Herpes Simplex Virus
Herpes is a virus, specifically “herpes virus hominus”. Simplex is a sub-category of the herpes virus family. Herpes Simplex is defined by five categories, types 1, 2, 6, 7, and 8. Generally herpes type 1 infects the mouth in humans and type 2 affects the genital area (sometimes referred to as the boxer short region), however recent studies indicate there is substantial contradiction to that former belief since more and more type 1 genital herpes cases are being diagnosed. Type 6 and 7 cause an infection of infancy (i.e. Roseola and Chickenpox) and Type 8 has been associated with Kaposi’s sarcoma which is most often seen in HIV related conditions.
Herpes simplex virus (HSV) is extremely common in humans. It’s estimated that as many as 80-90% of the entire human population experience oral herpes infections by the age of twelve years old. Some who are infected with oral herpes will have an acute episode that may appear as infected gums and lips, causing high fevers, but most oftentimes those who have oral herpes will have few if any symptoms. A substantial portion of the population has recurrent oral herpes infection, showing up as annoying “cold sores” on lips and sides of the mouth. Oral herpes does have a tendency to show up elsewhere on the face thus creating the position for not realizing that the infection actually is “oral herpes.”
Herpes infects the nerve cells of the spinal cord in the pelvic region (as is the case for genital herpes) and of the nerve ganglia in the facial region at the base of the brain (as is the case for oral herpes). Herpes is a DNA-type virus, inserting its DNA directly into the nerve endings of the skin, which then leads along nerve fibers to the nucleus of the nerve cell. Once the viral information is inserted into the cell’s nucleus, this blending of viral genetic information with human genetic information is permanent (meaning there is no cure and herpes virus remains in the body forever). The nerve cell then becomes somewhat of a “factory” for making more viral particles which can lead to recurring herpes outbreaks or conditions suitable for active viral shedding.
Herpes is not a “skin infection”, but rather an infection of nerve cells, by way of the skin. It is not the “skin” that is infected but rather the nerve cell. When the infection becomes active again in the nucleus of the nerve cell, the viral particles flow back out, down the nerve, and out through little blisters that form in the skin. If the quantity of viral particles coming down the nerve cell isn’t enough to form a blister, then a number of viral particles can be excreted through the skin without any symptoms at all.
“Genital herpes” and “oral herpes” refer to the location where the herpes infection is found on the individual, not the type of herpes. Most genital herpes is caused by HSV-2, but can be caused by HSV-1 in as many as 30% of new cases. Oral herpes is most often caused by HSV-1, and rarely if ever by HSV-2. Because these locations are often associated with a particular type of herpes (which seem to “take hold” in those particular locations more easily), medical people, websites and literature often equate the location with the herpes type. You might find that people speak of genitally-located herpes infections as HSV-2 and orally-located herpes as HSV-1. However, either virus can occur in either place, and in fact, potentially anywhere on the body depending on the point where infection takes place.
Someone with an HSV-1 lesion on the mouth can transmit the infection to an intimate partner through oro-genital contact with the genitalia of the other (oral sex), causing a recurrent HSV-1 lesion on the genitalia of the partner. Also, other sites of HSV infection can be produced, such as on a finger (often referred to as “herpetic whitlow”) or elsewhere.
NOTE: Genital herpes is not always HSV-2 and oral herpes is not always HSV-1.
Genital herpes affects about 20-25% of Americans (that equates to 1 in 5 or even as many as 1 in 4), these numbers likely exceed 50 million Americans. Though most other STDs are seen to be decreasing in their rate of new infections, genital herpes remains one of the fastest growing infectious diseases in the world in absolute numbers of cases. However, Human Papillomavirus (HPV) infections are believed to outnumber herpes infection in both growth rate and likely in absolute numbers.
Generally genital herpes infections are not considered to be extremely contagious. Casual contact on toilet seats, chairs, and similar sorts of common social contact is almost certainly non-contagious, though there is some debate that exists on that issue. Anecdotal case reports of persons acquiring genital herpes through contact in hot tubs have been published though never proven. Obviously such matters would be very difficult to verify. The herpes virus does not survive outside the body for more than about 10 seconds, and although it can survive for slightly longer in warm, damp conditions (i.e. wet towels), it dies very quickly once exposed to the air.
