Defining the differences in types of HSV
For anyone living with genital herpes – the most common attempt at disclosure will be to compare the infection to that of oral herpes or “cold sores.” There always seems to be an underlying need to somehow “lessen” the severe perceptions that one may have by drawing attention to the herpes that is socially acceptable. Contrary to scientific fact, many believe there will always be a “good” virus (oral herpes) and a “bad” virus (genital herpes).
Based on the various up to date information resources and the assistance of a licensed healthcare provider, we will explore the two types of herpes based on varying criteria.
According to The American Social Health Association, under a microscope HSV 1 and HSV 2 are virtually identical, sharing approximately 50% of their DNA. Both types infect the mucosal surfaces of the body – most often the mouth or the genitals and then establish latency in the nervous system. For both types, it is estimated that two thirds of those infected have no noticeable symptoms or no symptoms at all. Studies have show that both viruses can be spread when there are no symptoms present.
The primary difference between the two types is their “site of preference” when establishing latency in the body. HSV 1 usually establishes latency in the trigeminal ganglion, a collection of nerve cells found near the ears. Recurring outbreaks will generally occur around the mouth or facial region. HSV 2 usually establishes latency in the sacral ganglion, a collection of nerves found at the lower base of the spine. HSV-2 recurring outbreaks will generally occur in the genital region.
Though this is the most commonly noted difference, it is not absolute. Either type can reside in either or both parts of the body and infect orally and/or genitally. Unfortunately, many are unaware of this and this lack of knowledge contributes to the ongoing spread and to the growing number of type 1 genital cases.
With many years of believing that type 1 is only related to oral herpes, many people are not aware that type 1 can and is being contracted both orally and genitally. So many people are under the presumption that there is that “Good versus Bad” virus and with these beliefs social stigmas are thriving. While the “Good Virus” is believed to be “just a cold sore” – society has that euphemism to hide behind and don’t have to acknowledge that cold sores are indeed Herpes.
Common myths give indication that HSV 1 causes a mild infection that is at times bothersome, but never dangerous. The reality is that type 1 is usually very mild when affecting the lips, face or genitals. There has been speculation that type 1 can occur spontantiously in the eye “ocular herpes” however, herpes never occurs spontaneously, it has to come from somewhere – either moving along the trigeminal nerve top branch or autoinoculation. Ocular herpes can be very serious and could potentially lead to blindness. In some very rare cases, herpes has spread to the brain causing herpes encephalitis, an extremely dangerous infection that can result in death. These are however, Very rare! Herpes can be spread to the finger “herpetic whitlow”. Herpes is also quite common among wrestler’s “herpes gladiatorium” (a herpes infection of the chest or face).
Though society believes type 1 to be the “Good Virus”, researchers are finding HSV-1 to be more “risky” than previously perceived. Some medical professionals are finding type 1 to be a more “significant” infection than HSV 2 in the neonate and the prevalence of HSV 1 isseverely underestimated. For years it was believed that90% of people had HSV 1. We know now it is 60%. Even at sixty percent having type 1 orally and the unknown figures of HSV 1 genital cases gives indication that herpes is not a virus to be ignored.
For many years HSV 2 was believed to be a painful and dangerous infection that affects people with an “active sex life”. Genital Herpes can infect anyone who has sex, even if only once. An estimated 22% of adults from varying backgrounds, income levels and ethnic groups have HSV 2. HSV 2 is often so mild that an estimated two thirds of those infected don’t even realize they have it. Type 2 rarely causes complications and more rarely spreads to other parts of the body outside of the risk of autoinoculation that most often occurs during the primary episode.
HSV 2 is the most common cause of neonatal herpes, a rare ut often dangerous and potentially fatal condition that affects newborns. HSV 1 is the primary cause of one third of neonatal infections. You can find comfort in knowing that both are largely avoidable with proper education, instruction and testing.
Because the two types have a “site of preference” both can behave very differently depending on the infected person. HSV 1 and HSV 2 are quite common and neither pose a serious health threat when the patient is introduced to proper information, care procedures and precautionary measures. Due to the common existence of herpes in society, many health care providers dismiss them easily; even considering the long-term emotional effects a positive diagnosis will have on their patient.
HSV – though not life threatening, it is stealing the quality of life of many of those who are infected. At the same time, many of us who carry the virus, regardless of location, realize its common place in society and know it’s nothing more than a “cold sore.”
Outbreaks? And How Often?
The physical problem that HSV poses is primarily based on the individual and three varying factors. Those being; the strength of their immune system, how long they have had the virus, and is the virus affecting the “normal site of preference?”
Obviously a challenged immune system seems to have a strengthening affect on many “viruses” and is the main reason people are bothered by more frequent outbreaks and the primary reason types 1 and 2 are a greater threat to infants who have limited immune response. Having a weakened immune system does not cause the virus to become stronger, it simply makes the body less able to cope with the virus that is there. This factor also causes the viruses to greatly affect those with compromised immune systems due to other illnesses such as cancer, HIV, severe burns, etc.
How long a person has the virus also plays a large role in frequency of outbreaks. It is not clear why a decrease occurs over time. The people with the highest levels of antibody have the greatest number of outbreaks. It’s unclear why people have fewer outbreaks over time but it is likely not an antibody function, but rather perhaps some other part of the bodies immune system.
It is estimated that 100 million American’s who are infected with HSV-1 contracted the virus as a young child. Due to the substantial time of living with the virus, by the time they reach adulthood only about 5% will find it to be a medical problem and seek treatment for shingles.
The estimated 40 million American’s infected with the HSV-2 virus acquired the virus as a teen or as a sexually active adult. Those infected will, on average, experience 4-6 outbreaks that first year, with a decrease in outbreaks occurring over time.
