Health Care and Herpes

One of the most communicable diseases in the world is herpes, and it is very contagious to both men and women. Herpes is considered a virus. Most commonly, one strain of is transmitted through sexual contact and is classified as an STD—sexually transmitted disease. The other is typically known as a fever blister or cold sore, usually found on the face, mouth, and lips.

According to WebMD, herpes simplex viruses -- more commonly known as herpes -- are categorized into two types: herpes type 1 (HSV-1, or oral herpes) and herpes type 2 (HSV-2, or genital herpes). Most commonly, herpes type 1 causes sores around the mouth and lips (sometimes called fever blisters or cold sores). HSV-1 can cause genital herpes, but most cases of genital herpes are caused by herpes type 2. In HSV-2, the infected person may have sores around the genitals or rectum. Although HSV-2 sores may occur in other locations, these sores usually are found below the waist.

Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries, according to Avert.org. Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners. Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sexual intercourse. The virus affects the areas where it enters the body. This can occur during:

• vaginal sex
• anal sex
• oral sex (HSV-1 or HSV-2)
• kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact. If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:

• Itching or tingling sensations in the genital or anal area;
• small fluid-filled blisters that burst leaving small painful sores;
• pain when passing urine over the open sores (especially in women);
• headaches;
• backache;
• flu-like symptoms, including swollen glands or fever.

Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal, according to Avert.

Genital herpes, according to the Centers for Disease Control (CDC), is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, 16.2%, or about one out of six, people 14 to 49 years of age have genital HSV-2 infection. Over the past decade, the percentage of Americans with genital herpes infection in the U.S. has remained stable. Genital HSV-2 infection is more common in women (approximately one out of five women 14 to 49 years of age) than in men (about one out of nine men 14 to 49 years of age). Transmission from an infected male to his female partner is more likely than from an infected female to her male partner. A significant amount of information about this topic can be found at this site: http://www.cdc.gov/std/herpes/stdfact-herpes.htm

Herpes infections, no matter where they occur first, have a tendency to recur in more or less the same place. Such recurrences may happen often (for example, several times per year) or only occasionally (for example, once or twice a year), according to MedicineNet.com. After infection, the virus enters the nerve cells and travels up the nerve until it comes to a place called a ganglion. There, it lays quietly in a stage that is referred to as "dormant" or "latent." At times, the virus can become active and start replicating again and travel down the nerve to the skin, causing sores and blisters. The exact mechanism behind this is not clear, but it is known that some conditions seem to be associated with recurrences, including

• a fever, a cold, or the flu;
• ultraviolet radiation (exposure to the sun);
• stress;
• changes in the immune system;
• trauma to the involved area;
• sometimes there is no apparent cause of the recurrence.

Infections caused by HSV are contagious. The virus is spread from person to person by kissing, by close contact with herpetic lesions, or even from contact with apparently normal skin that is shedding the virus. Infected saliva is a common means of virus transmission. People are most contagious when they have active blister-like sores. Once the blisters have dried and crusted over (within a few days), the risk of contagion is significantly lessened. However, a person infected with HSV can pass it on to another person regardless of the presence or absence of symptoms and visible sores or blisters. This is because the virus is sometimes shed in saliva even when sores are not present. Despite popular myth, it is almost impossible to catch herpes (cold sores) from surfaces, towels, or washcloths. Much more detailed info can be found at this site: http://www.medicinenet.com/herpes_simplex_infections_non-genital/article.htm  .

There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners, according to the CDC. The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Genital ulcer diseases, as per the CDC, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes. Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.

According to Merck, during recurrences, antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, may relieve discomfort slightly and help symptoms resolve a day or two sooner. Treatment is most effective if started early, usually within a few hours after symptoms start—preferably at the first sign of tingling or discomfort, before blisters appear. For people who have frequent, painful attacks, the number of outbreaks can be reduced by continuous therapy (suppression) with antiviral drugs. Antiviral drugs are available by prescription only.

Penciclovir cream, applied every 2 hours during waking hours, can shorten the healing time and duration of symptoms of a cold sore by about a day. Nonprescription creams containing docosanol (applied 5 times a day) may provide some relief. Acyclovir, valacyclovir, or famciclovir taken by mouth for a few days may be the most effective treatment. Severe HSV infections, including herpes encephalitis and infections in newborns, are treated with acyclovir given intravenously. If the virus becomes resistant to acyclovir, foscarnet can be given. People with herpes simplex keratitis are usually given trifluridine eye drops. An ophthalmologist should supervise treatment.

For people who have minimal discomfort, the only treatment needed for recurring herpes of the lips or genitals is to keep the infected area clean by gentle washing with soap and water. Applying ice may be soothing and reduce swelling. Applying prescription or nonprescription topical anesthetics, such as tetracaine cream or benzocaine ointment, may help relieve pain. If the mouth contains many sores, the mouth can be rinsed with lidocaine, which should not be swallowed. Topical anesthetics should be used only about once every few hours. If used more often, these drugs can have harmful side effects. Pain relievers may be taken for pain, according to Merck.

Herpes is a medical condition that can be painful and embarrassing. Learning to understand it, treat it, and live with it is something everyone can do who suffers from this health care issue. If you feel that you have symptoms, see your primary care physician for diagnosis. The common sense rules of personal interaction with someone who may have herpes should apply. Be careful, and be smart.

Until next time.