Oral and Genital Herpes: Lifelong, Yet Manageable Infections

Oral and Genital Herpes: Lifelong, Yet Manageable Infections

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Herpes is one of the most common and widely known sexually transmitted infections (also known as STIs, sexually transmitted diseases or STDs) in the world. Oral and genital herpes are viral infections caused by 1 or more types of the herpes simplex virus (HSV). While it’s likely that you have at least heard of herpes before, you may have questions about what it is exactly, who it affects and how to protect yourself from it. In this blog, we’ll answer these questions and provide more information about this common STI.

While there are more than 100 types of herpes virus, just 8 affect humans.1 Of those 8, there are 2 common types of herpes simplex virus, known as “HSV type 1” and “HSV type 2,” which cause genital and oral herpes.1 Both HSV-1 and HSV-2 are incurable viruses; that is, once a person has herpes infection, he or she has it for life.2 While herpes cannot be cured, it can be managed, and people with herpes can live completely normal, healthy lives. The most common signs of infection are blister-like sores on or around the mouth, genitals or other areas such as the eyes, throat or inner thighs.2,3 A person can be infected with HSV-1 or HSV-2, and it’s possible for either of these types to infect the genital or oral areas.3 While herpes cannot be cured, healthcare providers can provide treatment for symptoms.1

Herpes testing is simple. If you are worried you may be infected, talk to your doctor as soon as possible. With the help of certain medication and other therapy, people who test positive for HSV can live happy, healthy lives.

Hologic Offers Herpes Testing

Hologic, Inc., is an innovative medical technology company that makes tests and instruments that are used in labs and doctors’ offices across the world to detect problems and help healthcare providers give the best care to each patient. Hologic makes a test to identify herpes from anogenital lesions (blister-like sores around the genitals) when a patient has symptoms: the Aptima® HSV 1 & 2 assay. The Company also has tests for other infections like hepatitis B, HIV-1 (the virus that causes AIDS), chlamydia, gonorrhea and trichomoniasis.

What is HSV?

HSV infections cause “outbreaks” of the blisters we discussed earlier.4 Herpes outbreaks on and around the mouth are called oral herpes, or sometimes “cold sores.” Infection with HSV-1 almost always causes oral herpes, though in rare cases may be caused by HSV-2.3 Genital herpes causes outbreaks of blisters around a person’s penis, vagina or anus.3 It is most commonly caused by HSV-2, but can also can be caused by HSV-1.3

Oral Herpes Genital Herpes
HSV-1 HSV-1 is the most frequent cause of oral herpes.5 HSV-1 can cause genital herpes.5
HSV-2 HSV-2 very rarely causes oral herpes, although people with compromised immune systems are more at risk.5 HSV-2 is the most frequent cause of genital herpes, but more and more cases of genital herpes are caused by HSV-1.5

Origin and Discovery of Herpes

Both types of herpes are part of the scientific family Herpesviridae.6 The name herpes, which was first given to certain skin disorders by ancient medical writers like Hippocrates, is Greek for “creep or crawl.”6

Before HSV-1 and HSV-2 infected humans, they were present in ancestors of modern humans and in ancient chimpanzees.7 HSV-1 infected hominids, an ancient primate ancestor of humans, more than 6 million years ago.7 HSV-2 is thought to have passed to an ancient human ancestor, Homo erectus­, from chimpanzees around 1.6 million years ago, and later was found in modern man.7 Today, different types of herpes affect humans and primates like gorillas and chimpanzees, although only human beings have shown the ability to be infected with both HSV-1 and HSV-2 at the same time.7

Prevalence of Herpes Simplex Virus

Herpes is one of the most common sexually transmitted infections (STIs) in the United States and globally.8,9

  • About 1 in 2 people ages 15-49 in the United States have HSV-1 (which commonly causes oral herpes).8 Globally, more than 3.7 billion people ages 15-49 are infected.9
  • About 1 in 6 people ages 15-49 in the United States have HSV-2 (which commonly causes genital herpes).8 Globally, more than 417 million people ages 15-49 have HSV-2 infection. 9

Herpes Transmission

Both types of HSV spread through direct contact with another person. Herpes spreads through:

  • Herpes sores – HSV may be transferred when an uninfected person comes in contact with a herpes sore either during genital contact or through kissing.10
  • Saliva – Oral herpes can transfer through saliva when it comes in contact with an open sore.10 Most oral HSV-1 infections are acquired in childhood through saliva or direct contact with an oral herpes sore.2
  • Genital secretions – Whether or not a herpes sore is present, the virus can pass through genital secretions.10
  • Skin – HSV can pass from an infected person through the skin around the mouth or genitals during an outbreak.10
  • During birth – In rare cases, HSV-1 and HSV-2 can pass from a mother to her baby during childbirth. However, there are precautions (such as C-section delivery) that can help avoid transmission.2

