Information on Genital Herpes

General Information and Terminology

The herpes virus which causes both genital herpes and cold sores is the herpes simplex virus, abbreviated HSV. There are two types of HSV: HSV-1 and HSV-2. Most oral (i.e, cold sores) and ocular infections are caused by HSV-1; most genital infections are caused by HSV-2. However, either can cause infection anywhere on the body.

The other herpes viruses are the Epstein-Barr virus, which causes mononucleosis, and the varicella-zoster virus which causes chicken pox and shingles. Apparently shingles is an adult recurrence of chicken pox!

In addition, there is something ominous (and often fatal) called herpes encephalitis in which the herpes simplex virus infects the brain and spinal cord. Genital and presumably oral, ocular, and other variants of herpes does NOT lead to herpes encephalitis.

The technical literature refers to infections as being primary, initial, or recurrent. A primary infection is one where blood tests don't show antibodies for HSV-1 or HSV-2 at the time that the infection is diagnosed; i.e., one has not been previously exposed to the type of herpes for which one will now be treated. An initial infection is one where no symptoms of infection have previously been noticed, but blood tests show antibodies for HSV-1 or HSV-2. A recurrent infection is just that.

What it's doing when it's doing it

"During a ... primary infection of either type 1 or type 2, herpes simplex will multiply at the original site of skin exposure to cause the characteristic sores. Also, very early in the course of the infection, some viruses will leave the sores to migrate up the sensory nerve that serves the site of the sores. These viruses become inactive, or latent, when they reach the nerve cell center, or ganglion. Even after the sores have healed, the virus remains in the ganglia to form a permanent reservoir of infection." During a recurrence, "the virus becomes reactivated, probably returns down the same nerve, and multiplies on the skin at or near the site of the original sore". (5)

Symptoms

Symptoms of a primary episode usually appear (if they appear) 2 to 20 days after exposure, and last an average of 2 to 3 weeks. However, the first noticeable symptoms of infection can also appear years after exposure.

"...Early symptoms can include a burning sensation, pain in the legs, buttocks, or genital area, vaginal discharge, or a feeling of pressure in the abdominal region. Within a few days, sores (lesions) appear on the penis, on the vulva or in the vagina, or around the anus. These small, red bumps, later develop into blisters or painful open sores. Over a period of days, the sores become crusted and then heal...

Symptoms that often accompany a person's first infection with herpes can include fever, headache, muscle aches, painful or difficult urination, and swollen glands." (1)

Generally, the first outbreak is the most severe and most prolonged. Later outbreaks tend to be less severe, and the intervals between recurrences tend to lengthen over time. Sometimes there is no recurrence, but usually there is.

Reading between the lines, it would seem that most HSV infections are asymptomatic. In one study of over 2,000 individuals only one-fourth of those with antibodies to HSV- 2 had symptoms which by their own description seemed to the researchers to be symptoms of herpes. In another group, 57% had type 2 antibodies, but only 3% "gave histories of any syndrome compatible with genital herpes". (4)

Transmission - symptomatic and asymptomatic

Herpes is definitely contagious from the time that the first symptoms of an outbreak occur (i.e., before the blisters appear) until the sores are completely healed. Once again, the first outbreak is the most virulent; in recurrences less virus is present in the sores.

"Herpes infections can be transmitted when any part of person's body directly touches active herpes virus or sores containing active herpes simplex virus. Mucous membranes, such as those in the mouth or genital area, are very susceptible to herpes invasion. Intact skin is usually resistant, but skin that is broken or damaged - for example by cuts, abrasions, burns, eczema, or infection - may easily be infected by herpes simplex virus" (5)

Asymptomatic transmission is also possible, although there doesn't seem to be any consensus about how common it is. Various statements on the subject are:

"Anywhere from 1 to 10 percent, depending on the population studied." (2)

"Three-fourths of source contacts known to patients with documented primary infections gave no histories of genital lesions at the time of contact." (4)

"Sometimes." (5)

"Minuscule" (HAH!)

Autoinoculation (spreading the infection from one part of ones own body to another part) is possible, though not likely. Once again, it is most likely to occur during a primary infection.

Prophylactic Measures

When there is ANY sign of an outbreak, abstain. Any signs means a suspicion of discomfort, not the appearance of sores. Abstain until the sores are healed and the scabs have fallen off.

While the virus is too large to pass through a condom, in "real-life" situations their protective value is uncertain." Possibly spermicidal jellies containing Nonoxynol 9 have some deterrent effect. Oral acyclovir reduces virus shedding during an outbreak, and so may reduce risk of transmission, but is not given as a prophylactic. (It's expensive, it hasn't yet been determined that it reduces shedding during asymptomatic phases, and the risks of long term use are not known).

Vaccines have been under development since the early 80's (at least), but apparently it is extremely difficult to develop a vaccine against herpes which isn't excessively hard on whatever takes it. NO VACCINE IS CURRENTLY AVAILABLE!

Treatment

The discomfort can be relieved to some extent by keeping the infected area clean and dry, and by wearing loose fitting clothing. This may also help the sores to heal faster. Obviously, avoid touching the sores, since they contain active virus. Aspirin may provide symptomatic relief.

Oral acyclovir reduces the severity and duration of primary outbreaks, if taken early enough in the course of the infection. Maintenance dosages reduce the frequency and duration of recurrences, but once treatment is stopped the preventative effect stops also. In recurrences, oral acyclovir reduces the duration of virus shedding, but has little effect on the symptoms.

Hazards

The major hazard is to infants at the time of birth. Also there is a danger of spontaneous abortion associated with primary infections during pregnancy. Children delivered vaginally during the course of a herpes episode are at considerable risk (estimated 40 to 60 percent) of being infected. Of the infected infants, more than half develop fatal diseases. In the presence of active infection, the infant is generally delivered by C-section, which protects the infant from infection. The infant cannot be infected through the mothers bloodstream.

For adults herpes (after the first outbreak) is generally more of a social catastrophe then a physical one, although infrequently adults are incapacitated by severe and/or frequent recurrences.

Pervasiveness

Herpes is EXTREMELY common. Various statistics are:

"Affects an estimated 30 million Americans. Each year as many as 500,000 new cases are believed to occur." (1)

"The prevalence of HSV infections (Types 1 and 2) in the general population is high. Estimates vary from 40 to 100 percent based on random sampling of sera for HSV antibodies" (2)

References

(1) The Search for Health. The National Institutes of Health. Bethesda, Maryland. October, 1988

(2) Herpes: Facts and Fallacies. American Journal of Nursing. June, 1982

(3) Oral Acyclovir for Treatment and Suppression of Genital Herpes Simplex Virus. Journal of the American Medical Association. April, 1986

(4) Epidemiology of Genital Herpes Infections in the United States - The Current Situation. Journal of Reproductive Medicine. May 1986.

(5) Genital Herpes. U.S. Department of Health and Human Services. Sept. 1983.

Information sources

Herpes Resource Foundation. Provides information, therapy, etc. Contact them at HELP, P.O. Box 100, Palo Alto, CA 94302 or call (415) 328-7710 or (800) 227-8922.

Technical Information Services, Division of Sexually Transmitted Diseases, Center for Disease Control, Atlanta, GA, 30333. Written material available upon request.