Herpes Infection

April is Sexually Transmitted Disease Awareness Month (#STDMONTH17).  This year the focus is on syphilis.  Since we wrote a blog about syphilis not too long ago, this blog will be about a different sexually transmitted disease: herpes.

What is herpes?

There are many types of herpesviruses, but the ones we are focusing on are Herpes Simplex Virus types 1 and 2. You likely have heard that herpes is a sexually transmitted infection that causes painful ulcers in the genital region, but it is also a common cause of cold sores on the mouth and oral blisters (and not necessarily sexually transmitted in all circumstances). It can even cause infections of the brain and spinal cord (meningitis) in newborns and immunocompromised individuals. However, herpes infections can go unnoticed.  Many people don’t even know that they have the herpes virus in their bodies! The Herpes Simplex Virus (HSV) is transmitted when skin or mucosal surfaces (mouth, vagina, etc) come into contact with infected skin lesions or bodily fluid. This can happen with oral, anal, or vaginal sex; you can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected.  I repeat: Herpes can be spread without open sores! It can even happen with kissing or sharing utensils with an infected person. It can be passed from a mother to her newborn during birth, which is usually prevented via cesarean delivery in mothers with active lesions.  If you touch your own sores or the fluids from the sores, you may transfer herpes to another part of your body, called autoinoculation. Do not touch the sores or fluids, but if you touch the sores or fluids, immediately wash your hands thoroughly.

Traditionally, HSV 1 caused oral infections and HSV 2 caused genital infections, but either virus type can actually lead to oral or genital lesions (a study made famous at our very own University of Wisconsin). After exposure to HSV you may have what’s referred to as a “primary infection”, which will last a couple weeks (or shorter with medication). After the symptoms of the primary infection resolve, both types of HSV hang out in your nervous system and can cause episodic outbreaks in the future (usually during times of stress).

If you have concern for lesions or a rash that might be herpes, you should see a healthcare provider for an examination and discussion of potential testing. Currently, the best way to test for herpes is with a direct swab of the area of concern to check for the herpes virus. Blood testing is also available, but unfortunately current methods are not reliable and might give you unhelpful results. A blood test can determine HSV type, but using a blood test to determine HSV location is utterly impossible, and you may have the virus and not have any symptoms (for example, you had a cold sore when you were 6 years of age, but never have another outbreak). Thus, at this point in time, we do not recommend routine screening for HSV in asymptomatic people. It may cause more grief and harm than benefit.

Unfortunately, there is no cure for HSV and there is no vaccination to prevent it. Once you have HSV in your body, it will stay in your body (and you may or may not have future outbreaks). Some antiviral medications may help reduce the duration and discomfort from HSV symptoms. There is also “suppressive” therapy that can decrease the amount of outbreaks you have and decrease the chance of spreading infection to your sexual partner. This would be something your healthcare provider will discuss with you if you test positive for HSV.

Preventing transmission of HSV

The best way to prevent transmission of HSV is by being careful with direct skin contact with others who have known HSV lesions or rashes. Avoid kissing, sexual contact, and sharing common utensils with those who have active lesions on their body. Use barrier protection such as condoms when coming into sexual contact (ANY sexual contact…even oral sex) with individuals who have a history of HSV. However, outbreaks can also occur in areas that are not covered by a condom, so condoms may not fully protect you from getting herpes. It is important to have an open discussion with any sexual partners regarding sexually transmitted infections so that you can take appropriate action to prevent further transmission.