Herpes Simplex Infections

Used with permission from www.herpes.org

Herpes is a virus, specifically "herpesvirus hominus". Simplex is a sub-category of that family. Simplex falls into four categories, types 1, 2, 6, and 8. Generally type I infects the mouth in humans and type II affects the genital tract, but there is a substantial overlap. Type 6 causes an infection of infancy and Type 8 has been associated with Kaposi’s Sarcoma which is seen in HIV.

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Herpes simplex virus (HSV) has a vast presence in humans. It has been estimated that 90% of humans experience oral herpes infections by the age of ten years old, an acute episode manifesting as infected gums and lips, causing high fevers. A substantial portion of the population has recurrent oral herpes infection, showing up as those nuisance little "cold sores" on lips and sides of the mouth, and occasionally elsewhere on the face.

Herpes infects the nerve cells of the spinal cord of the pelvis (in the setting of genital herpes) and of the nerve ganglia serving the face at the base of the brain (in the setting of oral herpes). Herpes is a DNA-type virus, inserting its DNA directly into the nucleus of the nerve cell. Once the viral information is inserted into the cells’ nuclei, this blending of viral genetic information with human genetic information is permanent. The nerve cell then becomes a factory for making more virus.

Generally medical people speak of genitally-located HSV infections as HSV II, though humans can have either virus in either place. Someone with an HSV I lesion on the mouth can certainly transmit the infection to a significant other through oro-genital contact with the genitalia of the other, causing a recurrent HSV I lesion on the genitalia of the other. Also, other sites of HSV infection can be produced, such as on a finger (the so-called "herpetic whitlow") or elsewhere.

FIRST POINT: PEOPLE WHO HAVE SYMPTOMS OF HERPES INFECTIONS EITHER ON THE FACE OR ON THE GENITALIA SHOULD REFRAIN FROM ALLOWING THESE AREAS TO COME INTO CONTACT WITH A SIGNIFICANT OTHER DURING INTIMATE CONTACT.

For discussion sake, I will call genital herpes infection "GHI" and I will call oral herpes infection "OHI". I will refrain from calling GHI the more typical name "HSV II" for the reason discussed above.

GHI affects about 20-25% of Americans, numbers exceeding probably 50 million Americans. It remains one of the fastest growing infectious diseases in the world in absolute numbers of people. Probably Human Papillomavirus infections outnumber GHI (see the article on HPV) in both growth rate and probably in absolute numbers.

Generally GHI is not considered to be extremely contagious. Casual contact on toilet seats, chairs, and similar sorts of workplace contact is almost certainly non-contagious, though debate exists on that issue. Anecdotal case reports of persons acquiring GHI through contact in hot tubs have been published. Obviously such matters would be very difficult to verify.

However, GHI IS contagious. The method of transmission is usually through an active herpetes blister with a broken area of skin. A male with an open blister could transmit the virus into the vagina of a female through a tiny abrasion in the mucosa of the female that would occur during intercourse. Similar modes of transmission can occur from female to male, male to male, and even female to female. Oral to oral transmission of either type of virus can happen. The virus may be transmitted to the penis, the vagina, the rectum, the mouth, the esophagus, the trachea, and even onto broken areas of skin anywhere. The New England Journal of Medicine published a photograph of a herpes infection deep down inside the esophagus of a woman in April, 1999. Herpes simplex pneumonias have been reported. And, of course, the Herpes simplex infections of the brain in newborn babies who acquire infection during delivery are well known and are medical disasters. Herpes simplex may also cause wide-spread rashes on the body with redness and swelling in these areas, reminiscent of measles.

Again, once the viral DNA has been transmitted to the receiving person’s nerve cells, the infection is permanent.

Viruses are very tiny, of course, far smaller than bacteria and far smaller than the cells of the human body. Viruses are so small that they can even slip through the tiny cellular holes of the "lamb-skin" type of condom which are normally small enough to prevent sperm cells from getting through. Latex-type condoms are probably protective against viral particles getting through, provided the condom covers the affected area completely during the sex act. Viral particles from an active lesion can become liquid borne from inside the condom however and possibly leak out the base of the condom.

Herpes infections produce a number of different signs and symptoms. Traditional "first episode" herpes, most commonly described in women, are serious illnesses, with high fever, often large-sized outbreaks, and even inability to urinate. Hospitalizations are sometimes necessary, with urinary bladder catheterization, IV fluids, and intravenous anti-viral medications being required. Most people who present with infection don’t describe such a first onset illness, however, showing up in the office or the ER with a cluster of small blisters surrounded by a red base showing up on the genitalia, in the case of GHI. Often the blisters have already ruptured, leaving behind a cluster of ulcers which required one to two weeks to heal.

SECOND POINT: DURING THE BLISTER AND ULCER PHASE, THE HERPES LESION CONTAINS AND LEAKS OUT BILLIONS OF VIRAL PARTICLES AND IS CONTAGIOUS TO ANY AREA OF BROKEN SKIN OR WET MUCOSA, INCLUDING THE EYE, THE MOUTH, THE ESOPHAGUS, THE TRACHEA, THE LUNGS, THE ANUS, THE URETHRA, AND THE VAGINA.

Herpes infections are often more subtle, however. Sometimes the skin will just be slightly reddened without obvious lesions. This area is probably contagious, though probably much less so than blistered areas. Sometimes the skin will form tiny red bumps that don’t blister, called "erythematous papules". Sometimes there are no signs on the skin at all but rather a "prodrome", such as urinary urgency and frequency AND/OR aching or tingling in the legs. Finally, many people with GHI (and probably OHI as well) produce virus even when they have no symptoms at all. These people are likely contagious even when they have no symptoms at all. This term is called "asymptomatic shedding" and is well described in the herpes literature.

Confusing the picture even more in women is that a herpetic lesion within the vagina may only produce a vaginal discharge as an external symptom, resembling a yeast infection. It may be difficult without examining the patient to know which is which. So, some women with both chronic yeast infections and GHI may find themselves confused as to which problem is bothering them. These patients should be under the care of a gynecologist and should not attempt to self-medicate until the symptoms have been clearly explained.

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Herpes Simplex Infections