HSV-2 increases the risk for H.I.V. acquisition. Someone infected with HSV-2 has two to five times greater risk of acquiring H.I.V. through sexual intercourse compared with someone who is not infected with HSV-2. HSV-1 does not increase the risk of H.I.V.

Your question about whether herpes increases the risk of contracting hepatitis C is an interesting one. The biggest risk for hepatitis C is through sharing needles while injecting drugs. But hepatitis C can also be sexually transmitted, and it appears that the risk may be increased in women and in men who have sex with men who are also infected with HSV-2.

Do Cold Sores Protect Against Genital Herpes?

Q.

As a kid, I had oral herpes (painful sores on inside of mouth, etc.), and then many years later I dated a girl for two years who had herpes, and I never caught it (though we often, though not always, used condoms). I’m long since married now, but I’ve always wondered, does having had oral herpes make one immune to contracting genital herpes?
Nathan, NYC

A.

Dr. Peter Leone responds:

Cold sores are almost always – 98 percent of the time — caused by HSV-1. Having HSV-1 infection may make it more difficult to acquire HSV-2 infection, but, at best, offers only partial immunity.

If someone with HSV-1 acquires HSV-2, he or she is likely to have a mild first outbreak of HSV-2 — or there may not be any symptoms at all. Nearly 40 percent of individuals infected with HSV-2 are also infected with HSV-1. Maybe you don’t have HSV-2 infection, but the only way to know for sure is to get a blood test for HSV-2.

To learn more, see Dr. Leone’s earlier responses in the Related Posts below, and The Times Health Guide: Genital Herpes, which includes an interview with Dr. Leone, “Understanding Genital Herpes.“

Key Facts

  • Genital herpes is an STI that results from sexual contact with someone who has the virus.
  • Most people with herpes do not have symptoms and do not know that they are infected.
  • If you have an oral or genital sore, don’t have sex – see your health care provider.
  • There are effective ways to manage herpes.

Herpes is one of the most common sexually transmitted infections in the U.S. It’s an infection caused by two different but closely related viruses, called Herpes Simplex Virus Type 1 (HSV-1) and Herpes Simplex Virus Type 2 (HSV-2).

  • HSV-1 is usually transmitted by touching and kissing but it can also be transmitted by sexual contact. Infections with HSV-1 may cause cold sores, and/or fever blisters on the lips, sores around the teeth and gums or no symptoms. HSV-1 is also spread by oral sexual contact and can cause genital herpes.
  • HSV-2is almost always spread by sexual contact and can cause genital herpes with painful lesions around the vulva, cervix, anus, and penis.

How common is herpes?

Almost 90 percent of Americans will have oral herpes (“cold sores”) caused by Herpes Simplex Virus type 1 (HSV-1) at some time in their life. In the United States, 776,000 people per year are diagnosed with new genital herpes caused by HSV-1 or HSV-2. However, many people don’t know they are infected because they have never had or noticed the symptoms. Genital herpes is more common among women than men.

How is herpes spread?

Herpes is spread through contact with infected skin or mucosa, secretions from vagina, penis, or anus, or oral fluid of someone who is infected with the virus. This includes touching, kissing, and sexual contact (vaginal, anal, penile, and oral). Moist areas of the mouth, throat, anus, vulva, vagina, and eyes are very easily infected. Herpes can be passed from one partner to another or from one part of your own body to another part. If one partner has oral cold sores, he/she can pass on the virus during oral sex and cause genital herpes. Herpes is most easily spread when there are open sores, but it can also be spread before the blisters actually form or even from people with no symptoms. It’s very unlikely that herpes is spread by toilet seats, swimming pools, bathtubs, whirlpools, or moist towels. An infected mother can pass the virus to her baby during or after childbirth. Women who get infected for the first time close to the time of delivery are particularly likely to pass the virus to their baby. Pregnant women should always let their doctor know if they have had herpes or been exposed to herpes.

What are the symptoms of oral herpes?