Due to HSV-1 and HSV-2 having their sites of preference and though HSV can account for both genital and oral herpes cases, regardless of type, both are known to be milder when they are “outside their site of preference.” You could easily say the type located in its “site of preference” has the home court advantage.
An example of this is most people infected with HSV-1 genitally have reported fewer outbreaks if any in a single year. It is estimated that HSV-1 now accounts for as many as 30% of all genital herpes cases in the U.S and 2-5% of the recurring outbreaks are associated with the type 1 virus.
HSV-2 oral infections are Very rare and in those few known cases, recurring outbreaks are extremely rare.
Spreading the Virus?
One of the most common “haunt’s” of those infected with genital herpes is the concern of transmitting to a non-infected partner. At the same time, those infected with oral herpes show little concern if any at all of possible transmission.
In reality one type is just as easily transmitted to their site of preference, and can be spread to other locations as well. Both types are most contagious during active outbreaks, however they can be transmitted during times of viral shedding, when no symptoms of an outbreak are present. HSV-1 is shed into the saliva and is likely coming from the mucosa inside the mouth and on the lips, approximately 18% of the days on average, of asymptomatic days, in the person who has intermittent cold sores, when measured by PCR. To date there is no way of possibly knowing when shedding is occurring without the constant supervision of trained researchers.
Typically in the first year of infection with the HSV-2 genital virus, one will shed about 6-10% of those days when there are no symptoms. This of course will decrease over time as well.
There are always questions of transmittability as it pertains to those who already have one type of herpes. As stated by a licensed healthcare provider, “it is true that having HSV 2 protects against getting HSV 1, but there is controversy about whether HSV1 protects against HSV 2 or not. There are two large studies with very different results. At a minimum, HSV 1 keeps the acquisition of HSV 2 more likely to be unrecognized.
HSV-1 is the most commonly acquired form of herpes and is typically spread through a social kiss such as that of a family member. Due to the lack of immune response in children, new HSV-1 infections typically occur in childhood.
Update: “Recent research indicates that HSV 1 is probably not more easily acquired than HSV 2. And now, the average age of acquisition of HSV 1 is in the teens, rather than childhood” according to a licensed healthcare provider.
By the time that child reaches adulthood, they will be one of 50% of American’s living with HSV-1. By the time a person reaches the age of 50, they will be one of 80-90% of those who carry HSV-1.
Nearly all HSV-2 infections are encountered after childhood when they began having sex. Those who have a prior infection of HSV-1 have an acquired immune response that lowers – but will not eliminated the risk of acquiring HSV-2. According to some studies, a previous infection of HSV-1 reduces the acquisition of subsequent HSV-2 by as much as 40%.
A prior infection with HSV-1 orally greatly lowers the risk of contracting type 1 genitally. Studies have shown that the majority of HSV-1 genital cases are occurring in those with no prior history of HSV of either type.
In the absence of prior oral infection, HSV-1 can be spread to the genital area, usually through the practice of oral sex. In some countries, genital HSV-1 accounts for more than half of their entire genital herpes cases.
Some researchers have stated that a prior infection of HSV-2 genitally will protect against infection of HSV-1.
Another common question is – If you have genital HSV-2 will your partner contract it orally through oral sex? The answer is most probably not! About 98% of all HSV-2 infections are genital.
If you have HSV-1 genital can you give this to your partner through genital sex? The answer is Yes! Though the risk is reduced due to the infection not being located in its “site of preference” which means there is far less shedding and much fewer outbreaks.
So now the question is “If HSV is so easily spread from oral to genital, then why are people not taking stronger precautionary measures?” This is due largely because of the social stigma’s that are associated with “the bad virus”. It is all a matter of public education and social acceptance. Many times there is no convincing that person who has a history of cold sores that the lesions have nothing to do with a “cold” but are in fact herpes, because “they went away!” The nearest thing to a cold that is linked to oral herpes is the fact that a challenged immune system will on occasion lead to an outbreak. These cases will typically occur during times of colds or flu’s. The symptoms associated with the primary infection of HSV that includes flu like symptoms often leaves room for this misconception.
Health care providers, researchers and other informed people can offer as much data and information on the differences between HSV-1 and HSV-2, but reality is that as long as society chooses to remain the judge and jury with their opinions and remain locked in the belief that genital herpes is “the bad herpes”, there is little that can be done to begin to erase the social stigmas or alter the mindset of those who choose not to become more educated.
Regardless of all efforts being made, the common belief that “oral sex is safe sex” will also continue. Should unsafe sexual practice continue without proper precautions and testing, Americans could see the numbers of genital herpes increase. On the flip side of that coin, the new NHANES data shows a considerable decrease in HSV 2 infections from about 22% to about 17% so the broad scale efforts into STD awareness must be working.
Because an infection is associated with the genitals and through the act of sex, regardless of how sex is portrayed on television, viewed by society or practiced by as many as 98% of adults, there will always be something “taboo” about any virus that is associated with sex, period.
We can only hope that one day, through the continued efforts of concerned organizations, the walls of social stigma and a judgmental society will begin to fall. Today living with the virus and realizing that you are indeed a part of a majority rather than a minority can offer you the first step to emotional freedom.
Regardless of location, herpes is herpes is herpes. It is only a “cold sore” and is a virus that is treatable, controllable and in many cases avoidable even with a partner who carries the virus. By taking the time to become educated, learning your body, your triggers, your symptoms, etc. you can take control over your life and the virus.
It is all a matter of how proactive and educated you choose to be.
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*This information has been provided with special thanks to Dr. H of Herpes.org, The American Social Health Association, Centers For Disease Control and input from many who live with the Herpes virus.
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