* Blisters or ulcers — most often on the mouth, lips and gums, or genitals
* Enlarged lymph nodes in the neck or groin (usually only at the time of the initial infection)
* Fever blisters
* Fever — especially during the first episode
* Genital lesions — there may first be a burning or tingling sensation
* Mouth sores
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Herpes simplex is a viral infection that mainly affects the mouth or genital area. There are two strains of herpes simplex viruses:
* Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus and many people develop it in childhood. HSV-1 often causes sores (lesions) inside the mouth, such as cold sores (fever blisters), or infection of the eye (especially the conjunctiva and cornea). It can also lead to infection of the lining of the brain (meningoencephalitis). It is transmitted by contact with infected saliva. By adulthood, 30 – 90% of people will have antibodies to HSV-1. The likelihood of childhood infection is higher among those with lower socioeconomic status.
* Herpes simplex virus 2 (HSV-2) is usually, but not always, sexually transmitted. Symptoms include genital ulcers or sores. However, some people with HSV-2 have no symptoms. Up to 30% of adults in the U.S. have antibodies against HSV-2. Cross-infection of type 1 and 2 viruses may occur from oral-genital contact. That is, you can get genital herpes on your mouth, and oral herpes on your genital area.
A finger infection, called herpetic whitlow, is another form of HSV infection. It usually affects health care providers who are exposed to saliva during procedures. Sometimes, young children also can get the disease.
HSV can infect a fetus and cause abnormalities. A mother who is infected with HSV may transmit the virus to her newborn during vaginal delivery, especially if the mother has an active infection at the time of delivery. However, 60 – 80% of HSV infections acquired by newborns occur in women who do NOT have symptoms of HSV infection or a history of genital HSV infection.
It’s possible for the virus to be transmitted even when there are no symptoms or visible sores. Two-thirds of people with genital HSV infection have recurrences of their symptoms, and one-third have three or more recurrences (outbreaks) per year.
HSV is never eliminated from the body, but stays dormant and can reactivate, causing symptoms.
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Q: What are the dangers, if any, during pregnancy if one has herpes? Is there a possibility of passing herpes to the fetus or of the fetus having birth defects?
A: Genital and oral herpes are infections by the herpes simplex viruses, referred to as HSV-1 and HSV-2. As many as 25 percent of women of childbearing age may have been infected with HSV-2, the primary cause of genital herpes. (For more information on these viruses and how they are transmitted, please see my previous column on genital herpes.) It is possible for a pregnant woman who has genital herpes to infect her baby. Usually this occurs at the time of delivery as the baby passes through the birth canal, but in rare cases, it can occur during gestation, if the infection spreads from the vagina to the womb. Though it is rare, infection of the fetus in the uterus can cause early miscarriage or birth defects such as eye problems and abnormalities of the brain and spinal cord. More commonly, the baby is infected at the time of delivery. This results in symptoms days to a few weeks after birth. The spectrum of disease varies from a few blisters on the baby’s skin to a severe widespread illness involving the brain and internal organs. Such infection can result in death.
The overall risk of a newborn being born with or developing herpes is between 1 in 2,000 and 1 in 10,000 births. A woman who acquires herpes a short time before delivery is at much higher risk of passing it to her baby than if she was infected early in pregnancy or if she has a recurrence of her herpes at the time of delivery. This is probably because the quantity of virus is highest with a recent first infection. One study estimates the risk to the fetus to be almost 50 percent if the woman has her first herpes outbreak with an active lesion during delivery. In other words, the baby has a 1 in 2 chance of being infected in that circumstance. For women who have a recurrent outbreak and an active lesion at delivery, the risk is about 4 percent, or 1 chance in 25. If the woman is having a recurrence without noticeable symptoms (but still shedding the virus) the risk is less than 0.1 percent, or 1 chance in a 1,000.
In general, any woman who has not had herpes and who has a sexual partner with herpes is considered at high risk. Experts recommend that such women abstain from sex — or at least use condoms — in the second half of pregnancy. Cesarean section clearly lowers the risk of infection, but there is some controversy over when to recommend it. Before delivery, physicians should question women about symptoms of active herpes infection and examine them for any signs. In most if not all cases of active herpes, the doctor should recommend C-section. After a baby is born to a woman with herpes, the newborn should be closely monitored for any sign of disease. At the first sign of infection, the baby should receive the antiviral drug acyclovir (trade name Zovirax).
In some medical centers, women with a history of genital herpes are tested for HSV at the time of delivery. However, it is unclear what to do if the mother’s HSV cultures are positive. By the time the results are back from the lab, the baby has already been born and it is too late to decide to perform a C-section. And experts generally do not recommend giving acyclovir to every baby born to a mother with positive cultures, because most such infants will not develop disease even without treatment.
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Q: What can you tell me about “genital” herpes in the throat? Every once in a while I see a reference to oral sex and the possibility of transmission. However, I see nothing on dealing with this aspect of the disease. What are possible complications, treatments, things to avoid, etc.?
