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What is herpes? Herpes is an infection caused by HSV, or the Herpes Simplex Virus. The herpes simplex virus, or herpes, is categorized into two types, herpes simplex virus type one, otherwise known as HSV-1, or oral herpes, sometimes commonly known as a cold sore, or two, herpes simplex virus type two, HSV-2, otherwise known as genital herpes. Let's take a closer look at herpes simplex virus type one known as oral herpes. We know that it's 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 majority of the HSV-1 infections are oral herpes, and they're infections that are around the mouth known as orolabial, oral-labial, or oral-facial herpes. Let's talk about the incidence of HSV-1, known as oral herpes. 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, there were 87%, and the lowest in the Americas, which ranged between 40 and 50 percent. 140 million people aged 15 to 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. Now let's take a look at herpes simplex virus type one, oral herpes, and how it's transmitted. Oral to oral contact, which is the main transmission of the virus in sores, saliva, and surfaces around the mouth, oral to genital contact, which may cause genital herpes. HSV-1 can be transmitted from oral or skin surfaces that appear normal, and when there are no symptoms present. 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. In looking at the incubation period, it normally lasts between two to 12 days. Its signs and symptoms may include, nothing at all, which is mostly asymptomatic, or tingling, itching, or burning sensation around the mouth before the appearance of sores. Painful blisters or open sores called ulcers in or around the mouth, known as cold sores. Clusters or groups of painful blisters, also termed fever blisters, or vesicles, erupt or ooze with a clear to yellowish fluid that may develop into a yellowish crust. Frequency of recurrences varies from person to person. When looking at oral sores, we may want to pay special attention to the fact that they cause intense pain, occurring at the onset, and makes eating and drinking difficult. It may occur on the lips, the gums, the front of the tongue, the inside of the cheeks, the throat, and the roof of the mouth. They may also extend down the chin and neck. Gums may become mildly swollen and red and may bleed. Neck lymph nodes often swell and become painful. In people in their teens and 20s, herpes may cause a painful throat, with shallow ulcers and a grayish coating on the tonsils. It's important to remember that there's a period of communicability. Secretion of virus in the saliva may occur for up to seven weeks after recovery from stomatitis. Patients with primary genital lesions are infectious for seven to 10 days. Now let's look at herpes simplex virus type two, otherwise known as genital herpes. It's 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 one. Infection with HSV-2 is lifelong and incurable. Let's take a look at the incidence of HSV-2, or genital herpes. Annually, 776,000 people in the United States get new herpes infections. Nationwide, 15.7% of persons aged 14 to 49 years have HSV-2 infection. HSV-2 infection is more common among women than among men, 20.3% versus 10.6%, in 14 to 49-year-olds, possibly because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. So, how is herpes simplex virus type two transmitted? Primarily sexually. 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. Let's talk about the incubation period, which normally ranges between two and 12 days. The signs and symptoms include asymptomatic, which means no symptoms at all, or they could have a very mild symptom that goes unnoticed or is mistaken for another skin condition. There can be one or more vesicles, or small blisters, on or around the genitals, rectum, or the mouth. On its first outbreak, it usually has longer duration of herpetic lesions. It has increased viral shedding, making the HSV transmission much more likely. It has systemic symptoms which include fever, body aches, swollen lymph nodes, or a headache, and the recurrence of the outbreaks are usually localized by genital pain, tingling or shooting pains in the legs, hips, or buttocks, which occur hours to days before the eruption of herpetic lesions and are typically shorter in duration and are less severe than the first outbreak of genital herpes. Now let's talk about the diagnosis of herpes simplex virus. First, HSV-1, or oral herpes, first by Immonosorbent Assay, ELISA. This type-specific HSV-1 blood test looks for antibodies to the HSV-1 virus in the bloodstream. This test is highly sensitive, and will only detect the presence of HSV-1 antibodies. For HSV-2, or genital herpes, a polymerase chain reaction, which is a more sensitive test, allows for more rapid and accurate results and is increasingly being used. They can also use a viral culture, which requires collection of a sample from the lesion and once viral growth is seen, specific cell staining to differentiate between HSV-1 and HSV-2. The CDC does not recommend screening for HSV-1 or HSV-2 in the general population. Several scenarios where type-specific serologic HSV tests may be useful include, patients with recurrent genital symptoms or atypical symptoms and negative HSV PCR or culture, patients with a clinical diagnosis of genital herpes, but no laboratory confirmation, patients who report having a partner with genital herpes, patients presenting for an STD evaluation, especially those with multiple sex partners, persons with HIV infection, and MSM at increased risk for HIV acquisition. Now let's talk about the treatment for herpes simplex virus. Currently, there are no cures for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time that the person takes the medication. Daily suppressive therapy, for example, daily use of the antiviral medication for herpes, can reduce the likelihood of transmission to partners. There is currently no commercially available vaccine that is protective against genital herpes infection. It is important to talk about prevention. Avoid oral contact with others and sharing objects that have contact with saliva. Abstain from oral sex to avoid transmitting herpes to the genitals of a sexual partner. When talking about HSV-2, or genital herpes, it's important to remember to abstain from sexual contact, and it's good to be in a long-term, mutually monogamous relationship with a partner who has been tested for STDs and is known to be uninfected.