The first oral contact with herpes often causes no symptoms, but it may cause sores in the mouth around the teeth and gums (“gingivostomatitis”). Typically the infection shows up later as small blisters on the lips (“cold sores” or “fever blisters”), a flare-up of an earlier infection. The flare-ups are more common during colds, fevers, and sun exposure. Oral herpes can be spread through contact such as kissing, or through oral sex. Direct contact for a short amount of time is enough to spread the virus. Cold sores can cause genital herpes through oral sex. If you have oral herpes, you should avoid contact with newborn babies.

What are the symptoms of genital herpes?

Genital infection with herpes may not cause any symptoms and the person may not know they have the virus until they pass it on to another person or get symptoms when the virus is “reactivated.” If symptoms are present, they often include painful bumps or sores (also called vesicles). These bumps or sores can be mistaken for other rashes (such as a pimple or ingrown hair). The first outbreak is usually the worst and most painful and occurs within 2-20 days after contact with the virus. The sores usually will go away within 2-3 weeks.

The first time a person becomes infected with the virus is called “primary herpes.”

Symptoms may include:

  • Tingling in the genital area at first
  • Small, painful red bumps that turn into small blisters in about 24-72 hours. They can appear on the labia, clitoris, vagina, vulva, cervix, anus, thighs, or buttocks in girls and penis, scrotum, anus, or buttocks in boys.

Other symptoms of primary herpes infection can include:

  • Burning, painful feeling if urine passes over the sores; unable to urinate (pee) if the vulva is swollen (because of the many sores)
  • Swollen, tender lymph glands in the groin, neck, and under the arms (can remain swollen for up to 6 weeks)
  • Muscle aches
  • Headache
  • Fever
  • Nausea
  • Headache
  • “Run-down” feeling
  • Achy, flu-like feeling

Symptoms usually go away within 2-3 weeks; even faster if you are treated with medication. The sores usually scab over and heal without scars. But after going away, the virus stays in the body, even with treatment. The infection can flare up and cause sores again days, weeks, months, or even years later (“outbreaks”). Symptoms are usually worse during primary herpes, and are milder with “outbreaks”.

How is herpes diagnosed?

Your health care provider can diagnose herpes by looking at the sores during a physical exam and by testing fluid taken from the sores to see if you have HSV-1 or HSV-2. There are also specific blood tests, which can be helpful in some patients to figure out which virus type caused the symptoms or to figure out if one partner has been infected by herpes. Testing for herpes may or may not be included when your health care provider tests for other sexually transmitted infections (STIs) because the Centers for Disease Control and Prevention (CDC) doesn’t recommend routine screening. If you think you have symptoms of herpes or have a partner with genital herpes, see your health care provider right away and ask if you need testing and treatment.

Is there treatment for herpes?

Yes. Your health care provider can prescribe medications that quicken healing, make symptoms less painful, and lower the risk of getting outbreaks. These medications don’t kill the virus and don’t prevent you from getting outbreaks in the future. Even when you don’t have any symptoms, the virus is in the body and can flare up. However, the flare ups and outbreaks of sores usually become fewer and less severe as time goes on. Outbreaks can be prevented or treated early with anti-viral medication to lessen symptoms.

Does treatment cure herpes?

No. Although herpes cannot be cured, it can be treated! For oral herpes, using a sun block on and around the borders of the lips and a hat can lessen the chance of cold sores from sun exposure. Oral medications, prescribed by your health care provider, can be used to treat herpes infections, prevent genital herpes recurrences, and decrease the chance of passing the infection to partners.

Is there anything I can do to relieve my symptoms for genital herpes?

  • Keep sores clean and dry
  • Don’t touch the sores. If you do, wash your hands well with soap and water
  • Wear loose, cotton underwear and clothes to keep your clothes from rubbing against the sores
  • Take warm or cool baths
  • Try holding cool compresses or ice packs to the sores for a few minutes several times a day
  • Drink plenty of water
  • Get plenty of rest
  • Take acetaminophen or ibuprofen to help with pain and fever
  • If urination (peeing) is painful, you can urinate sitting backwards on the toilet so the urine doesn’t touch the lesions or urinate (pee) in a warm bath or shower. You can also use both hands to separate the lips of your vulva, so that urine doesn’t touch the sores. It’s important to wash your hands right after touching your vulva so the virus isn’t spread to your fingers or face.
  • Don’t touch or rub your eyes; don’t wet contact lenses with saliva
  • Wash your hands before touching a contact lens

You may have some early warning signs that an outbreak is coming. These signs include: tingling, burning, and itching where you had sores before. These signs could start a few hours or days before the outbreak.

