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Herpes: Understanding the epidemic
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Herpes, six letters that strike fear in the heart of anyone who has ever been sexually active. No one wants a sexually transmitted infection (STI), especially one you can’t get rid of.
There are actually two kinds of sexually transmitted herpes viruses: type 1 and type 2. They both cause painful cold sores that come and go. Sores on the mouth (orolabial herpes) are most commonly due to herpes type 1 and sores on the genitals are most often the result of herpes type 2 (genital herpes). However, both type 1 and 2 can travel above and below the belt and there is no way to tell by looking at a cold sore if it is due to herpes 1 or 2.
Herpes type 1 is ubiquitous, by the age of 18 more than 90% of the population has been infected. Herpes type 2 affects 20-25% of people, meaning 50 million Americans carry the genital herpes virus somewhere in their body. Herpes is so common because the virus is transmitted even when there is no cold sore. Once you have the infection your body intermittently sheds the virus and you can’t predict when: on average, people who carry herpes 1 or 2 shed the virus 15-20% of the time.
What are the consequences of a herpes infection? Most people don’t get cold sores and so they never know they have an infection. Among the 15% or so who do get cold sores, a few lifetime outbreaks is the norm. Only a small percentage of people have recurrent outbreaks. People with immune system problems (such as HIV or those taking medications that suppress the immune system) may have more problems with recurrent infections. In rare cases, herpes infections can cause serious eye problems or even encephalitis (an inflammation of the brain). For women, a cold sore on the genitals during labor can place a baby at risk for a serious infection so when a cold sore is present a c-section will be recommended to reduce the risk.
How can you prevent genital herpes? Avoid sexual contact during an outbreak. Condoms can reduce transmission by 25% and medications (called antivirals) to suppress the infection reduce the chance of passing the infection to a partner by 50%. So, there are steps to take, but nothing is 100%. Because the herpes virus is shed from the skin on the genitals (areas not covered by a condom like the vulva or scrotum) it can be transmitted by close skin-to-skin contact, so even 3rd base can increase your risk.
If you have genital herpes talk with your doctor so you can understand your risks and decide if antiviral medication is right for you. Be open with your partner and encourage them to get a blood test to see if they have been previously exposed - there is a 25% chance they also carry the infection. But don’t feel ashamed. Remember, it’s a cold sore that just happens to be on your genitals.
For more info: www.cdc.gov/STD/
Remember, the information in this column does not constitute individual medical advice.
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Sexually transmitted infections (STIs)
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