Like many STIs, there is a lot of incorrect information that swirls around about herpes. You cannot get herpes from:

  • Toilet seats10
  • Sheets or other bedding10
  • Swimming pools10
  • Other objects like towels, silverware or soap10

Symptoms of Herpes

While herpes is one of the most widespread viral infections in the world, most infected people do not have symptoms and do not know they have the STI. When signs of infection do appear, they are often mild and easily mistaken for other skin conditions such as a pimple or insect bite or for other infections like yeast infection. The herpes virus can live in your body dormant – as if it were asleep – for many years without causing noticeable symptoms.11

As discussed earlier, when herpes infections do show symptoms, the most common, recognizable symptoms are outbreaks of blister-like sores. These can last anywhere from 2-4 weeks during the first outbreak.11 The first outbreak a patient experiences may also be accompanied by flu-like symptoms, like fever and swollen lymph nodes, especially near the groin.11 A person may also experience headache or pain during urination.11

Repeated Herpes Outbreaks

The first herpes outbreak is almost always the most severe outbreak that a person will experience.11 After the first outbreak, symptoms are usually much more mild, and may not include body aches, fever or headaches like the first outbreak.10,11 These outbreaks are typically shorter and can last just a few days.11 HSV-2 infection is more likely to lead to recurrent outbreaks than HSV-1 infection.2

After a first outbreak, some patients report noting different “triggers” that may contribute to the start of an outbreak. While they differ for different people, contributing factors may include illness, poor diet, stress, exposure to ultraviolet light, friction in the genital area (such as from tight pants or wet underwear) and more.11

Prodrome Feeling

Some patients who have already experienced what a herpes outbreak feels like may begin to tell when new outbreaks are coming in the future. Patients have said they feel an itching, tingling or pain in the area where they get outbreaks. This is called “prodrome,” which is a type of warning sign the body gives to let patients know that an outbreak is coming on.11 If you have been diagnosed with herpes and have this feeling, it is smart to begin avoiding skin-to-skin contact and take other safety steps to avoid spreading the virus.11

Testing for HSV

Though many people have HSV infection, the Centers for Disease Control and Prevention only recommends testing for people who have symptoms.12 If you are worried you may have been exposed to HSV, it’s important to ask your healthcare provider about testing.

For people with blisters or other symptoms that may be herpes, the CDC recommends “type-specific” testing for HSV.12 Type-specific testing means using a test that detects if a person has herpes and which type of HSV they have (HSV-1 or HSV-2).12

In addition to testing patients with herpes-like symptoms, the CDC says testing may be useful for:

  • People who have a current or past partner with herpes.12
  • People who want to have a full sexual health evaluation, especially patients with multiple sex partners.12

The Physical and Emotional Consequences of HSV Infection

While herpes is incurable, identifying the presence of the virus can help patients (with guidance from their healthcare providers) manage outbreaks.

Physical Impact of HSV Infection

Herpes infection typically does not have symptoms, but can lead to meningitis or encephalitis, which are serious diseases that affect the nervous system (brain and spinal cord).13

Certain groups may experience more serious physical problems relating to herpes than other groups. They include:

  • Patients with compromised immune systems, such as people with HIV, may experience more severe outbreaks, which may require additional care.13
  • Pregnant women should notify their providers immediately if they suspect they have been exposed to or shown signs of herpes infection. Some research suggests that HSV infection may lead to miscarriage or preterm delivery.10 If you are diagnosed, providers can better prepare for any additional risk. Additionally, there is an increased risk of passing herpes to your baby (which can happen during pregnancy, but is more likely to happen during birth). If you have genital herpes, your doctor may provide medicine to reduce your risk of having symptoms when you have your baby.10 If you still have symptoms when it’s time to deliver, your doctor may suggest a caesarean section (C-section).10
  • Patients who have HIV and HSV infection have a higher risk of transmitting HIV to an uninfected sex partner. HIV-positive patients should discuss additional precautions with their doctors.10

Mental and Emotional Impact of HSV Infection

In addition to the physical impact and increased risk involved with HSV-1 or HSV-2 infection, the mental and emotional consequences of herpes infection can make a huge difference in people’s lives. When patients find out they have herpes, they can have strong emotional reactions, which is completely normal.14

What if You Test Positive for Herpes?

