Judging from the number of people who end up at my blog after doing a "herpes" google search, I'm guessing a lot of you. Ok, maybe you don't want to talk about it as much as you want information on it.
I'm not even kidding when I say reading the book "The Good News About the Bad News" by Terri Warren has blown my mind. I might even go as far as saying that this is probably the only book you need on herpes if you are a sex educator, are interested in sexual health, or have a herpes diagnosis. Not only is it funny (you can tell she has been on the front lines of sexual health because of her sense of humor), but it is filled with great and actionable advice.
I've previously written about herpes and how the the two main players are Herpes Simplex Virus Type 1 (HSV 1) and Herpes Simplex Virus Type 2 (HSV 2). I've come to find out that there is so much more to herpes than I, most people (and even clinicians) know.
Most people believe that cold sores (sores on the outside of your mouth, chin, and nose) are HSV 1 and genital herpes (herpes around your genital area) are HSV 2. In other words, sores about the waist are HSV 1 and sores below the waist are HSV 2.
HSV 1 cause the majority of recurrent cold sores that appear on your chin, lips, nose, and other places on your face. Many people believe that in order to have HSV 1, there must be some noticeable blister that forms a crust, heals, and goes away. Like with many STI's, the majority of the HSV 1 oral infections are asymptomatic (or even go unrecognized). This means that there are A LOT of people who honestly don't know they have HSV 1. This wouldn't be so bad if HSV 1 weren't so infectious to others.
A term you will hear time and time again when it comes to the herpes virus is "shedding". This basically means that a person is literally giving off the virus...kinda like our skin is always shedding but we don't really think about it or notice it unless our skin is really dry or we have a peeling sunburn. During the past 10 years (give or take) there has been a really interesting shift when it comes to herpes and STI transmission. The old school of thought is that you are only infectious to others when you are currently exhibiting visible or noticeable symptoms. What we now know is that the herpes virus is being shed even when there are no obvious symptoms. This is a pretty significant finding.
Besides HSV 1 causing cold sores, it is also responsible for the majority of herpes in the eye. This can happen when you touch your cold sore and then touch your eye without washing it first. It can also happen when the virus travels along the same nerves that provide sensation between the mouth and the eye. HSV 1 of the eye is treatable and something best left to an ophthalmologist and not an optometrist.
The big news about HSV 1 is that is can cause genital herpes. Studies show that about 40% of new genital herpes cases in the United States are caused by HSV 1. Also it is thought that the popularity of oral sex is why there are more HSV 1 cases than HSV 2 cases in teens and college students.
HSV 1 is transmitted via mouth/genital contact and it can occur even in the absence of cold sores. The good news is that about 50% of people with genital HSV 1 have zero recurrences.
An oral HSV 1 outbreak can be triggered by anything from too much sunlight to trauma, and I don't mean that in a "Fight Club" kind of way. Trauma can be anything from a new lip piercing, oral surgery, or even lip injections (now I know why my dermy asked me if I were prone to cold sores when I tried Restylane on my lips). Remember that shedding happens even with out obvious symptoms.
Another thing to remember when it comes to HSV 1 is "who is infected". Studies show that more than 50% of people in the United States who are over the age of 14 have HSV 1 infection. Unfortunately, there is no delineation between the number of oral and genital infections.
HSV 1 can be diagnosed a number of different ways:
- Visual diagnosis only (error rate of 20%) **not advised & in 2002 the CDC began recommending a lab test for confirmation.
- Viral swab tests **they are ONLY effective when having visible symptoms and the testing culture must be done correctly with vigorous swabbing. Out of several choices, only the PCR (Polymerase Chain Reaction) swab testing gives a clinician the opportunity to tell if you have HSV 1 or HSV 2. It's important to know what type of swab test is being performed.
- Blood tests. Just like with HIV tests, blood tests for HSV look for the antibody or the protein that your body makes in response to an infection. Blood tests are preferable when it comes to herpes because they can be type-specific to tell you if you have HSV 1 or HSV 2. When it comes to herpes blood testing, there are many options (and some are more effective than others) so it's important to figure out what type of testing is being offered.
So what are the big take aways from the above information?
- Knowing that HSV 1 can cause genital herpes is huge! This can even come as a surprise to clinicians and I know it did for me.
- Knowing that people shed the virus and are infectious to others even when there are no visible symptoms is also a fairly recent finding.
- Testing is complex and some test for the virus, but they don't specify if you have HSV 1 or HSV 2.
- "The Good News About the Bad News" by Terri Warren is a great book!
- HSV 1 & HSV 2 can be managed quite well with a variety of treatment therapies! This is really, really good news. Because it is a virus, there is no cure, but the treatment options have much improved in the past 30 years.
- A huge percentage of people who have HSV 1 & HSV 2 are completely unaware and it can lay dormant for years and years before an outbreak ever happens. This is why I always advocate for COMPREHENSIVE HIV/STI testing for all sexually active people.