However, genital herpes IS contagious, most oftentimes through direct skin-to-skin contact with an infected area. The method of transmission occurs through an active herpes blister on one person with a challenged or broken area of skin on the other person. For example, a male with an open blister could transmit the virus into the vagina of a female through even the tiniest abrasion in the vaginal mucosa of the female that could occur during intercourse. Similar modes of transmission can occur from female to male, male to male, and even female to female. Oral to oral transmission of either type of virus can also happen much the same way, through infected skin with active viral activity coming in contact with challenged or broken skin.
The virus may be transmitted to the penis, the vagina, the rectum, the mouth, and more rarely, the esophagus, the trachea, and even onto broken areas of skin that may appear anywhere on the body. The New England Journal of Medicine published a photograph of a herpes infection deep down inside the esophagus of a woman in April, 1999. Herpes simplex pneumonias have been reported. And, of course, the Herpes simplex infections of the brain in newborn babies who acquire infection during delivery are well known and may have disastrous consequences. Herpes simplex may also cause wide-spread rashes on the body with redness and swelling in these areas, similar to that of measles.
Once the viral DNA has been transmitted to the receiving person’s nerve cells, the infection is permanent.
Viruses are very tiny, far smaller than bacteria and far smaller than the cells of the human body. Viruses are so small that they can even slip through the tiny inter-cellular holes of the “lamb-skin” type of condom which are normally small enough to prevent sperm cells from getting through. Latex-type condoms have been shown to be most protective against viral transmission, considering the condom covers the affected area completely during the sex act. Viral particles from an active lesion can become liquid borne from inside the condom and possibly leak out the base of the condom.
Herpes infections produce a number of different signs and symptoms. Traditional “first episode” herpes, most commonly described in women, are serious illnesses, with high fever, often severe outbreaks, painful urination and even inability to urinate. Hospitalization is sometimes necessary, with catheterization, IV fluids, and intravenous anti-viral medications being required. Most people diagnosed with a genital herpes infection don’t describe having such severe symptoms; however, they might experience a cluster of small blisters surrounded by a red base on or around the genitalia. Often the blisters have already ruptured, leaving behind a cluster of ulcers which scab over and require as much as one to two weeks to heal. Once the blisters have ruptured, it’s likely that a culture cannot be taken to determine if the blister is in fact herpes related. Thus, it is important to seek medical attention upon first notice of blisters to insure that an accurate culture can be taken and proper diagnosis occurs.
During the blister and ulcer phase, herpes lesions contain enormous amounts of viral particles and should be considered highly contagious to any challenged or broken skin it may come in contact with including but not limited to: the eye, mouth, esophagus, trachea, lungs, anus, urethra, penis and vagina.
In most cases herpes symptoms are subtle and often go undetected. Many have reported slight redness in the skin but without obvious lesions. This area, even without textbook symptoms should be considered contagious. Sometimes the skin will form tiny red bumps that don’t blister, called “erythematous papules”. Sometimes there are no signs on the skin at all but rather a “prodrome” such as urinary urgency, urinary frequency, and/or aching or tingling in the legs. Tingling has been described best as a sensation similar to a rub burn or mild sunburn. Also, itching, burning, tingling, pain or pressure at a previous or potential outbreak site may occur.
Many people with genital herpes and likely in oral herpes cases produce viral particles even when they have no symptoms whatsoever. These people are likely contagious even when they have no symptoms at all. This term is called “asymptomatic shedding.”
In cases of women with genital herpes, herpetic lesions inside the vagina may only produce a vaginal discharge as an external symptom, resembling a yeast infection. It may be difficult without examining the patient to know whether the “yeast infection” is actually what it seems or if it is in fact genital herpes. Some women with both chronic yeast infections and genital herpes infections may find themselves confused as to which problem might be causing the symptoms. These women should be under the care of a trusted doctor and should not attempt to self-medicate until the symptoms have been clearly explained. Self diagnosing and treatment can only make genital herpes symptoms worse.
Viral shedding can occur from people who have acquired the infection asymptomatically. This means that people can acquire a herpes infection and have no symptoms, and later they can be shedding virus and therefore be contagious. In an article that appeared in the New England Journal of Medicine in 2000, Anna Wald concluded that “seropositivity [testing positive in a blood test] for HSV-2 is associated with viral shedding in the genital tract, even in subjects with no reported history of genital herpes.” This means that people can be infected and that only their blood tests might be positive, that they may have no symptoms or few symptoms that are recognized as being caused by herpes, and yet that they may still be shedding virus and may be contagious.