Understanding herpes is your key to control of the disease. The following is a question and answer summary.
Q. What causes herpes?
A. Herpes is caused by a virus. There are actually five different viruses that cause diseases in man. The viruses that cause labial herpes and genital herpes are herpes simplex virus type 1 and herpes simplex virus type 2.
Q. What other conditions besides genital or labial herpes are caused by herpes simplex viruses?
A. Ocular herpes occurs when herpes simplex virus infects the eyes. Herpes encephalitis is a serious but infrequent herpes simplex infection of the brain and spinal cord. Newborn babies may develop a severe form of herpes infection if born through an infected birth canal or are infected soon after birth.
Q. Are some people immmune to herpes infections?
A. Infections in different people will show different degrees of severity. As with any other disease, some people are able to withstand herpes inoculations better than others.
Q. Does each type of herpes simplex virus favor certain parts of the body?
A. Most genital herpes infections are caused by the type 2 virus, while the majority of oral and ocular herpes infections are caused by the type 1 virus. However, about 15 percent of all genital herpes cases are type 1 and about 15 percent of oral herpes cases in adults are type 2. Both types of herpes simplex can cause infection on any area of the body, and both types cause similar symptoms. Learn more about herpes symptoms.
Q. What is the incubation period?
A. The incubation period begins with the first exposure to the virus and lasts until the symptoms appear, generally two to ten days after exposure.
Q. What are the symptoms of genital herpes?
A. A person may notice itching or pain in the genital area, a burning sensation when urinating, or a vaginal discharge. Usually within a week, small and painful blisters appear on the vagina, cervix, urethra or anal area in women, and on the penis or around the anus in men. The sores become crusty and heal without scarring. Local swelling and flu-like symptoms (such as fever, sore throat, headache, and malaise) may also be present.
Q. What are the symptoms of labial herpes?
A. Generally, a blister, surrounded by swelling, appears at the outside edge of the lip, but it may also form at the edge of the nostril. In a day or two the blister breaks and the ulcer becomes covered with a yellow crust.
Q. In a first infection, how long do the symptoms generally last?
A. Symptoms normally disappear within two to three weeks.
Q. Can a person have genital herpes and not have any symptoms?
A. Yes. Some infections can occur without symptoms, or the symptoms may be so mild that they go undetected.
Q. Can the symptoms be relieved?
A. Yes, to a limited extent. Bathing with water and agents such as Burow’s solution or an Epsom salt solution may make the patient feel more comfortable. Moisture retards healing, so it is important to dry the infected area thoroughly. Most physicians recommend keeping the area clean and dry and wearing loose-fitting clothing. Aspirin and other symptomatic treatments help relieve pain and fever. Acyclovir should help relieve some pain and should decrease severity of lesions and length of viral shedding. Learn how to treat herpes pain and and discomfort.
Q. Can herpes recur?
A. Yes. Once the first or primary infection has occurred, the virus can reactivate, causing new sores at or near the site of the original infection.
Q. What causes herpes to recur?
A. It is not clear exactly what causes recurrent infections. They may be brought on by other infections, menstruation, emotional upsets, sexual intercourse, and nonspecific conditions.
Q. Are the symptoms the same in recurrent herpes?
A. The signs and symptoms may be similar to those of primary infection, but not necessarily so. Several days or hours before the blisters appear, many patients experience what are called prodromal signs—pain, itching or burning. For some people, these warning signs are the most painful part of the recurrence. The symptoms of recurrent infections are usually milder, and the sores may heal more rapidly than during the primary infection.
Q. When are herpes infections contagious?
A. The sores and the areas under the scabs contain lots of active viruses. Therefore, herpes is most contagious when the sores are present and continues to be very contagious” until sores are completely healed and scabs have fallen off.
Q. Is the infection contagious if no symptoms or no sores are present?
A. Possibly. Active virus has been isolated from the sites of former genital sores. Also, in persons who have repeated labial sores, the herpes virus is sometimes present in the saliva even when oral sores are not present.
Q. What precautions should be taken during sexual intercourse to avoid spread of the virus to an uninfected person?
A. From the first sensation that the blisters are about to occur until the sores are completely healed (not just scabbed over) the only sure way to prevent spread of the virus is complete abstinence. Condoms are not a fool-proof way to prevent the spread of infection, and spermicidal jellies and diaphragms are not believed to be effective protection either.
Q. What happens to the virus the first ti me a person gets a herpes simplex virus infection?
A. During the first, or primary, infection of either type 1 or type 2, herpes simplex virus will multiply at the original site of skin exposure to cause the characteristic sores. Also, very early in the course of the infection, some viruses will leave the sores to form a permanent reservoir of virus within certain nerve cells.
Q. Where does the virus go when the sores are not present?
A. The virus hibernates in the cell centers, or ganglia, of specific sensory nerves. While symptoms are present, some viruses migrate up the sensory nerve that serves the site of the sores. These viruses become inactive, or latent, when they reach the nerve cell center.
Q. Can I get herpes internally?
A. Yes. Herpes can occur in the mouth, throat, vagina, cervix, and anus. Any area covered by delicate mucous membrane is a potential site.
Q. What happens to the virus during a recurrence?
A. When herpes flares up in a recurrence, the virus becomes reactivated, probably returns down the same nerve, and multiplies on the skin at or near the site of the original sore. This does not happen in all patients. Many people have a primary infection and then never have a recurrence, while others may have recurrences once a month or more.
