Caitlin Gallagher
October 22, 2018 1:04 pm
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Cold sores are unsightly, sure. But it’s weird to think that something as harmless as a fever blister on your mouth can be connected to a dreaded sexually transmitted infection (STI). That’s what makes the virus herpes so darn bewildering. The word “herpes” usually elicits a negative reaction, but what is herpes? And is the fear of it justified? In order to answer all of our questions about herpes, HelloGiggles spoke to family practitioner Honore Lansen, M.D., of One Medical, a medical group with offices around the country. Dr. Lansen outlined the different types of herpes and highlighted the fact that whether it’s oral or genital herpes, this common virus isn’t all that scary.

When I got a cold sore in elementary school, the doctor diagnosed me with herpes and said I had to take a sick day. I was too sheltered to understand the implications of this and the presumed connection to genital herpes, but my classmates weren’t. A friend told my class that I had herpes and some people made fun of me for having a gross disease. In the end, I was more concerned that this thing on my mouth ruined my perfect attendance record than anything else. But clearly, the confusion—and stigma—surrounding this virus and its different types starts young.

Dr. Lansen notes below that the two types of herpes are oral and genital and, for the most part, they aren’t that big of a deal. Of course, there are some exceptions. For instance, Johns Hopkins Medicine covered how the herpes simplex virus can cause meningitis and encephalitis. And researchers are looking into the connection between herpes and Alzheimer’s disease with a new study reviewing evidence that herpes could be a risk factor for Alzheimer’s.

But overall, herpes on your mouth or even your genitalia is far from the end of the world as Dr. Lansen will help you realize through the following Q&A.

What is herpes?

“Herpes is a virus, much like any other virus you may encounter, such as the influenza or chicken pox viruses.”

What are the different types of the herpes simplex virus?

“Herpes simplex virus (or herpes, as it is commonly referred) comes in two forms: HSV-1 and HSV-2. Most of the time, HSV-1 is classified as oral herpes, like cold sores, while most of the time, HSV-2 is classified as genital herpes. While both types of herpes used to be exclusively associated with where they appeared on the body, the two strains are actually more interchangeable now than we once thought—meaning that HSV-1 can appear on genitalia and HSV-2 can appear orally. Oral herpes and genital herpes are technically two separate viruses but can spread interchangeably between areas of the body.”

What are the symptoms of herpes?

“Oral herpes symptoms most often appear as cold sores on or around the mouth, while genital herpes symptoms appear as blisters around or inside the genitals. However, some people who have the herpes virus do not exhibit symptoms, which is how it gets transmitted widely. Many infected people instead experience asymptomatic viral shedding, which means the body is replicating the virus inside but does not externally show symptoms. The virus can still be transmitted during this period.”

How do I know if I have herpes?

“If you are experiencing symptoms consistent with a herpes outbreak, make an appointment with your primary care provider to get tested. Tests are conducted either via swab or a blood test. In a swab test, your primary care provider will use a Q-tip to collect fluid from a fluid-filled blister and send it to the lab. This test allows us to tell the difference between an HSV-1 and HSV-2 infection and is more accurate than a blood test.

The blood test is not as useful for initial screening because it detects whether the herpes virus has ever been present in your blood. For example, it’s not uncommon for children to get cold sores but not exhibit any herpes symptoms as adults—yet the blood test would still yield positive results in this case.”

Can I have herpes without symptoms?

“Yes, you can have herpes and not exhibit symptoms. A doctor would diagnose you through a skin swab or a blood test mentioned above.”

How is herpes spread?

“Herpes is spread through skin-to-skin contact. Although condoms help to diminish risk, there’s still a small chance of transmitting herpes despite protected sex, as the virus can appear on other parts of the pubic area and mouth.”

How is herpes treated?

“There is no known cure for the herpes simplex virus, but antiviral medication (like the commonly prescribed Valtrex) can help reduce the course of symptoms and decrease potential contagion. Your primary care provider can write you a prescription, which should be taken at the first sign of outbreak (which usually manifests as tingling at the site of previous outbreaks). Some people who have been diagnosed with the herpes virus use this antiviral medication preventively, particularly if they have regular sexual partners or often have intense outbreaks. It’s often recommended that the diagnosed person takes a daily lower dose of the medication to help prevent the transmission of the virus to any sexual partners.”

