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Volume CXXXIII, Number 8 |
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Herpes affects many students
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER
Dear Dr. Jeff: Can someone have genital herpes and not know it? Can a person infect you with herpes, even if they've never had any sores?-D.C.
Dear D.C.: Unfortunately, the answer is YES to both of those questions. There is new concern in public health circles about the rapid spread of genital herpes, and you have underlined two of the main reasons for that increase.
Genital herpes is caused by herpes simplex virus (HSV). There are two strains, type 1 and type 2. Type 1 causes nearly all oral herpes infections ("fever blisters" or "cold sores") and probably 40 percent of genital herpes infections (transmitted by oral sex). Type 2 causes about 60 percent of genital herpes infections and a very small number of oral infections.
About 80 percent of the population has, at some time, had oral herpes. The prevalence of genital herpes has increased significantly over the last 20 years, with more than 20 percent of adolescents and adults in this country estimated to be infected. Among college students, the prevalence is likely to be even higher.
The "classic" signs of an initial genital herpes infection are grouped blisters or sores in the genital area. The sores usually itch or burn or hurt and are often accompanied by flu-like aches and pains and a low grade fever. After the initial infection, the herpes virus lies dormant in nerve bundles at the base of the spine. The virus periodically reactivates, travelling back down the nerve bundle and causing a recurrent outbreak.
Recurrent outbreaks are usually milder and briefer and typically occur four or five times per year. They are frequently triggered by other illnesses, poor diet, or emotional or physical stress. Over time, recurrent outbreaks become less frequent and less severe and usually eventually cease altogether.
It is now clear, however, that most cases of genital herpes do not present "classic" signs and symptoms. In fact, up to 60 percent of infections are not recognized by patients or diagnosed by clinicians because they do not cause the typical sores. An additional 20 percent of infections cause no symptoms whatsoever.
Transmission of herpes occurs most readily from skin-to-skin contact with an actively, broken-out site. The virus is very fragile, though, and does not live long on surfaces. Herpes cannot be transmitted via contact with a toilet seat, bathtub, or towel. Most skin on our bodies is too thick for the virus to penetrate, but mucosal surfaces (oral and genital) are quite susceptible.
Herpes virus can also be shed, and so transmitted, when no signs or symptoms are present. This asymptomatic shedding is thought to occur only a few days per year. On the other hand, because most people naturally tend to avoid sex when they have active sores, most transmission of herpes-in fact over 70 percent-occurs in the absence of warning signs or symptoms.
Herpes is diagnosed most reliably by culturing the virus from active lesions. Diagnosis is more problematic in between outbreaks or in an asymptomatic carrier. Blood tests can be done to measure antibodies to both viral types, but they are not always accurate. Interpretation of test results can be difficult, because neither HSV-1 nor HSV-2 is anatomically restricted.
If 80 percent of the population has at some time had oral herpes, for instance, nearly 80 percent of the population can be expected to have antibodies to HSV-1, whether or not HSV-1 is also the cause of a second genital infection. While positive HSV-2 antibody titers indicate that it is likely that the individual has had genital herpes, the results are similarly not definitive.
Genital herpes rarely leads to other health problems, with the very important exception that it increases both the sexual acquisition and the sexual transmission of HIV and presumably of Hepatitis B as well.
There is at present no cure or vaccine for herpes. There are three medications that help speed healing in both initial and recurrent outbreaks. All three can also be taken to prevent recurrences. It is likely that daily medication decreases, if not largely prevents, asymptomatic viral shedding.
All of this means that safer sex practices remain the key to decreasing herpes transmission. Avoiding intimate contact when sores are present is an obvious place to start. In between outbreaks, using condoms, dental dams, or female condoms significantly lowers the risk of viral transmission.
Of course, no safer sex practices can eliminate all infectious risks. But being informed about the risks can be a critical first step.
Be well, be thoughtful, and be safe!
Jeff Benson, M.D.
Dudley Coe Health Center
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