Herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). Many people do not have any symptoms and are unaware that they have HSV infection. In the first infection, the virus remains inactive in the body but can get reactivated repeatedly.
It is approximated that 1 in every 5 persons is affected by HSV. It is common in people between the ages of 14 and 49 years old where it is estimated the prevalence to be 16%. This amounts to half a billion people with genital herpes, and several billion with oral herpes.
Even if people have HSV but are asymptomatic, they can transmit the virus to their sexual partners.
Causes of HerpesHerpes simplex virus (HSV) is divided into two types:
- HSV-1: This type generally causes cold sores surrounding the mouth. It usually spreads through skin-to-skin contact but can go to genital parts during oral sex causing genital herpes.
- HSV-2: This type usually produces genital herpes and it spreads via sexual contact as well as skin-to-skin contact. It is extremely infectious.
HSV can only live inside the body and are dead when outside in the open. They move into the body through tissue layers that are present in the openings of the body like the nose, mouth, and genitals. When they are inside the body they make a clump and remain in the nerve cells of the body. They can grow and increase their numbers when the environment is favorable. HSV can be observed in body fluids such as saliva, semen, vaginal discharge.
Having multiple sexual partners can increase the risk of getting HSV infection.
Preventing HerpesHerpes is a sexually transmitted disease hence, the most important area to focus on to prevent herpes is increasing awareness about practicing safe sex and avoiding contact with anyone who has open herpes sores. Doctors also recommend regular testing.
If a person is already infected, there are some precautions you have to take before you involve yourself in intimate contact. Some are as follows:
- Using a latex condom with every sexual activity, even when you do not have genital blisters/ulcers.
- Avoiding sex when you have genital ulcers.
- Avoiding oral sex if oral blisters are present.
- Do not have multiple sex partners.
- Pregnant women should avoid sex with someone with active herpes.
Symptoms and Signs of HerpesLots of people infected with herpes do not have any symptoms. The symptoms one might get depends upon wherever they have a first or recurrent infection.
As common with many viral infections, the first thing people notice after getting herpes is feeling ill with a mild fever, body weakness, and body pain. Small, sore blisters appear around the genitals or mouth usually over 1-2weeks, which shortly rupture and turn to empty painful ulcers. Lymph glands that counter infection may get swollen.
After initial infection, the virus groups up and remains inactive in the nerves at the base of the spine. People are asymptomatic at this stage.
Recurrence is very common. This is commonly caused by triggers such as illness, stress, sunlight, and tiredness. It occurs when the virus moves through nerves to the outside of the skin, which leads to multiple ulcers. Routinely, reinfection has milder symptoms and tends to go early than the initial infection.
Diagnosis of HerpesThe diagnosis of genital herpes is established on an individual’s medical history, thorough physical examination with aid of tests. Genital herpes resembles other sexually transmitted diseases, hence it is necessary to rule out those infections such as syphilis, gonorrhea, and chancroid.
Tests are used to confirm the diagnosis and also to recognize the responsible virus either HSV-1 or HSV-2. Some of the tests available to doctors are given below:
- Polymerase chain reaction (PCR) test: In this test, copies of DNA are made from blood, or tissue samples. This is used to confirm and determine the type of HSV.
- Viral culture: It is a difficult and time-consuming test that shows the presence of HSV in blisters or ulcers.
- Blood test: This is done when a person has a past infection but does not have any symptoms currently. This can detect HSV antibodies that are formed after previous exposure to HSV.
Treatment of HerpesHerpes is an incurable infection. Treatment mainly focuses on easing the symptoms and reducing the outbreaks. The drugs that are mainly used are antiviral drugs such as acyclovir, famciclovir, and valacyclovir. They halt the multiplication of the herpes virus.
During the first episode, antiviral is given, usually for 7 to 10 days, which is taken by mouth. Sometimes, episodic therapy, taking antivirals only when there is an outbreak, is practiced. It reduces the length and severity of the symptoms by hours to a few days.
Suppressive therapy, taking low-dose antiviral drugs every day to stop outbreaks is also used. It lessens the duration of recurrences, and can also lower the risk of infecting an uninfected sex partner.
Apart from antiviral treatments, some self-care measures are also helpful in alleviating the symptoms and providing relief. These include:
- taking painkillers such as paracetamol
- Applying numbing ointments such as lidocaine 5% gel to decrease pain and itchiness
- Applying ice wrapped in a towel over the painful area
- Drinking plenty of fluids
- Sitting in a sitz bath (warm water tub)
Antiviral medications along with above mentioned general measures can help ease pain and discomfort in people with genital herpes.
Treatment for oral herpes may also involve topical ointments such as acyclovir and penciclovir, or over-the-counter anesthetics. For oral herpes, use a sunblock or lip balm containing zinc oxide before going outside.
Clinical Trials for HerpesClinical trials and research are mostly focused on developing a vaccine and finding treatments that can cure HSV. Presently, there is no officially proven vaccine to protect against the herpes virus. Some clinical trials are going on about the use of the vaccine and its usefulness. Developing a vaccine for HSV is difficult, costly, and time-consuming.
One active clinical trial is checking the safety and efficacy of 4 investigational HSV 2 Vaccines in Adults with recurrent genital herpes caused by HSV 2.
Another trial seeks to study the long-term effects of taking a homeopathic medicine that is already available on the market.
Generally, people are unaware that they have genital herpes because they do not exhibit any symptoms. Hence regular testing might help to detect if you are infected. If you have any symptoms or if you think you are infected with genital herpes, consult your doctors. They will help you find correct and proper treatment. If you are interested in participating in clinical trials, the doctors might help you find one.
Genital herpes: CDC detailed fact sheet. Centers for Disease Control and Prevention. https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm.
Klausner JD, et al., eds. Genital herpes. In: Current Diagnosis & Treatment of Sexually Transmitted Diseases. New York, N.Y.: The McGraw-Hill Companies; 2007. http://accessmedicine.com.
Albrecht MA. Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection. http://www.uptodate.com/home.
Longo DL, et al., eds. Herpes simplex virus infections. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.com.
Mertz GJ, Benedetti J, Ashley R, et al. Risk factors for the sexual transmission of genital herpes. Ann Intern Med 1992; 116:197.
Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med 1994; 121:847.
Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med 1983; 98:958.
Le Cleach L, Trinquart L, Do G, et al; Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients. Cochrane Database Syst Rev. 2014 Aug 38:CD009036. doi: 10.1002/14651858.CD009036.pub2.