Herpes Facts

The Herpes Virus Family

There are eight herpes viruses currently known to infect humans. These include; herpes simplex virus type-1 (HSV-1), commonly associated with cold sores or fever blisters; HSV-2, most commonly associated with genital herpes; varicella zoster virus, which causes chickenpox and shingles; cytomegalovirus (CMV), associated with retinitis and pneumonia in immunocompromised people; Epstein-Barr virus, which causes infectious mononucleosis; human herpesvirus 6 (HHV6), causing childhood roseola; HHV7, which results in infectious mononucleosis in children; and HHV8, associated with Kaposi’s sarcoma. Despite the extensive range of symptoms of herpes virus infections, all are characterized by the establishment of latent infection and all have the potential to reactivate from latency.

Herpes simplex virus type-1: commonly causes herpes labialis (also called oral herpes, cold sores or fever blisters), which are highly infectious open sores that crust over before healing. Although less probable, HSV-1 can also cause genital herpes.

Herpes simplex virus type-2: a contagious sexually transmitted viral infection primarily causing genital herpes in men and women. The telltale signs of genital herpes include recurrent clusters of blisters, bumps and rashes in the genital areas and rectal lesions. HSV-2 can also be responsible for herpes labialis, although less often than HSV-1

Structure of the Virus

The HSV-1 and HSV-2 viruses look identical by the electron microscope.

Genital Herpes Symptoms

Most people with genital herpes are unaware that they have the disease because they never have symptoms or do not recognize them. When they do occur, the symptoms (and severity) of genital herpes vary from person to person. First episode symptoms of genital herpes can appear within 2 to 10 days of infection and last an average of 2 to 3 weeks. In many people, the first infection may be so mild that it goes unnoticed. In other people, painful sores may appear at the site of infection. Other symptoms can include tingling, an itching or burning sensation; pain in the thighs, buttocks, or genital area; vaginal discharge; a feeling of pressure in the abdominal area; flu-like symptoms (which may include swollen glands, headache, muscle ache or fever;) and painful or difficult urination. Genital herpes symptoms are sometimes mistaken for simple skin irritation, jock itch, razor burn, or a yeast infection.

Transmission

HSV-1 and HSV-2 is released from the sores that the viruses cause, but they also are released between episodes from skin that does not appear to be broken or to have a sore. A person almost always gets HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. A person can get HSV-1 by coming into contact with the saliva of an infected person. HSV-1 infection of the genitals is caused by oral-genital sexual contact with a person who has the oral HSV-1 infection or genital contact with a person who has genital HSV-1 infection.

Increased risk of HIV with HSV-2 infection

There is significant evidence that there is synergism between HSV-2 and HIV-1. These findings are bringing about a fundamental change in physicians views about the importance of Herpes testing. The paradigm shift means that concerns of physicians and health officials are in concert with those of patients with known genital herpes infections who have been concerned about transmission of the disease. Almost all new cases of genital herpes are transmitted by a person who is unaware of their HSV-2 status. Type specific testing is important so treatment can be instituted. 

To date, there have been over 30 studies that have determined the risk for HIV acquisition among persons with HSV-2 is fairly high. In international studies, there is the establishment of linkage.

HSV-2 has a different natural history among HIV-infected persons. Those individuals that have both infections have more frequent HSV-2 activations, at much higher rates of viral shedding. Finally, there are some data that HSV-2 is associated with increased HIV plasma levels in people who have both infections. HSV-2 may be one of the core factors to determine the progression and natural history of HIV disease. There are some early indications that suggest that treatment for HSV may be associated with reductions in plasma HIV levels.