Herpes is not that scary

Just a few days ago, I narrated the story of a patient of mine with Kaposi’s Varicelliform Eruption (KVE).  Got overwhelming reactions, predominantly apprehensions about having herpes infection. Which is why I’m writing this, to alleviate fears about this virus.  Herpes Simplex Virus (HSV) has a vast presence in humans.  Actually, it is not that scary.  In fact, some 80 to 90 percent of humans experience oral herpes infections by 10 years old, mostly through casual contact.  It becomes scary only if you have other conditions such as immunosuppression or atopic dermatitis.

Herpes Simplex Virus (HSV) is quite common in humans. Many will have an acute episode manifesting as infected gums and lips, causing high fever, but most apparently have few, if any, symptoms. A substantial portion of the population has recurrent oral herpes infection, showing up as those nuisance little “cold sores” on lips and sides of the mouth, and occasionally elsewhere on the face.

Herpes Simplex Virus (HSV-1) causes about 80 percent of cases of oral herpes infections. In addition, skin contact with the lesions on an infected individual can spread the disease to another individual.  Transmission is generally via respiratory droplets (HSV-1) or direct contact (HSV-1 and HSV-2).  Simply stated, HSV-2 is primarily sexually transmitted, so it is less common than HSV-1.  The virus of Herpes Simplex Virus 1 can be transmitted most easily through saliva but can also be passed on through respiratory droplets and from mucosal contact with someone shedding the virus even though that person is asymptomatic or has no symptoms.

Where is herpes found?

Herpes infects the nerve cells of the spinal cord near the pelvis (in the setting of genital herpes) and of the nerve ganglia serving the face at the base of the brain (in the setting of oral herpes). Herpes is a DNA-type virus, inserting its DNA directly into the dendritic nerve endings of the skin, which then leads along nerve fibers to the nucleus of the nerve cell. Once the viral information is inserted into the cell’s nucleus, this blending of viral genetic information with human genetic information is permanent. The nerve cell then becomes a factory for making more viral particles.

Genital herpes and oral herpes refer to the location where the herpes infection is found in the individual. Most genital herpes are caused by HSV-2, but can be caused by HSV-1 in as many as 30 percent of new cases because of individual sexual practices.  Oral herpes is most often caused by HSV-1, and only rarely by HSV-2. Because these locations are often associated with a particular type of herpes (which seems to take hold in those particular locations more easily), medical people, websites, and literature often equate the location with the herpes type. You might find that people speak of genitally located herpes infections as HSV-2 and orally-located herpes as HSV-1. However, humans can have either virus in either place, and in fact, potentially anywhere on the body.

For discussion’s sake, I will call genital herpes infection “GHI” and oral herpes infection “OHI.” Generally, GHI is not considered to be extremely contagious. Casual contact on toilet seats, chairs, and similar sorts of workplace contact are almost certainly non-contagious, though this is debatable. Anecdotal case reports of persons acquiring GHI through contact in hot tubs have been published. Obviously, such matters would be very difficult to verify. The herpes virus does not survive outside the body for more than about 10 seconds, and although it can survive for slightly longer in warm, damp conditions, it dies very quickly once exposed to the air.

However, GHI is contagious, typically through skin-to-skin contact with an infected area. The method of transmission may occur through an active herpes blister on one person to a broken area of skin on the other person. For example, a male with an open blister could transmit the virus to the vagina of a female through a tiny abrasion in the vaginal mucosa of the female that could occur during intercourse. Similar modes of transmission can occur from female to male, male to male, and even female to female. Oral-to-oral transmission of either type of virus can also happen.

The virus may be transmitted to the penis, the vagina, the rectum, the mouth, and more rarely, the esophagus, the trachea, and even onto broken areas of skin anywhere on the body. Herpes simplex pneumonias have also been reported. And, of course, herpes simplex infections of the brain in newborn babies who acquire infection during delivery are well known, too, and can be medical disasters. About one in three cases of Herpes Virus Encephalitis (HSE) results from primary HSV-1 infection, predominantly occurring in individuals under the age of 18.   HSE is thought to be caused by the retrograde transmission of virus from a peripheral site on the face, following HSV-1 reactivation, along a nerve axon, to the brain.  Herpes simplex may also cause widespread rashes on the body with redness and swelling in these areas, reminiscent of measles.  Again, once the viral DNA has been transmitted to the receiving person’s nerve cells, the infection is permanent.

Finally, many people with GHI (and probably OHI as well) produce viral particles even when they have no symptoms at all and are likely to be contagious.  This is called “asymptomatic shedding.”

It is vital to realize that viral shedding can occur from people who have acquired the infection asymptomatically. This means that people can be infected and that only their blood tests might be positive.  That they may have no symptoms or few symptoms that are recognized as being caused by herpes, and yet they may still be shedding virus and may therefore be contagious.

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