A: From your description, I would say you are referring to oral herpes rather than genital herpes. Genital herpes is an infection of the genitals that results in painful, somewhat itchy blisters that rapidly burst to form ulcers. There can be a variety of other symptoms, including fever, headache and even a stiff neck. Oral herpes is a similar infection, except that it involves the mouth, the lips and the throat. There are usually no complications of throat infection. Rarely, there can be significant problems with swallowing, and very rarely there can be breathing difficulty.
In both oral and genital herpes, recurrences are common. The recurrent outbreaks are similar to the first infection, except they are usually milder. Recurrent oral herpes usually involves just the lips, with the mouth and throat involved to a much lesser degree.
Genital and oral herpes are caused by two viruses called herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). HSV-2 causes more than 80 percent of the cases of genital lesions, with the remainder caused by HSV-1. For oral herpes, the proportions are reversed. Roughly 70 percent are caused by HSV-1 and the remainder by HSV-2. Because HSV-2 causes most cases of genital herpes, it is sometimes referred to as the “genital herpes virus.” However, this is a misnomer because each virus causes disease in both areas. By “genital herpes of the throat,” I assume you are referring to oral herpes caused by HSV-2.
Q: Does it matter which virus infects where?
A: Not much. When HSV-1 causes genital herpes, the genital symptoms can be less severe than with HSV-2. Also, people with oral HSV-1 who then get genital HSV-2 usually have a milder genital illness than people who weren’t previously infected with HSV-1. Most people have been exposed to HSV-1 by adulthood, so most of the adult population is relatively immune to reinfection with that virus.
Herpes is a relatively contagious infection that is usually passed by direct contact. Someone performing oral sex on a person who has genital herpes can get oral herpes. The reverse is also true — the recipient of oral sex can develop genital herpes if the partner has oral herpes. To complicate the picture, a person can be contagious even when there are no obvious sores. However, the highest risk of transmission occurs when sores are present.
To prevent the spread of the virus, avoid direct oral or genital contact with someone who has herpes, especially if open sores are present. For genital contact, condoms should decrease the risk of spread, just as they do for HIV. I do not advise kissing someone intimately or performing oral sex when one has open oral herpes sores, but the risk of transmission is probably low if no sores are present. I cannot say that the risk of transmission is ever zero.
As to treatment, there is no known cure. Herpes is never gone from the body and can always recur. However, during an episode, especially a severe one, treatment can decrease the symptoms. Acyclovir (Zovirax) and two newer drugs, valacyclovir and famciclovir, speed recovery a little, especially if taken early during the episode. In someone who has frequent recurrences, these drugs can be taken daily at low doses to minimize, though not totally prevent, future episodes. Many factors go into the decision to begin ongoing suppressive therapy, including the severity of the illness, the frequency of recurrences, and the cost of the drugs, which can be quite expensive.
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Is there a connection between herpes and HIV infection?
People with herpes or other sexually transmitted diseases that cause genital sores are more likely to get HIV. The sores provide a place for the HIV virus to enter and start spreading. If a person with HIV also gets genital herpes, the herpes infection is likely to be more severe.
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Does herpes cause cervical cancer?
No! Cervical cancer is caused by infection with certain human papilloma viruses, not by herpes. However, you talk to your health care provider about when to start getting annual Pap tests.
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The general rules to follow if you are having a herpes outbreak are:
* Don’t touch the sores. If you do, wash your hands well with soap and water.
* Wash your hands after going to the bathroom.
* Don’t touch or rub your eyes.
* Wash your hands before touching a contact lens.
* Don’t wet contact lenses with saliva.
* If you have a cold sore, don’t kiss anyone, especially infants, children, or pregnant women.
* If you have a genital sore, don’t have sexual intercourse, even with a condom.
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How can I prevent spreading herpes?
If you are having a herpes outbreak, you should not have any sexual contact until all sores have healed, the scabs have fallen off, and the skin is normal again. Using condoms lessens the chance of getting herpes but does not completely protect against spreading the disease because the condom does not cover sores on the body. Touching sores can also spread herpes to other parts of the body or to your partner. If your skin has become normal again and you have no symptoms of herpes, you can have sexual contact again but herpes can still be spread when there are no symptoms (although the risk is low). You should always use condoms whenever you have oral, vaginal, or anal sex.
If you get any of the typical warning signs that an outbreak may occur—tingling, burning, and itching where sores were before—you should stop having sexual contact until the “flare-up” is over. These signs can start a few hours or a day before the sores flare up. Talk to your health care provider about whether you should take medication to lessen your chance of transmitting herpes to your partner. Pregnant women should particularly avoid getting a herpes infection and let their doctor know if they have ever had symptoms of genital herpes.
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Make sure that are you are eating a healthy diet, getting enough rest, exercising, and finding ways to relieve stress. If you have frequent or severe outbreaks, talk to your health care provider about taking a medication to prevent outbreaks or to treat them early.
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It is not clear what causes outbreaks. Some ideas are:
* Other infections
* Physical or emotional stress
* Fever
* Surgery
* Menstruation
* Sexual intercourse
* Skin irritations (ex.: sunburn) or sun exposure
* Trauma
* Alcohol
* Problems with your immune system
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