How often do outbreaks occur?

Half of the people who have herpes don’t have any more outbreaks after the first occurrence of symptoms. This is especially true if the infecting herpes was HSV-1. Some people only get a few outbreaks, while others get many. People can have many outbreaks in a row and then go months or years without one. People with illnesses that weaken the immune system such as leukemia and HIV are more likely to get more outbreaks and have symptoms that are more painful and last longer.

What causes an outbreak?

It is not clear what causes outbreaks. Some ideas are: other infections, physical or emotional stress, fever, surgery, menstruation, sexual intercourse, skin irritation (sunburn or sun exposure), trauma, alcohol, or problems with your immune system.

Is there anything I can do to prevent outbreaks?

Make sure that are you are eating a healthy diet, getting enough rest, exercising, and finding ways to relieve stress. If you have frequent or severe outbreaks, talk to your health care provider about taking a medication to prevent outbreaks or to treat them early.

How can I prevent spreading herpes?

  • If you are having a herpes outbreak, you should NOT have any sexual contact until all sores have healed, the scabs have fallen off, and the skin is normal again.
  • Using condoms lessens the chance of getting herpes but does not completely protect against spreading the disease because the condom does not cover all areas of the body where there may be herpes infection. Touching sores can also spread herpes to other parts of the body or to your partner.
  • If your skin has become normal again and you have no symptoms of herpes, you can have sexual contact again but herpes can still be spread when there are no symptoms. You should always use condoms whenever you have oral, vaginal, or anal sex.
  • If you get any of the typical warning signs that an outbreak may occur-tingling, burning, and itching where sores were before-you should stop having sexual contact until the outbreak is over. These signs can start a few hours or a day before the sores show up.
  • Talk to your health care provider about whether you should take medication to lessen your chance of transmitting herpes to your partner. It is helpful for your partner to get a blood test for herpes type specific antibodies so he/she knows if they have already had the infection. If he/she has a positive test for the herpes type you have had, then you don’t need to take medication to prevent transmission. Pregnant women should particularly avoid getting a herpes infection and let their doctor know if they have ever had symptoms of genital herpes.

Is there a connection between herpes and HIV infection?

People with herpes or other sexually transmitted infections that cause genital sores are more likely to get HIV. The sores provide a place for the HIV virus to enter and start spreading. If a person with HIV also gets genital herpes, the herpes infection is likely to be more severe.

If you’re concerned about herpes, here’s a tip on how to bring it up with your health care provider: How do I know if I have a pimple or herpes?

Both HSV-1 and HSV-2 Can Cause Genital Herpes

Should You Be Tested for the Herpes Virus?

The CDC does not recommend herpes testing for people who have no symptoms. They point out that diagnosing genital herpes in someone lacking any symptoms does not lead to them making changes in their sexual choices. They are no more likely to use condoms or to refrain from having sex than if they hadn’t been tested.

Also, false-positive test results can happen. A false positive is a test result saying you have herpes when actually you do not.

Even if you have no symptoms of herpes or of any other sexually transmitted disease, though, you should talk frankly with your doctor or another healthcare provider about your sexual activities to see if you should be screened for STDs, including herpes.

There are some situations where herpes blood tests can be useful, says the CDC:

  • If you have genital symptoms that could be related to herpes
  • If you now have, or have had, a sex partner with genital herpes
  • If you want a complete STD exam, especially if you have multiple sex partners

Testing Options for HSV

Your doctor can order one of two kinds of HSV tests:

  1. A test of some material taken from a lesion and then grown in a culture
  2. A DNA test

“The DNA test is generally more accurate. It picks up more infections than a culture,” says Handsfield.

DNA tests have become the more common HSV test in the United States, he adds, and suggests that you ask your doctor to order one if you’re being tested for herpes.

“If a test is done, also ask your doctor to request a determination of the virus type,” he says, to see if you have HSV-1 or HSV-2.

“The natural course of the disease and the need for treatment for HSV-1 and HSV-2 are different,” Handsfield says. With HSV-1, recurrent outbreaks are much less likely, and if they do occur are likely to be much more widely spaced.