Is there a way to figure out how I became infected with the virus?

“In some cases, if testing can be performed with timing that is consistent with suspected exposure and sexual history, it can help to determine when infection occurred. But in the majority of cases, this level of specificity is not possible. It depends on the individual’s sexual history and prior test results.”

Is there a way to avoid getting herpes or lessen my risk of contracting it?

“The only way to lessen the risk of getting herpes is consistent condom use. If your sexual partner has herpes, avoiding intercourse during an outbreak will help reduce your risk, as will asking that partner to take a daily antiviral medication.”

What should I do if I have an outbreak? Am I contagious?

“If you have a herpes outbreak and have previously been diagnosed, be sure to take your antiviral medication at the first sign of an outbreak. You are at increased risk of spreading the virus during this period. If you think you may be experiencing symptoms of herpes but haven’t been diagnosed, book an appointment with your primary care provider to get tested.”

If I’ve already been diagnosed and have an outbreak, do I need to see my doctor?

“You do not need to see a doctor for subsequent herpes outbreaks. I typically give my patients a prescription with a number of refills so they can make the decision to take their medication at the first signs of an outbreak and don’t need to make an appointment for each renewal.”

Why am I having another outbreak? How often does herpes recur?

“Like many other viruses (chicken pox for example), the herpes virus lives in your body throughout your lifetime. As time passes, it may become dormant, asymptomatic, and not contagious—but it’s impossible to tell when this may occur. Because of this, you may experience multiple outbreaks over the course of your lifetime. On average, HSV-1 outbreaks occur once or less per year; the number of HSV-2 outbreaks per year is typically between four and six. There is some solid evidence to suggest that outbreaks do taper down over time, but unfortunately, there is no way to guarantee that recurrences stop permanently.”

Can I spread herpes to other parts of my own body during an outbreak?

“You can spread herpes to other parts of your body during an outbreak. If you had a cold sore and you touched your mouth and then your genitalia, for example, you could theoretically transmit HSV to that area.”

Should I avoid kissing and sharing food if I have an outbreak of oral herpes?

“Kissing someone with a cold sore definitely puts you at risk of contracting oral herpes. Sharing food does not.”

Can I have sex (oral, vaginal, anal) if I have an outbreak of genital herpes?

“You should not have sex during a herpes outbreak, as you could spread the virus to your partner.”

Are there any other ways I can catch herpes?

“It’s a common misconception that you can catch herpes from public toilet seats or swimming pools. That is not the case. The virus is not that easy to pick up.”

Can I still spread herpes if I don’t have any physical symptoms?

“Yes, many people with the virus do not experience noticeable symptoms but are still contagious.”

Does herpes cause other viruses?

“Herpes does not cause other viruses, nor does it have an impact on your immune system.”

What about pregnancy? Can I deliver a baby vaginally?

“Most women can! You should always tell your doctor about any medical condition you have, so be sure to communicate with your obstetrician (OB) if you do have herpes. They will likely prescribe an antiviral medication during the last trimester to ensure you don’t have an outbreak when it’s time to deliver. If you don’t have any signs or symptoms of herpes at the time of delivery, there’s a good chance that you won’t need a C-section.”

Does herpes ever go away?

“Technically, the herpes virus stays in the body forever, but it may become asymptomatic or dormant over time.”

Is herpes something to be ashamed of or worried about?

“When I discuss the herpes virus with my patients, I try to emphasize that they are not alone. It is estimated that between 15 and 20% of Americans have herpes—it’s very common and nothing to be ashamed of. And although we don’t have a cure for it yet, it’s important to remember that herpes is a very manageable virus. It doesn’t have any lifelong impact that will debilitate you or cause adverse health effects.”

As Dr. Lansen said, herpes is common and the National Institutes of Health note that anyone can get the herpes simplex virus. So rather than be ashamed if you think you may have herpes, speak to your health care provider and get the facts.

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