In this lesson, we're going to look at herpes, including some shocking statistics, the two types of herpes, how it's transmitted, how it's diagnosed, treatment options, and how to prevent herpes.
The herpes infection is caused by the herpes simplex virus (HSV). There are two categories or types of herpes – herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
Herpes simplex virus type 1 refers mainly to oral herpes, which appears mostly as cold sores. Herpes simplex virus type 2 refers to genital herpes.
Herpes Simplex Virus Type 1 (HSV-1) Oral Herpes
HSV-1 is highly contagious and is a larger problem around the world than most would think. Most HSV-1 infections are acquired during childhood and infection is lifelong. Also, most HSV-1 infections are oral herpes (rather than genital) that occur in and around the mouth.
The incidence rates of HSV-1 are profound. In 2012, there were an estimated 3.7 billion people worldwide under 50 years of age with the infection. The highest area of prevalence was in Africa, at around 87 percent of the population. The lowest area of prevalence was in the Americas, at between 40 and 50 percent.
In 2012, there were 140 million people between the ages of 15 and 49 with the genital version of HSV-1 and prevalence once again varied by region. Most genital HSV-1 infections occurred in the Americas, Europe, and the Western Pacific region, where it continues to be acquired well into adulthood.
In other regions, like Africa, most HSV-1 infections are acquired in childhood, well before the age that most begin having sexual contact.
Herpes Simplex Virus Type 1 (HSV-1) Oral Herpes – How is it Transmitted?
This infection is mostly transmitted by mouth to mouth contact via sores, saliva, and surfaces in and around the mouth. The other mode of transmission is oral to genital contact, which is the cause of genital type 1 herpes.
Pro Tip #1: HSV-1 can be transmitted from oral or skin surfaces that appear normal and healthy, as in an absence of signs and symptoms. However, it's equally important to know that the greatest risk of becoming infected is when there is the presence of obvious and active sores.
Individuals who already have HSV-1 oral herpes are unlikely to also be infected with HSV-1 genital herpes. In rare circumstances, an infection can be transmitted from mother to baby during birth.
The incubation period for HSV-1 oral herpes is between 2 and 12 days.
Herpes Simplex Virus Type 1 (HSV-1) Oral Herpes – Signs and Symptoms
There are often no signs and symptoms of HSV-1 oral herpes. However, if there are, those symptoms include:
- Tingling, itching, and burning sensation around the mouth prior to sores appearing
- Painful blisters and open sores in and around the mouth, such as cold sores
- Clusters or groups of painful blisters that ooze clear, yellowish fluid that will crust over
This type of infection comes and goes, and the frequency of recurrences varies from person to person.
Oral symptoms, in particular, can result in intense pain at the onset of infection, making eating and drinking difficult. Symptoms can appear on lips, gums, the front of the tongue, inside the cheeks, in the throat, and on the roof of the mouth. Gums can become mildly swollen and red and may bleed.
