Fridae

One young man returned from his grandmother's birthday celebration with a huge blister on his lip. I told him he had herpes. "No way," he said. "This is a cold sore. My grandmother had one and I kissed her." Well then, grandma has herpes too.

Intro
The word "herpes" actually refers to a large class of viruses that causes many different types of infections, from chicken pox (herpes zoster) to Kaposi's sarcoma (HHV-8). The Centers for Disease Control and Prevention (CDC) estimates that there are more than 500,000 new cases of genital herpes in the United States each year, with over 30 million Americans infected. It gets worse: once you have herpes, you have it for life. Herpes outbreaks typically come and go. When an outbreak subsides, the virus enters a latent phase where it hides in your body (probably in large sensory nerves near your lower spine) until something triggers it to travel back down the nerves to your skin and start another attack cycle.

What is it?
Genital herpes is caused by a herpes simplex type of herpes virus. There are two types: herpes simplex I (HSV-1) and herpes simplex II (HSV-2). Doctors used to think that HSV-1 infections were confined to the area above your belt and caused common cold sores, while HSV-2 infections were thought to appear below your belt and were responsible for the common genital infections. We now know that HSV-1 can also spread to your anal or genital region and HSV-2 can turn up in your mouth.

Diagnosis
Doctors can diagnose a herpes infection based on the classic appearance of the blisters. They also diagnose herpes by actually culturing the virus from the blisters. A viral culture is very different from a bacterial culture and requires a different medium for the organism to grow in. If you have a sore throat and don't tell your doctor that you've had oral sex, the doctor may only do a routine bacterial throat culture, and your herpes diagnosis won't be made. Of course, a viral culture can only be taken during an acute outbreak when you have blisters. If you wait to see your doctor until your blisters are gone or have already crusted, the culture won't be accurate. A negative result might lull you into a false sense of security that you never had herpes when, in fact, you did. Your doctor can also check your blood for antibodies to herpes. This test is useful after your outbreak, when the blisters are gone but the presence of antibodies determines that you did have a prior attack.

Symptoms
The first sign of a herpes infection might be the same symptoms you've come to recognize from any viral illness: fever, aches, fatigue and loss of appetite. Within a week you begin to notice a burning pain in the skin at the site of infection, followed by a cluster of blisters a day or two later. The blisters are full of herpes virus making you highly contagious. Within three to five days the blisters rupture, leaving behind pink shallow ulcers that crust over and heal. Scarring is extremely rare (unless you scratch the blisters and they get infected with bacteria). The entire cycle lasts about two weeks. If the herpes infection begins in your mouth or throat, you will have a typical sore throat and the blisters will be hard to spot. When oral herpes recurs, it is usually in the form of a cold sore or blister at the edge of your lip.

---

Anal herpes is usually very painful and the blisters appear at the edge of your anus. If the infection spreads inside your anus and rectum, you can develop colitis with intense pain during bowel movements, and blood and mucus in your stool. If you've had prior outbreaks, no matter where they were on your body, you will probably learn to recognize the earliest symptoms and begin your medication immediately. This will drastically shorten the attack and lessen the symptoms. Attacks can vary with respect to severity of symptoms and duration. Typically with time the frequency, duration and severity of outbreaks diminishes.

How is it acquired?
Herpes is spread between partners during sex. There are rare cases described in medical literature where herpes has been spread through very close non-sexual contact: doctor/patient (hope it was non-sexual) or masseuse/client (non-sexual?). Penetration is not required and a condom may not be protective. Although the virus rarely grows on fingers and never on toys, they can act as conduits and carry the virus from one partner to the other.

How to treat it?
Three different drugs treat herpes infections well. Which one your doctor prescribes may depend on a number of factors -- from personal preference to ease in dose schedules. Although resistance and side effects are rare, some patients and physicians prefer one drug over the other.

INITIAL OUTBREAK: Zovirax (Acyclovir) 400mg three times a day for 7 to 10 days, Famvir (Famciclovir) 250mg three times a day for 7 to 10 days or Valtrex (Valacyclovir) 1gm twice a day for 7 to 10 days.

RECURRENT INFECTIONS: Treatment for recurrent infections is generally shorter and medication doses are lower than what is used for the first infection. Again any one of the three medications works well: Zovirax (Acyclovir) 400mg three times a day for five days, Famvir (Famciclovir) 125 mg twice a day for five days or Valtrex (Valacyclovir) 500mg twice a day for five days.

SUPRESSION: Some people with poor immune function (particularly those with HIV) are plagued by frequent herpes outbreaks. These individuals might benefit from chronic antiherpes therapy to cut down on the number of attacks. There is a danger, however, that chronic medications will lead to the development of a resistant herpes infection. Any one of the three medications works well for suppression: Acyclovir 400mg twice a day, Famciclovir 250mg twice a day or Valacyclovir 500mg daily. Some physicians advise combining oral medications with acyclovir cream to treat acute outbreaks. Most physicans, however, feel that the cream provides no added benefit.

---

Myths dispelled
Here are some facts to clear up some common misconceptions.
Cold sores are herpes, and herpes can spread even without signs of a visible outbreak. A canker sore (aphthous ulcer) is not herpes.

Prevention
A condom may not prevent you from getting herpes and penetration isn't necessary. The virus can pass between partners during foreplay involving close skin to skin contact or during oral sex. Although the virus won't grow on fingers or toys, they can act as a conduit carrying the virus between partners (use your imagination). If your partner has a cold sore or blisters on his/her anus or genitals, it might be best not to have sex. A condom covering the blisters will probably protect you as long as you use it from the start of any skin to skin contact. Washing with soap and water after sex may also help decrease your chances of infection.

If you have a herpes infection, keep your hands, partners or toys away from the blisters. You can spread the herpes to other parts of your body (including your eyes). If you've had herpes before, you might learn to notice the earliest signs of an infection (tingling or burning in the skin) and begin the medication immediately. This can drastically shorten if not abort the attack.

Although doctors do not know what triggers an attack, they think that stress, immune compromise, sunburn and injury might play a role. Avoiding these typical instigators might help prevent attacks. You might also learn (and avoid) what triggers an outbreak in your own body.

Of particular concern to Pregnant women
Sex toys can carry the virus between partners. If pregnant, some women with active vaginal herpes infections might require a cesarean section.

Of particular concern to persons with HIV
Herpes infections can be quite severe in people with HIV and others with compromised immune systems. Chronic suppression therapy might be necessary to limit the frequency of attacks. Herpes infections can even spread to other parts of your body.

Incubation period
The incubation period lasts from several days to one week.

Sex
Although you are more contagious during an acute outbreak, herpes can spread between partners even when there are no signs of blisters. Toys and fingers can carry the virus between partners. A condom may not protect you. If you have herpes on your lip, beware of kissing or oral sex, when you can easily spread the infection.

Prevalence
There are over 500,000 new cases in the U.S. each year and over 30 million Americans are infected.