“Forty percent of people with HSV-1 have no recurrent outbreaks in the year or two after infection, and often none after that,” says Handsfield.

In contrast, an infection with HSV-2 that produces symptoms often leads to outbreaks about four to five times each year. Also a person with HSV-2 is more contagious during symptom-free periods. “So transmission via sex is far more likely with HSV-2 than with HSV-1,” he says. (2)

“If you have HSV-2, you are more likely to benefit from ongoing antiviral therapy,” says Handsfield, considering how frequent outbreaks can be with that form of the virus.

Remember, though, while a herpes blood test can help determine if you have herpes infection, the test cannot tell you who gave you the infection.

Herpes Simplex Virus (oral and genital herpes)

Herpes is a general term for two different diseases: one that affects the area around the mouth (oral herpes, cold sores, fever blisters) and another that affects the area around the genitals (genital herpes). Herpes viruses cause both of these diseases.

Herpes simplex virus-1 (HSV-1) causes oral herpes; and both HSV-1 and herpes simplex virus-2 (HSV-2) cause genital herpes. While HSV-1 and HSV-2 are different viruses, they look very much the same and are treated similarly.

Herpes cannot be cured. Once someone is infected with either virus, it cannot be cleared from the body. Both viruses live in nerve cells, usually under the skin. Most of the time they stay silent or inactive in these cells, sometimes for many years or even a lifetime. This is called “latency.”

For reasons not entirely understood by scientists, the viruses can become active and cause symptoms, which include sores. This is called “reactivation.” These symptoms can come and go as an outbreak, or “flare-up.”

During a flare-up, the virus causes a chain of events leading to a cluster of small bumps to form. The bumps may rupture, heal, and then disappear for an indefinite period of time.

Anyone infected with either virus, regardless of their HIV status, can experience these flare-ups. About 95 percent of people living with HIV in the United States are infected with one of the two viruses. Herpes is spread by direct contact with an infected area, usually during a flare-up of the disease. Kissing and oral-genital sex can spread HSV-1. Other sexual activity, including vaginal or anal intercourse, is the way HSV-2 is usually spread.

Sometimes these viruses can become active without causing symptoms. This is known as viral “shedding.” A person with activated HSV can infect another person whether or not they currently have sores.

Anyone infected with herpes can experience flare-ups. In people with healthy immune systems, a flare-up can last a few weeks. In people with weakened immune systems, the herpes sores can last longer. Severe flare-ups can be incredibly painful. In a very small number of cases, herpes can spread to other organs, including the eyes, throat, lungs and brain.

What are the symptoms?

Symptoms depend on the disease site:

  • Oral herpes: Sores around the mouth and nostrils are usually raised and may itch or be painful. They usually are reddened and sometimes produce fluid or pus and may be crusty or hard to the touch.

  • Genital herpes: Sores may be found on the penis or near or in the vaginal opening. Sores may also be present near the anus, including the area between the anus and the genitals. Sometimes, genital herpes can cause pain when peeing or defecation.

How is herpes diagnosed?

Oral and genital herpes are well-known diseases. Many clinicians know herpes when they see it; however, simply looking at the lesions is not enough to diagnose it. Many cases go unreported or do not have symptoms that cause a person to seek medical help. Therefore, blood tests and swabs taken from the sores are used to diagnose the virus. Genital sores should be tested to determine which virus is present, as this may impact treatment decisions. HSV-1 recurs less often in the genitals than HSV-2.

How is herpes treated?

Once either virus is inside the body and settles into nerve cells, it cannot be eliminated or cured. But it can be treated to reduce symptoms and the risk of transmission. Treatment can speed up healing time, reduce pain, and delay or prevent additional flare-ups. Treatment should take in account the frequency of flare-ups and risk for genital ulcer disease.

Treatment is usually used during a flare-up, which is called “episodic therapy.” In people with weakened immune systems, flare-ups can occur often and may need long-term treatment to prevent recurrences. This is called “suppressive therapy.” Some people can tell when they are about to have a flare-up, usually because of tingling or itching at the site where a sore will appear, which is called the “prodrome” stage.

