Herpes

What is Herpes?
There are 2 main types of herpes: type 1 (HSV-1) and type 2 (HSV-2). Most oral herpes is caused by HSV-1 while most genital herpes is caused by HSV-2. Oral herpes is not necessarily caused by sexual contact. In fact, many people contract oral herpes from a parent or sibling. Actually, oral herpes is very common with about 65% of individuals being infected. However, genital herpes is a sexually transmitted disease passed through direct skin-to-skin contact with the genital area. Genital-to-genital and oral-to-genital are the 2 most common ways genital herpes is transmitted.

What are Symptoms?
Most individuals have no or only minimal signs or symptoms of HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the mouth, lips, tongue, genitals, inner thighs, lower abdomen or rectum. These blisters can be quite painful. If an individual is going to have an outbreak, the first one usually occurs within two weeks of the virus being contracted. The blisters may break, leaving tender ulcers (sores) that may take up to two to four weeks to heal the first time they occur. Other signs and symptoms during the primary episode may include flu-like symptoms, including fever and swollen glands. Typically, another outbreak can appear a few weeks or months after the first, but it is almost always less severe and shorter than the first outbreak. People who are diagnosed during a first outbreak of HSV often have several more outbreaks in the first year. Although the virus stays in the body indefinitely, the number and severity of outbreaks tends to decrease over time as the immune system releases antibodies to help fight the virus. Many individuals who have HSV outbreaks mistake the blisters for acne, ingrown hairs, insect bites or other minor skin irritations, which is one reason why the virus is transmitted so frequently.

Complications
HSV infections can cause major complications for infants born to mothers with the virus. Therefore, if a woman has an active genital herpes infection at delivery, a cesarean delivery is usually performed.
Herpes also plays a role in the spread of HIV. The skin is a barrier that protects us from contracting some infections. Since open sores on the body caused by herpes disrupt that barrier, people become more susceptible to infections such as HIV if exposed. An HIV-infected individual also becomes more infectious if he or she has an outbreak of herpes sores.

How is herpes Transmitted?
Both types can be found in and released from the sore(s) that the virus causes. A simple skin-to-skin contact with the sore(s) is all it takes for transmission to occur. However, transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected. When a person initially becomes infected, the nerve endings that came in contact with the virus are the ones that become infected. The herpes virus, when in its dormant state, resides deep within the nerves of those infected nerve endings. When an outbreak is triggered, the virus moves through the nerve in an effort to get to the surface of the skin (nerve ending) where it can cause a sore(s). The movement of the virus between its dormant state and the surface of the skin is called viral shedding. It is often asymptomatic. However, during the shedding period, some individuals can feel a numbness, tingling, itching and/or burning sensation at the surface of the skin while no visible symptoms are seen. These sensations occur due to the irritation of the nerve endings once the virus becomes active. Viral shedding, although free of visual symptoms, is still a contagious period. This is why it is said that individuals can pass herpes without having visible sores.

Testing for herpes
A visual exam is not always accurate in diagnosing herpes because the sores associated with the virus resemble several other skin conditions, including, acne, allergic reactions, and even eczema. Many people are misdiagnosed when only a visual exam is performed. A viral culture test can be beneficial in diagnosing herpes. However, an outbreak must be present in order to perform the culture test. The culture is a common method used for identifying the presence of a herpes infection, but it often fails to find the virus even when it is present. HSV infections can best be diagnosed during and between outbreaks by the use of a blood test. The blood test, which detects antibodies to HSV-1 and/or HSV-2 infection, is extremely accurate in detecting the presence of the virus. However, the blood test can not tell you the location of either type 1 and/or type 2 when no symptoms are present.

IgG Test
The Herpes 1&2 Type Specific IgG test is an ELISA test that detects antibodies specific to HSV-1 and/or HSV-2 infection. This test will tell you which type(s) of the herpes virus you have, if either. However, this test does not indicate the site of HSV infection, absent of any symptoms. The IgG test should be taken at least 3 weeks after a contact of concern. It is conclusive at 6 weeks.

IgM Test
The Herpes Types I/II IgM Combination test is also an ELISA test that detects herpes antibodies. The IgM is a non-type specific herpes test and, therefore, cannot distinguish between types 1 and 2. However, IgM levels can provide useful information about a new infection. The IgM may also detect antibodies from a recurring outbreak since those levels may be elevated every time the virus becomes active from its dormant state. The IgM can be taken anywhere between 10 days and 4 weeks after a contact of concern. After 4 weeks, the IgM antibody levels will more than likely not be present.

Treatment
Unlike other sexually transmitted diseases, herpes cannot be cured because medication that will attack the virus while it lies in it's dormant state will also damage the nerve cells. However, there is treatment available for acute outbreaks that involve the use of anti-viral drugs such as Acyclovir, Valacyclovir (Valtrex) or Famcyclovir. These medications are prescribed to help lessen the severity and frequency of outbreaks, and in some situations, may help to prevent outbreaks. Keep in mind, not every individual who is positive for herpes requires treatment.