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FAQ~ Herpes Infection

Q: What is Herpes?

A: Genital Herpes is an infection caused by the herpes simplex virus. There are two types of herpes simplex viruses, herpes simplex type I and herpes simplex type II. Both can be transmitted by sexual intercourse of any type, including vaginal intercourse, oral sex and rectal intercourse. Herpes simplex infections are characterized by three phases: an initial infection, latency (when viral infection is asymptomatic), and recurrence. Recurrences are when individuals have repeat outbreaks often at substantial time after the initial infection occurs.

Q: Where does the Herpes virus live in the body?

A: The herpes simplex viruses have the characteristic of latency this occurs because after the initial infection, gets into the nerve roots and spreads to the sensory nerve ganglia. The ganglia are the “nerve junctions” in which nerves from different parts of the body come together. For the genital area, the ganglia are adjacent to the spinal cord at the area called L-4, L-5 S-1. This is in the lower back. For the orofacial herpes (cold sores), the ganglia are in the trigeminal area which is behind the cheek bone.

Q: How common is Genital Herpes?

A: Genital herpes, is typically caused by herpes simplex type II. Current estimates by the Centers for Disease Control (CDC) are that 18% of adult age men and women in the United States are infected with HSV II. HSV II infection is more common in women, it is also more common in persons who have had more than 5 sex partners. Most people with HSV II do not know that they have it (i.e. it is asymptomatic). Based on the CDC’s estimates approximately 40-50 million adults in the United States have genital herpes.

Q: What if I don’t have lesions?

A: In fact, most people with genital herpes don’t have lesions. The typical lesions with herpes are either vesicles (little blisters) which then progress to open sores (genital ulcers). However, most people don’t know that they have it, and often find out either later in life when a serological exam makes the diagnosis, or in many cases they never find out.

Q: Can I spread Genital Herpes?

A: Persons with HSV I and HSV II genital infection can spread it to their sex partners. Typically, transmission efficiency (the likelihood that you would spread the infection from one partner to another) is highest when there are genital lesions or vesicles present. However, transmission during the asymptomatic period is extremely common as well. It is estimated that 1-3 % of persons with asymptomatic genital herpes are shedding the virus at any particular time. If you have sexual intercourse with an individual during that period, you have the risk of transmitting or acquiring the infection.

Q: What are the symptoms?

A: The symptoms of genital herpes are typically non-specific and actually quite mild. In the classic case, persons have the typical grouped vesicular lesions, or genital ulcers. These can be burning and painful. Often, prior to the development of the lesions, patients describe what is called a prodrome. The prodrome is typically a burning sensation in the area where the lesions will develop. Sometimes this can be accompanied by itching as well. Many persons, however, especially women do not have classical symptoms, either because the lesions occur in areas which are not usually observed, or they have mild outbreaks. In these cases, the symptoms can be genital itching, some genital burning, sometimes burning on urination, or occasionally, just a general sense of discomfort in the genital area.

Q: I had lesions when I was evaluated but my culture was negative, does this mean that I don’t have Herpes?

A: One of the biggest problems in diagnosing genital herpes is the issue of test sensitivity. There are a number of reasons why cultures can be negative. One reason can be the fact that the disease is caused by something besides herpes. However, cultures can be negative if the samples are not taken appropriately, if there is a long transport time between the clinic and the laboratory, or if cultures were taken late in the course of the lesions. For example, early lesions (those which occur early in the course of a herpes outbreak) are much more likely to have positive cultures than cultures taken after the lesions crust over.

Q: What are the different types of Herpes and what do they mean?

A: There are two types of herpes simplex virus, one is HSV I and second is HSV II. These are actually very closely related viruses, and in fact, it is difficult to differentiate them until quite recently. HSV I is the cause of most people with oral herpes, cold sores. This is typically acquired as an upper respiratory tract infection during early childhood. Genital herpes, until very recently was mostly caused by HSV II. However, one must realize that it is possible to get infection at the different sites, for example, genital herpes can be caused by HSV I and oral herpes can be caused by HSV II. From a clinical standpoint, and from a symptoms standpoint, it really doesn’t make any difference. Both are also treated the same way. Clinicians cannot tell the difference between the two types by physical examination alone. The importance of understanding the different types, however, is in the area of prognosis. For example, genital herpes caused by HSV II is much more likely to cause recurrence later, and therefore, that can be very helpful in establishing a prognostic plan for an individual patient.

Q: Can Herpes be transmitted by oral sex?

A: Yes, genital herpes can be transmitted by oral sex. This can occur with either type of herpes, and can also occur in the absence of lesions. For example, this is one of the reasons why the proportion of patients with genital herpes caused by HSV I is thought to be increasing. Furthermore, oral sex can transmit herpes even when there are no symptoms (asymptomatic shedding).

Q: Can Herpes be transmitted to other parts of my body?

A: This is a question which we are frequently asked. If you have genital herpes or orofacial herpes, you cannot transmit the infection to another part of your body after the initial infection occurs. For example, if you have genital HSV II, you will not get HSV II at another site in your body, unless you have a severe systemic illness which results in problems with your immune system, such as cancer chemotherapy. The reason why transmission does not occur is that the body produces antibodies which actually protect other parts of your body from becoming infected. There are persons who do have multiple site infections with the same virus. However, these are usually acquired at the time of the initial episode. For example, when an individual acquires herpes, they have oral and genital sex with an infected partner, they can acquire the infection at both sites, because they are susceptible at that time.

Q: Can Genital Herpes be treated?

A: Herpes Simplex Virus infections can be easily treated with drugs which inhibit viral replication. The drugs that are used are Acyclovir, Famciclovir and Valacyclovir. Treatment can reduce symptoms, can reduce the number of outbreaks, and can reduce viral replication. However, treatment is not curative.

Q: I have multiple Herpes outbreaks; can treatment help me prevent outbreaks?

A: Suppressive therapy, can be used to provide coverage for individuals who have frequent outbreaks. In this case, an individual with frequent outbreaks takes a small dose of anti-herpes medication every day, in these cases, it is found that this can reduce the number of outbreaks by over 90%.

Q: Are there side affects from the medication?

A: The drugs which are used to treat herpes have extremely low side affect profiles. Most patients tolerate them quite easily. There are not major complications associated with these medications.

Q: Can the drugs be used safely during pregnancy?

A: The drugs used to treat genital herpes have been safely used during pregnancy. In fact, a large study conducted by the Centers for Disease Control studying over 800 pregnant women and their infants, found that women who took these drugs inadvertently during early pregnancy had no increased incidence of fetal abnormalities or side affects.

Q: What about suppressive therapy?

A: Suppressive therapy with the anti-herpes drugs can successfully reduce asymptomatic shedding as well as the frequency of viral outbreaks. Patients have taken suppressive therapy for long periods of time (up to 10 years in some cases), but in most cases, patients can be weaned from suppressive therapy.

Q: Can I be treated to prevent transmission to my partner?

A: If a couple is “dichotomous”, (i.e. where one partner is documented to have herpes, and the other partner is not documented to be uninfected), then therapy can be used to prevent transmission. In order to document infection status, serological tests need to be performed, in case culture results are not available. Without therapy, and the absence of condom use, the transmission rate between individuals in a couple is approximately 10% per year. By treating the infected partner with suppressive therapy with Valicyclovire, other drugs, transmission of symptomatic herpes can be prevented in over 90% of cases. This is an option for couples who are interested in having unprotected intercourse. This is also an option in couples where pregnancy intention is a factor, especially where the female partner is not infected with HSV.