There are two main types of Herpes Simplex Viruses, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). Even though both viruses are closely related and may be responsible for either mouth and face disease or genital disease, herpes simplex virus 1 (HSV-1) is mostly responsible for mouth and face disease while herpes simplex virus 2 (HSV-2) is majorly responsible for the genital disease.
In 2018, it was estimated that nearly half of the world had been infected with herpes simplex virus 1 (HSV-1) with the disease present in around 6 of every 10 persons under 50 (3.7 billion people worldwide). Africa had the highest rate of estimated infection with 88% while the Americas had the lowest with 45%. herpes simplex virus 2 (HSV-2) is presented in around 13% of people aged 15 – 49 and commonest in women. It is commonest in Africa (44% in women and 25% in men). Many of the affected persons are unknown “carriers”.
What makes herpes unique?
The herpes simplex virus 1 (HSV-1) has a predisposition for the face area and the herpes simplex virus 2 (HSV-2) is attracted to the genital area. After the initial infection, these viruses can attach to nerve cells. This means that they can reside and multiply in these nerve cells and may become inactive – a process called latency or dormancy. This causes them to be permanently resident in the individual and can be reactivated at any time in the future.
After reaching a period of inactivity in nerve cells, recurrences may be triggered by fever, stress, sunburn, menstruation or other diseases. Infection is particularly worse in people with weakened immunity, such as people with HIV, and people on steroid therapy as well as people with eczema, on chemotherapy and people with concurrent infection. Infection with the Herpes virus is lifelong.
How is it spread?
Herpes simplex virus is spread through close personal contact with someone who already has the virus. It is highly infectious and single contact with an infected person may be enough for an infection to occur. Most people get the herpes simplex virus 1 (HSV-1) in childhood through non-sexual contact while herpes simplex virus 2 (HSV-1) is almost exclusively due to sexual contact which is typically much later in life which makes it a sexually transmitted disease. The herpes viruses gain entry into the body via:
- Small cuts or breaks in the skin with subsequent physical contact
- Contact with a cold sore or blister.
- Contact with objects like razors, toothbrushes, cosmetics, towels, and sex toys that were used by an infected person.
- Kissing, especially between an infected adult and a child. It may also occur when there is an exchange of saliva.
- Body fluids like blood and genital fluids (via oral sex)
- Unprotected anal or vaginal intercourse. The chance of spread is highest with unprotected sexual intercourse but herpes may be transmitted even when condoms are worn, especially on the uncovered parts.
- In rare occurrences, a pregnant mother may pass the virus to her unborn child (called neonatal herpes), often causing severe complications which may include brain damage or foetal death.
When the virus gets into the body through the skin, it locates the collection point of the nearest nerve cells (called a ganglion) and moves in there but does not cause any symptoms in the immediate period. Then, the areas around the ganglion flare-up by first becoming itchy and subsequently tingling or burning up before blisters show up.
The spread is greatest when the affected individual has a cold sore or a genital rash. Spread, however, may occur even in the absence or resolution of a cold sore or rash. Frequent contact with the affected individual increases the chances of spread.
What are the symptoms of herpes?
Most herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-1) infections are without symptoms (asymptomatic). Cold sores or genital rashes may appear for the first time or recur at any given time. In persons with symptoms, the most common ones are:
- Fever. This is usually high grade
- Vaginal discharge, especially in women
- Pain when urinating
- Muscle aches
- Swollen gums
- Sore throat
- Swollen lymph nodes in the groin region
These symptoms often appear in the first week of exposure and subside within 2 weeks. Fluid-filled raisings called vesicles occur on the face and genitals (skin of the penis and groin, vulva and vagina. Anal sores can also be seen in men who have sex with men). These are blister-like, often breaking down and drying up, to be replaced by a yellow crust which eventually falls off, all in a matter of a few days. This continues to recur throughout life but with less severity than the initial outbreak, often with no particular pattern. However, it may be seen monthly in some people or as infrequently as every year.
How is the diagnosis of Herpes made?
The most accurate way to make a diagnosis of herpes simplex virus 1 or 2 (HSV-1 or HSV-2) is after a consultation with your doctor who will ask you questions before proceeding to examine you. Thereafter, samples may be taken from the sores for a test called tissue culture which confirms the diagnosis.
Having genital herpes increases your chances of getting (Human Immunodeficiency Virus) HIV so it is important to also test for HIV and take steps to prevent infection.
How is Herpes treated?
Infection with the herpes simplex virus is lifelong and cannot be cured. However, treatment is instituted to reduce disease severity and to prevent complications. In some cases, treatment is also aimed at keeping the individual at such a state that they are not actively spreading the virus.
Treatment is mostly by prescribed antiviral medications, specific drugs that target and check the proliferation of viruses – most commonly, acyclovir (Zovirax). These are tailored based on the individual’s immune status and severity of the disease.
Genital rashes can be treated with special ointments that reduce the duration of the rashes and ensure quick resolution. Cryotherapy, the use of cold therapy to remove the sores can also be employed. Additional medications may be required if complications are present. Your doctor may also prescribe pain medicines, and a gel or cream to be applied on the sore for pain relief and to speed up healing.
How can one prevent oneself from contracting the virus?
Because most carriers are often without any symptoms, it may be difficult to avoid physical contact with individuals who are currently infected. However, here are some tips that will help prevent the spread of the virus:
- Avoiding contact with people with cold sore blisters or genital rash
- Avoid putting your hands in the mouths of people with mouth and facial herpetic disease. If you have to, wear gloves.
- Wash your hands after inadvertently touching a cold sore or blister.
- Avoid sharing items such as razors and sext toys.
- Use dental dams when engaging in oral sex
- If you already have the virus, ask your doctor about suppressive antiviral therapy to reduce the possibility of spread of disease from you to close personal contacts. You should also avoid oral contact (sharing objects that have contact with saliva) or sexual contact with others when you have active symptoms by abstaining from sexual activity.