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This is an infection that is caused by the herpes simplex virus that is very contagious and often spreads through human to human contact.
Types of Herpes
The herpes simplex virus family has 2 members : HSV-1 and HSV-2.
- HSV-1 is mainly transmitted through the oral to oral contact causing oral herpes, commonly known as cold sore. HSV-1 however is not limited only to oral herpes, it can also cause genital herpes as well.
- HSV-2 is a sexually transmitted infection that causes genital herpes. These are mild infections and are generally harmless but may lead to potentially fatal complications for newborns, pregnant women and those with weakened immune system.
- An estimated 3.7. billion people under the age of 50 have HSV-1 infection globally (about 67% of the human population )
- An estimated 491 million people aged 15-49 worldwide have HSV 2 infection.
It is a very common condition.
HSV 1 is not technically a sexually transmitted infection. Transmission occur mainly via contact with the virus in sores, saliva or surfaces in and around the mouth.
Kissing and sharing of utensils are some of the common modes of transmission. The greatest risk of transmission is when there are active sores appearing. Most HSV 1 infections are acquired during childhood and not uncommonly from their parents.
Oral herpes infection is mostly asymptomatic, but when symptoms do occur it can be very uncomfortable.
Infected persons often experience first a tingling, itching or burning sensation around their mouth before the onset of painful sores or vesicles. The sores will resolve on their own usually within 7-10 days. But can recur periodically throughout our lives.
Other common symptoms of HSV-1 infections include :
- fever with muscle aches
- lymph nodes swelling
- swollen red gums
HSV 2 is mainly transmitted during sex through contact with genital or anal surfaces, skin, sores or fluids of someone infected with the virus. It can be transmitted even if the skin looks normal and in the absence of symptoms.
Genitalia herpes can be asymptomatic or have mild symptoms that can go unrecognised. When symptoms do occur, one or more painful vesicles or ulcers may appear in the private area. Again, it may be preceded by pain, itching or burning sensations. Other symptoms of HSV 2 infection can include :
- fever with muscle aches
- swollen lymph nodes
These symptoms can resolve , but with HSV infections, they can recur periodically.
Testing of HSV
Herpes simplex virus infection is usually a clinical diagnosis made by the doctor.
No tests is necessary.
However if sores are noted, these can be swabbed and sent to the lab for microscopic examinations and viral culture or PCR testing.
Treatment of HSV
Treatment objective for HSV infections are
- to reduce the severity of symptoms
- speed up the healing process
- In patients with very frequent recurrence, to reduce the frequency
Unfortunately, HSV cannot be cured. Once you have it, the virus stays with you.
Hence, to avoid spreading this virus to others
- those with active oral herpes should avoid oral contact with others and avoid sharing objects that touched saliva until symptoms have fully resolved.
- individuals with genital herpes should abstain from sex until symptoms have resolved fully too.
However, given the fact that HSV can be transmitted even when no symptoms are felt,
- avoiding promiscuous sexual activities and
- using condoms
Are some other ways to reduce HSV transmission.
HIV and HSV
There are two important points about HSV infections, which is
- its relation with HIV and
- transmission of HIV from mother to child during delivery.
HSV-2 infection increases the risk of acquiring HIV infection by approximately 3 fold.
Additionally, people with both HIV and HSV-2 infection are more likely to spread HIV to others. Hence it is recommended to screen for HIV infection when someone has been diagnosed with HSV-2
In rare circumstances, Herpes simplex virus can be transmitted from mother to child during delivery, causing a condition called neonatal herpes. It is rare but when it does occur, can lead to serious consequences such as death to baby, brain infection with permanent neurological disability to the infant and even eye infection with potential blindness.Therefore, if you are pregnant and have symptoms of genital herpes, please inform your obstetrician right away.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)