Though there is no cure for HSV infection, antiviral medication (known as suppressive therapy) can reduce how often you have outbreaks and reduce your risk of spreading the infection.10 It’s important to know which type of HSV you have, because your doctors will adjust what type of therapy and medicine you receive.13 If you are pregnant and are positive for HSV, your healthcare provider can provide medication, adjust your birth plan if necessary and otherwise prepare for any complications relating to your infection.10

While discovering you have HSV infection can be a difficult experience at first, many patients learn to adjust over time. As you get answers to your questions and come to terms with social stigma and other feelings, you can live – and thrive – with herpes infection.14

Several resources and support forums are available to help you with common questions after diagnosis, such as how to tell a sexual partner you were diagnosed and how to tell someone you are dating that you have herpes. It is important to remember that right now, all around the world, there are people in healthy, successful relationships where one or both partners have HSV.14

The World Health Organization and partners are working to develop HSV vaccines and topical microbicides, which can help prevent herpes infections.9 The Director of WHO Department of Reproductive Health and Research also stresses the importance of educating patients:

“Access to education and information on both types of herpes and sexually transmitted infections is critical to protect young people’s health before they become sexually active.”9

How Can You Avoid Getting Herpes?

You can take steps to help reduce your risk of getting herpes, although it is difficult to completely avoid getting HSV-1 or HSV-2 unless you entirely avoid contact with others.2

Reducing Your Risk for Genital Herpes

The only way to completely avoid genital herpes and other STIs is to not have anal, oral or vaginal sex at all.2 There are ways, however, to lower your risk if you choose to have sex.2 People with genital HSV infection (both from HSV-1 and HSV-2) are more likely to pass the infection on when they have an outbreak, but they can also give it to someone even if they have no symptoms.2

If you do have sex, you can reduce your risk of getting herpes by using condoms every time you have vaginal, anal or oral sex.10 Even if you wear condoms, however, you can still get herpes from the areas of skin not covered by a condom.10 You can also reduce risk by having sex only with one person in a long-term relationship when that person has tested negative for herpes.10

Reducing Your Risk for Oral Herpes

Like genital herpes, oral herpes is contagious whether or not a person has an outbreak.2 You can reduce your risk of getting oral herpes by avoiding oral contact with others (kissing or otherwise) and sharing objects with an infected person’s saliva (spit).2

Stay Informed and Know Your Body

Herpes is a very common disease that affects millions of people. Whether you are worried about infection, have already tested positive or want to help reduce your risk of acquiring it in the future, it’s important to stay informed. Your healthcare provider is a great resource for any personal questions you have about this virus. You can also find information through the World Health Organization here and the Centers for Disease Control here. Remember: the more informed you are about your own body, the better you can take charge of your health.

1. Whitley RJ. Herpesviruses. In: Baron S, ed. Medical Microbiology. Galveston, TX: University of Texas Medical Branch at Galveston; 1996. 2. World Health Organization. Herpes simplex virus. http://www.who.int/mediacentre/factsheets/fs400/en/. Updated January 2017. Accessed December 4, 2017. 3. Planned Parenthood. Oral & Genital Herpes. https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes. Accessed January 8, 2018. 4. Centers for Disease Control. Sexually Transmitted Disease Surveillance 2016. Atlanta, GA: CDC Division of STD Prevention; 2017. 5. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA, 2006;296(8):964–73. 6. Hunt RD. Herpesviruses of Primates: An Introduction. In: Jones TC, et al, eds. Nonhuman Primates I. Monographs on Pathology of Laboratory Animals. Berlin, Germany: Springer; 1993. 7. UC San Diego Health. Herpes Infected Humans Before They Were Human. https://health.ucsd.edu/news/releases/Pages/2014-06-10-herpes-origins-in-chimpanzees.aspx. Published June 10, 2014. Accessed January 8, 2018. 8. Bradley H, et al.  Seroprevalence of herpes simplex virus types 1 and 2–United States, 1999-2010. J Infect Dis. 2014;209(3):325-33. doi:10.1093/infdis/jit458. 9. WHO Global. World Health Organization. Globally, an estimated two-thirds of the population under 50 are infected with herpes simplex virus type 1. [news release]. Geneva, Switzerland: WHO; October 28, 2015. 10. CDC. Genital Herpes – CDC Fact Sheet. https://www.cdc.gov/std/herpes/stdfact-herpes.htm. Updated September 1, 2017. Accessed January 8, 2018. 11. American Sexual Health Association. Herpes Signs and Symptoms. http://www.ashasexualhealth.org/stdsstis/herpes/signs-symptoms/. Accessed January 8, 2018. 12. CDC. Genital Herpes Screening FAQ. https://www.cdc.gov/std/herpes/screening.htm. Updated February 9, 2017. Accessed January 8, 2018. 13. CDC. Genital HSV Infections. 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/herpes.htm. Updated June 8, 2015. Accessed January 8, 2018. 14. ASHA. Emotional Issues. http://www.ashasexualhealth.org/stdsstis/herpes/emotional-issues/. Accessed January 8, 2018.

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