Herpes Simplex Virus (HSV): What You Need to Know Today

By Sondra Forsyth

Of the multiple types of the herpes simplex virus, HSV1 (oral herpes) most often causes “cold sores” or “fever blisters” around the mouth and HSV2 (genital herpes) most often causes sores in the genital area and the anus. (Keep in mind that many people confuse the Herpes Simplex Virus with Herpes Zoster, the virus that causes chicken pox and shingles. The two viruses are not in any way related. Also, canker sores are not the same as chancre sores, pronounced “shanker”, that can appear on the mouth as a symptom of syphilis. I’ll discuss this in detail in Part 6 of our STI series on September 11th.)

According to the recent guidelines from the World Health Organization (WHO), HSV1 is most often transmitted through “oral-to-oral contact”, meaning kissing

However, HSV1 can be transmitted by touch alone, which is why dentists and other healthcare providers now wear latex gloves. Not only that, but HSV1 can cause genital sores and anal sores, depending on sexual practices such as oral and anal sex.

HSV2 is a sexually transmitted infection that causes genital and anal herpes. Both HSV1 and HSV2 are incurable. The infections may be asymptomatic for long periods, but new outbreaks are always possible. Transmission from one person to another is most likely when an outbreak of sores happens, but the virus can be transmitted even if the infection is asymptomatic.

If there were ever a compelling reason for people to share sexual histories with new partners, this is it! When I was working on one of the books I wrote with our thirdAGE medical contributor, Marie Savard MD (Ask Dr. Marie), Dr. Marie told me about the case of one 44-year-old patient of hers and we included it in the book as follows; “She came to me complaining of horrendous vulvar pain and difficulty urinating. She was in severe distress and had no idea what was wrong with her. When I asked what was new or different in her life, she said that she had gone through a difficult divorce but that she had recently met a wonderful man and had started a sexual relationship with him. I knew immediately what was probably going on. She had the usual symptoms of an HSV2 infection.”
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Prevention

WHO reports that research is ongoing with the goal of developing prevention methods against HSV infection such as vaccines or topical microbicides that could be applied inside the vagina or rectum. In the meantime, don’t have sex or kiss someone who has active HSV symptoms. The rest of the time, condoms are your best bet if your partner has HSV. Also, don’t share food, drinks, eating utensils, or towels with someone who has HSV. (An HSV2 infection can be transmitted from a mother to her infant during delivery, although this rarely happens.)
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HSV2 and HIV

The most compelling argument for attempting to avoid an HSV2 infection is that people with the infection are three times more likely to get a human immunodeficiency virus (HIV) infection, which can lead to acquired immunodeficiency syndrome (AIDS).
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Diagnosis of Genital Herpes

A viral culture or swab and blood tests make for the most precise diagnosis. If the result of a culture is positive, the diagnosis is almost 100% correct. On the other hand, a viral culture has a sensitivity of only 50 percent. This means that even if herpes is present, the culture will only be positive 50 percent of the time. In case of a negative test result, the Western blot blood test is the gold standard and is almost 100 percent accurate in making a correct diagnosis.

Your doctor may also do a pelvic exam to look for blisters, and the doctor may check out the lymph nodes in your groin to find out whether or not they are swollen and tender.
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Treatment

Although HSV is lifelong, antivirals such as acyclovir, famciclovir, and valacyclovir can help to ease the severity and frequency of symptoms.
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Sondra Forsyth is Co-Editor-in-Chief of thirdAge.com.