Four medications are available to treat herpes:

  • Acyclovir (Zovirax):Acyclovir has been well studied in people living with HIV and used for many years to treat both types of herpes. It is available in a topical cream, pills and IV formulation, and rarely causes side effects. Most experts agree that the cream is not very effective and that pills are best for mild to moderate flare-ups or suppressive therapy. IV acyclovir is used for serious flare-ups or outbreaks that affect internal organs, such as the central nervous system. The oral dose used to treat flare-ups is taken three times a day, usually for 5–10 days. It works best if it’s started within 24 hours of the first sign of symptoms or the prodrome stage. The dose can be doubled if the sores fail to respond. Acyclovir has been well studied during pregnancy and appears safe to use.
  • Valacyclovir (Valtrex):Valacyclovir has been approved specifically for treating herpes in people living with HIV and rarely causes side effects. For mild to moderate herpes flare-ups, the dose is taken twice a day for 5–10 days. Treatment will work best if it is started within 24 hours of the first sign of symptoms or the prodrome stage. Valacyclovir appears safe to use during pregnancy, and offers better dosing.
  • Famciclovir (Famvir):Famciclovir is taken by mouth twice a day for 5–10 days. Treatment will work best if it is started within 24 hours of the first sign of symptoms or the prodrome stage. Famciclovir appears safe to use during pregnancy, and offers better dosing.
  • Trifluridine (Viroptic):Trifluridine drops are used to treat HSV infection of the eye(s). One drop is placed in the affected eye, every two hours, for up to 21 days. It is not used to treat or prevent HSV disease in other parts of the body.

In some cases, herpes flare-ups do not respond to acyclovir, valacyclovir or famciclovir, probably due to resistant forms of HSV-1 and HSV-2. People living with HIV with suppressed immune systems—CD4 counts below 100—who have been on long-term acyclovir have developed drug-resistant herpes. Because acyclovir is similar to the other two drugs, simply switching one for the other is not usually effective.

Currently, foscarnet (Foscavir) is the most common treatment for acyclovir-resistant herpes. It must be given by an IV line, usually three times a day, often in a hospital or under the close supervision of an in-home nurse.

Some healthy tips:

  • During a flare-up, it’s important to keep the sores and the area around the sores as clean and dry as possible. This will help it heal well. Some doctors recommend warm showers to cleanse the infected area. Afterwards, towel dry gently, or dry the area with a hair dryer on a low or cool setting. To prevent chaffing, avoid tight-fitting underwear. Most creams and lotions do no good and may even irritate the area.
  • The amino acids lysine and arginine have been shown to play a role in herpes flare-ups. According to some new research, lysine can help control flare-ups. On the other hand, arginine can actually make them worse. In turn, foods that are rich in lysine—but low in arginine—can help control both oral and genital herpes. Fish, chicken, beef, lamb, milk, cheese, beans, brewer’s yeast, mung bean sprouts and most fruits and vegetables have more lysine than arginine, except for peas. Gelatin, chocolate, carob, coconut, oats, whole wheat and white flour, peanuts, soybeans, and wheat germ have more arginine than lysine.

Can herpes be prevented?

Vaccines to prevent herpes infections are currently being studied and may be available in 3–5 years. Vaccines will only prevent the infection from occurring in the first place—they won’t likely help control flare-ups in people who already have herpes.

Since herpes is often transmitted when it’s shedding with no symptoms, people with herpes may want to take suppressive treatment in order to prevent passing the virus onto others. In this case, acyclovir, valacyclovir and famciclovir may be used. The correct and consistent use of condoms can also help prevent transmission, as well as disclosing herpes status to sex partners.

To prevent transmission to a newborn, Caesarian section may be recommended if HSV-2 prodrome or disease is present prior to childbirth.

Are there any experimental treatments?

New drugs are being studied for treating herpes, including a topical foscarnet cream and a topical cidofovir gel. Trifluridine is also being studied as a topical cream.

If you would like to find out more about these studies, visit ClinicalTrials.gov, a site run by the U.S. National Institutes of Health. The site has information about all HIV-related clinical studies in the United States. For more info, you can call their toll-free number at 1-800-HIV-0440 (1-800-448-0440) or email [email protected]

Last Reviewed: January 24, 2019

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