New Information on Herpes
Source: Curr Opin Infect Dis. 2014;27(1):75-83.
OK so we all know Herpes is bad news. How bad news? This bad news:
- It cannot be cured. Once you have it, you have it for life.
- It is highly contagious and spread by skin-to-skin or skin-to-mucosa contact EVEN WHEN a person does not have any symptoms. This is called asymptomatic viral shedding. More on that later.
- It increases the risk of contracting HIV 2 to 3 times.
- It can infect a baby during delivery and cause the baby to become very sick.
- It can cause very painful blisters and ulcers.
Some new information was recently made available on Herpes and I would like to share it with you.
- Herpes Type 1 infects the mouth and Herpes Type 2 infects the genitals right? WRONG!
HSV 1 (Herpes Simplex Virus Type 1) is found to be twice as commonly found in the genitals compared to HSV 2 (Herpes Simplex Virus Type 2). So if you test positive for HSV 1, it could be because you have had cold sores your whole life. It could also be because you have HSV 1 infection in your genitals. Unfortunately, there is no way for you to know unless you actually develop symptoms in the genitals. How often people who are infected in the genitals with HSV 1 develop symptoms is discussed below.
- How many people in the world actually carry Herpes?
HSV 1 – 80% to 90%. Oh yes. Scary thought. HSV 2 – 16% (This study is only for people between the ages of 19 and 49. It could be more if the age range was wider.) Yes it is extremely common. Which means universal screening for Herpes might not be too useful. In other words, if you do not have symptoms, you might not want to screen for Herpes as statistically, there is a good chance your test will turn out positive.
- How many people develop symptoms?
When a person is first infected with HSV 1, 74% of them do NOT develop any symptoms. Same goes for HSV 2 except the number is a little lower at 63%.
As time goes by, 57% of people infected with HSV 1 in the genitals will develop symptoms. The number is much higher for HSV 2 at 89%. Those with HSV 1 infection of the genitals have a median of 1.3 outbreaks per year and those with HSV 2 infections of the genitals have a median of 4 outbreaks per year.
This means there are a good number of people infected with HSV that go through life happily oblivious of the fact.
- What’s this thing about asymptomatic viral shedding?
That means even when a person does not show any symptoms, he/she is still shedding the virus and can infect someone else. Recent very smart studies using repeat genital sampling and spatial mathematical modelling have demonstrated that reactivations are brief (i.e. <12 h) and occur frequently. More specifically, 80% to 90% of people infected with HSV 2 undergo asymptomatic viral shedding in approximately 20% of days.
This means that many people are spreading Herpes without even realizing it. This makes it very challenging if not impossible to completely protect oneself from getting Herpes.
- Should I screen for Herpes?
Hmm. No surprise the jury is still out on this one. In Singapore there is no recommendation for universal screening for Herpes. Similarly, in the US, screening is not recommended by the US Preventive Services Task Force. The reason given is that current blood tests are not all that accurate and that is a very fair statement. The other concern is that Herpes screening can lead to ‘detrimental psychological outcomes’. I definitely can relate to that. Many of my patients, completely well and asymptomatic, are driven to near madness because of a positive Herpes test. Of course when there is a clinical need, you should still screen for Herpes. The emotional and psychological aspect of it just has to be dealt with. However, universal screening for Herpes is still not recommended because there are no studies to actually show that people who know that they carry Herpes will change their behaviours to lower transmission rates.
If there is a good reason for you to screen for Herpes, please do it.
- Any chance of a vaccine in the near future?
Sorry nope. Vaccine trials for Herpes has been nothing short of disappointing. Kinda like vaccine trials for HIV actually. There is a candidate for a Therapeutic Vaccine but it is only in Phase 1. Industry insiders will know to tell you not to hold your breath.
Statistically, it is more likely that you are carrying Herpes than not. If you develop symptoms like blisters or ulcers in the genital region, go see your doctor immediately. Swab tests of the blister or ulcers are much more accurate than blood tests for Herpes. There are medicines that you can take that will reduce the number of days you have to suffer with the symptoms. There are also medicines you can take to prevent outbreaks and reduce the risk of passing it on to your partner.
If you truly have been found to have Herpes don’t freak out. I know it sucks to be diagnosed with an STD that will stay with you for life but really things could be worse. At least Herpes is not going to kill you. It may cause you to have painful blisters or ulcers that can be controlled with medicines. It will not be passed to your children. The way infants are infected is if the mother has active Herpes blisters in the genital region at the time of delivery. If that is the case, your doctor can discuss alternatives with you like delivering the baby via a C-Section.
If you have Herpes don’t freak out. Manage the problem.
Click for the old article on Herpes.
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.