Picture from: southmed.usouthal.edu

It is estimated that at least 20-30% of people in developed countries have contracted Herpes Type II (also called genital Herpes) and 60-85% of people have contracted Herpes Type I (also called cold sores of fever blisters). It has been reported in some studies of developing countries that the percentage of people infected with type II is at almost 50% and the percentage of the population that has contracted type I is almost 100%. Now before we continue take a moment to stop and think about those numbers and statistics that I have just given to you.

What comes to mind about those numbers?
Were they higher then you expected?
Does it sound like either type of Herpes infection is common?
Should we assume that contracting Herpes is totally easily and cheaply preventable?

Did you know that Herpes Type I & II infections are related to the same virus that gives us chicken pox and shingles? Most people at one time (usually when they were younger) were either infected with chicken pox or were vaccinated against it. (However, while they are related, having had either chicken pox or shingles before will not prevent an infection of Herpes.)

The only true method of prevention of any type of Herpes infection seems to be to prevent contact with another person. Oral Herpes can be transmitted from sharing a glass or utensils and genital Herpes is passed from direct genital contact. As with any STI/STD the best method of prevention when involved in a sexual relationship is condoms - but it does not prevent 100% of transmissions.

When people are infected with Herpes II (and sometimes in the case of Type I when outbreaks occur often) many times their doctors will prescribe what is called "suppressive therapy" which is where the infected person takes anti-viral drugs daily to help prevent out breaks and has been shown to help reduce the asymptomatic shedding. Asymptomatic Shedding is when an infected person is releasing virus but has no visible signs or symptoms but still could infect another person. In the cases of both I and II this shedding does occur as most cases of Herpes are transmitted by people that do not know that they have been infected with Herpes and end up passing it along due to the asymptomatic shedding. There are many couples in serious commented relationships where one person has Herpes and the other does not (they are often referred to as "discordant couples" in the science journals). For them open and honest communication is the key to preventing transmission.

There are three proven drugs for the treatment (both for an active out break and for suppressive therapy) of both Type I & II Famvir (Famciclovir), Valtrex (Valacyclovir), Zovirax (Acyclovir). After the first out break, the reoccurring outbreaks are brought on due to things such as stress, lack of sleep, sun exposure, and chemical exposures. Type I can infect the genital area and Type II can infect the face and lip area. There have been some studies that have shown that in some people being infected with one Type can help reduce the risk of being infected with the other Type but, because there are a fair number of people that have contracted both Types of Herpes.

The first outbreak usually occurs 2-20 days after an exposure to the virus. The symptoms can be very prominent and pronounced and flu like along with an outbreak of sores or in some cases there were no feelings of being ill. In most cases the liquid filled blisters can and will appear in the area that was infected. Often times they are painful and the area around them can itch and or be very sensitive to being touched. Something call auto-inoculation can occur when a person touches a blister and then touches another body area (either near or close). While the biggest problem with having Herpes (especially with Type II) is actually not problems with outbreaks of the disease but actually with public perceptions of it as seen in this display.

herpesweb.net

We also must mention some implications to be considered for women who wish to have children. While the risk of transmission to a child is low and for the most part can be prevented if there is an active outbreak during labor and delivery in the form of drug treatment and careful monitoring by the patient and medical personnel. There is always the method of delivery via c-section which eliminates almost all risk to the child. Women who contract Herpes during pregnancy, most notably while in the third trimester are at the highest risk for transmitting the disease to their child.

Until recently medical personal could test a person for an exposure to Herpes but could not say for sure what Type of Herpes the person had without a fresh active lesion to directly test. The old blood test, which is taken during a physical and/or STI/STD screening, could not tell the difference between the two Types. For many years some doctors only tested patients for Herpes when they had a history of similar symptoms or were requested to do so by the patient. Now there is a blood test that can say for sure exactly if a person has been infected and with what types. However, the medical "gold standard" is still being able to obtain a positive culture directly from the lesion plus a positive blood test.

Right now in the US and Canada there is an on going Phase III Clinical Trials (in other words, the final testing in trials before being approved for the general public usage). The Herpevac (Herpes Vaccine) for Women is currently recruiting women 18-30 in the US and Canada that are Type I &II negative to be part of the study. While it seems to totally prevent Herpes in about 40% of women that have taken the vaccine, there are many questions about if a women is infected with Herpes after being vaccinated such as will she be less likely to have outbreaks and will she be less likely to pass along the virus to other sexual partners and will she shed less virus then a person that was not vaccinated. The biggest drawback for the vaccine is that it is only effective in women that have not been infected with either I or II at any point of their life so this vaccine would most likely be given at a young age to prevent any type of infection - which has stirred up a lot of controversy. Also, while this vaccine is known to prevent type II, it is not known if it will make women less likely to develop type I. If interested, please see the site above for more information and contact them if you have any questions. (Please note, in the interest of full disclosure I personally am involved in this vaccine trial.)

Overall both types of Herpes infections are VERY common. Having either Type is not a death sentence nor can truly impact and affect your life unless you allow it to do so. With current drug treatment the symptoms are very treatable and manageable when proper attention is paid to it. Public acceptance of this viral infection needs to be worked on as there is no need for the discrimination that sometimes occurs when someone's status is disclosed.

I have added some links to selected sites for more information:

Center for Disease Control (CDC)
American Social Health Association
The National Institutes of Health (NIH)

While most of the information of these two sites are for Americans, both have resources for those living elsewhere as well:
Herpes Support Groups
Herpes "Friendly" Doctors and Medical Personnel

This is the archive of past columns; enter if you dare!