Symptoms aren't limited to the oral areas and can extend down the chin and neck. Lymph nodes in the neck are often swollen and painful. For people in their teens or 20s, sore throats with swollen sores and a grayish coating on the tonsils are also common symptoms.
Pro Tip #2: Herpes is highly communicable (easily transmitted to others). The secretion of the virus in saliva can occur for up to seven weeks after recovery from stomatitis – inflammation of mouth and lips. And people with primary genital lesions are infectious for 7-10 days.
Herpes Simplex Virus Type 2 (HSV-2) Genital Herpes
HSV-2 is also widespread around the world and is almost exclusively sexually transmitted and the main cause of genital herpes, though as you've just learned the HSV-1 virus can also cause genital herpes.
Infection with HSV-2 is also lifelong and incurable.
The incidence rates of HSV-2 are just slightly less shocking than HSV-1. Annually, 776,000 people in the U.S. get a new HSV-2 herpes infection. Slightly more than 15 percent of people ages 14 to 49 have an HSV-2 infection.
HSV-2 is more common for women than men (20.3 percent vs. 10.6 percent) as genital infection is more easily transmitted from men to women.
Herpes Simplex Virus Type 2 (HSV-2) Genital Herpes – How is it Transmitted?
This type of herpes 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 or around the genitals and anal area that appears normal and symptom-free. And in rare circumstances, it can be passed from mother to baby during birth.
The incubation period for HSV-2 genital herpes is between 2 and 12 days.
Herpes Simplex Virus Type 2 (HSV-2) Genital Herpes – Signs and Symptoms
Like HSV-1, HSV-2 can also be present without any symptoms at all or just mild symptoms that go unnoticed or are mistaken for something else. When symptoms are present, they include:
- One or more small blisters on or around the genitals, rectum, or mouth
- Fever
- Body aches
- Swollen lymph nodes
- Headache
Pro Tip #3: The first outbreak usually includes longer-lasting symptoms (like sores or lesions) and a greater chance of transmitting the infection to others.
Symptoms of recurrent outbreaks also include:
- Localized genital pain and tingling
- Shooting pain in the legs, hips, and buttocks
Recurrent symptoms can occur hours or days before the eruption of lesions, which are typically shorter in duration and less severe than the first outbreak.
How is Herpes Diagnosed?
HSV-1 (Oral Herpes)
HSV-1 diagnosis is done through an Immunosorbent Assay (ELISA) test. This is a blood test that looks for antibodies to the HSV-1 virus in the blood. This is a highly sensitive test and will only detect the presence of HSV-1 antibodies.
HSV-2 (Genital Herpes)
HSV-2 diagnosis is done using a Polymerase Chain Reaction (PCR) test. This test produces rapid and accurate results and is increasingly being used. A viral culture requires a sample from a lesion and if viral growth is found, a procedure will differentiate the HSV-1 virus from the HSV-2 virus.
Pro Tip #4: With the shocking statistics presented in this lesson, you may be inclined to be tested immediately. However, the CDC does not recommend screening for the general population.
Having said that, there are several scenarios where HSV tests may be recommended and these include:
- People with recurrent genital symptoms
- People with a clinical diagnosis of genital herpes even though lab tests have not been done to confirm an infection
- People who have a sex partner with herpes
- People who have another STD or have multiple sex partners
- People who have HIV
What are the Treatment Options for Herpes?
As already mentioned, there is no cure for either type of herpes. However, antiviral medications can prevent or shorten outbreaks for those who are infected. Also, antiviral medications can reduce the chance of spreading the disease to others.
At this time, there is no commercially available vaccine to protect against either herpes virus.
What are the Prevention Techniques for Herpes?
Herpes prevention looks like a recipe for becoming a Buddhist monk and includes:
For HSV-1 (Oral Herpes)
- Avoid oral contact with others and sharing objects that come in contact with saliva
- Abstain from oral sex to avoid the transmission of herpes to the genitals of all sex partners
For HSV-2 (Genital Herpes)
- Abstain from sexual contact
- Be in a long-term, mutually monogamous relationship with sex partners who have been tested and shown to be uninfected