Q. Does the virus affect the nerve along which it travels or the nerve center where it rests?
A. Usually not. Herpes has just recently been suspected of causing sciatica type pain normally experienced by persons with lower back disease, but this is not a usual symptom.
Q. Is it possible for a person to have a primary infection with one type of herpes simplex virus and then, years later, have another primary infection after exposure to another type or strain of virus?
A. Yes. For example, during childhood, a girl may get herpes type 1 cold sores. As a young adult, this same person may be exposed to herpes type 2 in the genital area and have a new primary infection with the type 2 virus. That same person may later be exposed to a different strain of type 2 virus and develop another primary infection.
Q. Should a person consult a physician if he or she suspects genital herpes?
A. Yes. It is important to see a physician as soon as possible. Only a physician can determine whether or not you have genital herpes, and this should be done as early in the disease as possible. Herpes cannot be diagnosed if the sores have healed.
Q. How are herpes simplex virus infections usually diagnosed?
A. Herpes infections may be diagnosed by a physician who recognizes the characteristic sores. Sometimes it is difficult to diagnose herpes on the basis of clinical appearance alone. In such cases the physician can use a cotton I applicator to collect cells from the patient’s sores and ask a laboratory to grow them in a culture. A sample from the patient is added to a test tube that contains healthy cells growing in an artificial nutrient broth. The viruses will invade the cells and begin to multiply. After a few days, a trained technician will be able to recognize the viruses as herpes simplex. Most major laboratories can prepare the culture.
Q. How can the exact type of herpes simplex virus (type 1 or type 2) be determined?
A. The two have different patterns of viral growth, and may be distinguished in a viral culture.
Q. Is typing of the herpes simplex virus easy to do?
A. No. Unfortunately, the average clinical lab is not prepared to do viral identification. The special equipment and reagents needed for herpes typing usually are stocked only by research or reference laboratories. Also, the expense and time required for herpes typing are not medically necessary. The course of the disease, possibility for transmission, and effects of genital herpes in pregnant women are the same for both type 1 and type 2.
Q. Can a blood test be used to assist in the diagnosis of herpes?
A. Yes, but it is an indirect method of diagnosis.
Q. What does a positive blood test mean?
A. If a blood sample is analyzed, the lab will test for the presence of antibodies to herpes simplex virus and not for the virus itself. If specific antibodies are found, it is assumed that: (1) the patient has, at some time, been exposed to herpes simplex virus, and (2) because of this exposure, his or her body has made antibodies against the virus. Such antibodies may remain in the blood for years after the original infection, even if they produced no symptoms in the patient. A positive blood test means that a person has or has had a herpes simplex virus infection at some time in the past.
Q. Can a blood test be used to type the herpes simplex virus?
A. Yes, but it is an indirect method that is not always accurate. Blood antibodies can be typed. However, in some tests, antibodies to type 2 behave as if they were antibodies to type 1 and vice versa. Therefore, unless very sensitive procedures are used, it may be impossible to tell, on the basis of blood antibodies alone, exactly which strain of herpes
simplex virus a person has or has had.
Q. Can a Pap smear help diagnose genital herpes?
A. A Pap smear can diagnose genital herpes in about two-thirds of the cases. In the other third, it results in a false negative diagnosis.
Q. In general, how are herpes simplex virus infections spread?
A. Herpes infections can be transmitted when any part of a person’s body directly touches active herpes virus or sores containing active herpes simplex virus. Mucous membranes, such as those in the mouth or genital area, are very susceptible to herpes invasion. Intact skin is usually resistant, but skin that is broken or damaged (for example, by cuts, abrasions, burns, eczema, or infections) may be easily infected by herpes simplex virus.
Q. What other factors play a role in the transmission of herpes from person to person?
A. Some of the variables are: (1) the amount of virus a person is exposed to, (2) the concentration of that virus, and (3) the state of the person’s resistance at the time of inoculation.
Q. How can a person avoid the complications of herpes infections?
A. Good hygiene and common sense should include: (1) washing the hands thoroughly after touching infected areas and on waking in the morning, (2) not touching the areas expect to apply medicine, and (3) getting a Pap smear every six months if one is a woman.
Q. Why is genital herpes considered a sexually transmitted disease?
A. For a case of genital herpes to occur for the first time, intimate contact with a partner who has active herpes sores is usually necessary.
Q. Can genital herpes cause impotence?
A. There is a relationship between genital herpes and impotence, but it is a psychological rather than a physical one. Herpes sufferers sometimes have a fear of spreading the disease and/or a fear of rejection because of having the disease. Once properly informed, few people find need for counseling regarding impotence.
Q. Can herpes be transmitted through use of toilet seats or water glasses?
A. This would be almost impossible. The herpes virus dies quickly once outside the body and to catch it from a toilet seat would require unusual contortions to bring mucous membrane in contact with virus even if it could survive.
Q. Can herpes be acquired in the genital area through oral-genital sex?
A. Yes, if one of the partners has active oral herpes sores. Virus in an oral sore can be transmitted to a partner’s genital area during oral-genital sex. It does not matter what type of herpes simplex virus is involved. If genital contact is made with the oral sores, then the virus may spread.
Q. Can oral herpes ever be considered a sexually transmitted disease?
A. Only if it is acquired through oral-genital sex. Herpes simplex virus from active genital sores may be spread to the mouth area of the partner under these circumstances.