Get the facts about herpes

THERE are two types of herpes simplex viruses (HSV), HSV-1 and HSV-2, which both produce a variety of infections involving mucocutaneous surfaces (mouth and skin), the nervous system and occasionally abdominal organs. They are lifelong infections as the viruses tend to live and remain dormant in nerve cells of the body.

According to internist Dr Jomo James, herpes infections are either sexually transmitted or transmitted via the skin. Sexual infections are acquired through intimate sexual contact and oral infections (cold sores) can be spread by sharing contaminated glasses, utensils and kissing.

“The manifestations and course of HSV infections depend on the anatomic site involved, the age and immune status of the host, and the antigenic type of the virus (type 1 or 2),” Dr James said.

He explained that there is no one type of herpes that is more serious than the other since both can lead to complications.

“HSV-2, which mainly causes genital herpes, is more worrisome and dramatic in its presentation due to the area involved, and as a result psychological damage and awareness are more profound,” he said.

He added that the diagnosis of both types of herpes can be done based on the manifestation of the infection.

“In a few instances a blood test can be done to determine antibody reaction. It also differentiates between the types. Rarely a smear/biopsy of a lesion can confirm the diagnosis,” Dr James said.

Below he explains a few facts and differences about HSV.

1. HSV-1 is more common and can be acquired earlier in life than HSV-2.

2. The HSV-1 herpes is more ubiquitous than you think. “According to a study done in USA, approximately 80 to 90 per cent of people were positive for HSV-1 by age 50 and up to 25 per cent for HSV-2. These were individuals without any symptoms. The main reason is that HSV-1 is more readable and accessible for transmission by kissing and contaminated utensils so one is potentially exposed from it by birth, whereas HSV-2 is mainly through sexual contact so potential start of exposure is from puberty,” Dr James said.

3. “HSV-1 is associated more with oral herpes and over 90 per cent of the time this includes infection of the oral cavity leading to cold sores or night fever, while HSV-2 is more associated with genital herpes 80 per cent of the time,” he said. He added that genital herpes manifests as blisters and sores in the genital area accompanied by burning and itching.

4. According to Dr James, if HSV-1 causes genital herpes the symptoms are not only milder, but recurrences are rare as opposed to HSV-2, because the symptoms are more severe and the recurrence rate is much more frequent. The converse is true for oral herpes.

5. “HSV-1 is more transmissible and more frequently acquired as, apart from sexual activity, it can be transmitted more easily through kissing,” he said.

6. Dr James said HSV-2 is twice as likely to reactivate than HSV-1. “Recurrence or reactivation is the reappearance of symptoms throughout a person’s lifetime. The rate of, severity and frequency depends mainly on the immune system of the individual. There are also many triggers for a recurrence including stress and menstruation in women. Reactivation herpes symptoms are usually milder than first attack infections.”

7. “The majority of people who acquire HSV, particularly type 1 infections, will never have a clinical manifestation of the disease or spread the infection. The few who do end up with first episodes only, and only a minority will have reactivation,” he said.

8. Dr James said both types of viruses can cause either oral herpes or genital herpes, or both, with one type having a predilection over the other.

9. The main manifestation of both is sores, blistering, and multiple water bumps over the affected area. “Rarely do complications occur, for instance, brain infections or liver infections,” he said.

With regards to treatment, Dr James said many aspects of HSV infection are amenable to antiviral therapy.

“The three most commonly used antivirals are acyclovir, famciclovir and valcyclovir. These range from topical creams to oral and intravenous forms of these medications,” he said.

Dr James added that the creams are usually used for mild cold sores and tablets for genital outbreaks, while the intravenous forms are used for serious, complicated infections.

“First attack episodes are usually treated with any of the above. Reactivation herpes are also treated in this way; however, people with frequent attacks may qualify for preventative therapy, whereby continual oral administration of antivirals may limit the amount of recurrence. It is best to speak with a doctor about the right treatment options for you.” he said.

To reduce the risk of contracting HSV-1, avoid touching the saliva, skin or mucous membranes of people who have HSV-1 symptoms. Dr James said prevention of genital HSV may be accomplished by latex condoms, but protection is never 100 per cent. Inquiring about your partner’s sexual history, limiting your sexual partners, getting tested for herpes, and refusing intimacy from people with clear symptoms of both types are ways in which you can protect yourself from the virus.