This article is not meant to alarm or cause fear. The purpose is to educate, to state what it is, how to prevent it and deal with it should you contract it. Many people already carry the virus and do not show symptoms.

A New York Times article published on June 23, 2014 states, “About two-thirds of people are infected with one of two herpes simplex viruses, oral (HSV-1) or genital (HSV-2). New research says both viruses have been infecting humans and our ancestors for longer than previously thought. HSV-1 has been infecting hominids since before they split from the chimpanzee lineage six million years ago, a new study says. HSV-2 was introduced more recently, the researchers said, making the jump from chimpanzees to human ancestors about 1.6 million years ago.

'If you think of humans as Homo sapiens proper, then both viruses have been with us since before we were human,' said Joel O. Wertheim, a virologist at the University of California, San Diego, and lead author of the study.”

Most people contract oral herpes when they are children by receiving a kiss from a friend or relative. Oral herpes is commonly referred to as “cold sores” and “fever blisters.” While symptoms of oral herpes most commonly appear on or around the lips, oral herpes is not always limited to this area. For some, symptoms may appear between the upper lip, on or inside the nose, or on the chin or cheek. In these instances, herpes is referred to as oral-facial herpes. You have most likely seen someone experiencing an oral herpes outbreak before.

Herpes is transmitted through direct contact between the contagious area and broken skin (a cut or break) and mucous membrane tissue (such as the mouth or genitals). Herpes can also be transmitted when there are no symptoms present. There are several days throughout the year when the virus reactivates yet causes no symptoms (called asymptomatic shedding, viral shedding, or asymptomatic reactivation). By performing oral sex on someone who has genital herpes, it would be possible to contract oral herpes - but this is rare. Most cases of genital herpes are caused by HSV-2, which rarely affects the mouth or face.
 

If a person is experiencing symptoms, I recommend abstaining from kissing others directly on the mouth, performing oral sex, having genital or anal contact with another until signs have healed and the skin looks normal again. Because so many adults carry the Herpes Simplex Virus, I do not advise that a person stop giving or receiving affection altogether between outbreaks (when there are no signs or symptoms) simply because they have herpes. However, using a barrier (such as a dental dam or condom) when performing any sex act (even though there are no symptoms present) can reduce the risk of contracting herpes.

Herpes is not curable, however it is not fatal. The virus does not go away, although it can be asymptomatic.

First Episode

A primary infection with herpes is when pronounced symptoms occur. During the first episode, classic lesions tend to form as small fluid-filled blisters that can appear as a single blister or in a cluster. Sores may also appear inside the mouth, on the back of the throat, on or around the genital or anal area, even on the thighs and the lymph nodes in the neck may swell.

Symptoms can be very mild and go unnoticed. Subtle symptoms can be easily mistaken for another infection or condition such as a small crack or cut in the skin, chapped lips, bug bite, pimple, infected hair - to name a few examples.

 

Recurrences
Some people with herpes experience recurrences. Symptoms vary from person to person. Lesions may appear as either a blister or a cluster of blisters or sores. It is possible that a recurrence will involve only subtle symptoms. Symptoms of an outbreak (when they occur) tend to last about 8-10 days on average. Lesions will usually crust over during the healing phase.

If the first episode produced fairly mild symptoms, then subsequent recurrences also tend to be mild. The frequency of recurrences varies from person to person and tends to decrease over time. Exposure to sunlight's ultraviolet rays may trigger a recurrence.

 

Prodrome

Many people will experience a “prodrome” or warning symptom prior to developing an outbreak. A “prodrome” is an itching, tingling, or painful sensation in the area where their recurrent lesions will develop. The prodrome often precedes lesions by a day or two. During this time, it is best to assume virus is active (and, therefore, can be spread through close contact).

 

Vaccinations

One important prevention tool against sexually transmitted infections is vaccination. Currently, vaccines are available to protect against infection with HPV, Hepatitis A and Hepatitis B. Other vaccines are under development, including those for HIV and herpes simplex virus (HSV).

Both the CDC and the U.S. Food and Drug Administration say HPV vaccines are safe. There is an incorrect internet meme that states women die from the vaccine or have other severe side effects. It is just a meme and not based on scientific evidence. The most commonly reported side effects include pain, swelling, and redness at the injection site. Some patients report fainting, so those receiving the vaccine are encouraged to wait at least 15 minutes before leaving the clinic or medical office.

HPV vaccines currently on the market, Gardasil and Cervarix, offer close to 100% protection after three doses against the two types of HPV (HPV 16 and HPV 18, respectively) that are found in 70% of cervical cancers. Gardasil also protects against two additional HPV types that are responsible for approximately 90% of genital warts. Neither vaccine protects against all types of HPV, so women who are vaccinated still need regular cervical cancer screening (such as Pap tests).

 

Alternative Therapies

Over-the-counter creams and/or ointments are not recommended for genital herpes, since they can interfere with the healing process in a number of ways, causing genital outbreaks to last longer. Keeping the area clean and as dry as possible and allowing the area to get air can help to speed the healing process.

Many people find that outbreaks tend to lessen in severity and frequency with time. What triggers an outbreak is highly individual, but with time, many people learn to recognize, and sometimes avoid, factors that seem to reactivate HSV in their own bodies. For example, illness, poor diet, emotional or physical stress, friction in the genital area, prolonged exposure to ultraviolet light (commonly for oral herpes, such as a beach trip or skiing weekend), surgical trauma, or steroidal medication (such as asthma treatment) may trigger a herpes outbreak.

The frequency of outbreaks can often be managed through effective stress management, and getting adequate rest, nutrition, and exercise.

People often ask about an amino acid by the name of lysine (L-lysine), because of Internet claims or claims from other people that it helps control outbreaks. While some studies have suggested that lysine supplements can reduce the frequency of recurrences or healing time, other trials have been unable to replicate those results. Therefore, there is not sufficient information to discern how effective it may be, in addition to what the effective dosages or frequency of L-lysine may be.

Lysine can be found with other nutrients and supplements at your local grocery or drug store, but people should only take the recommended dosage if it is taken and always check with their health care provider first before starting any new medication or supplement. Megadoses of lysine may throw other amino acids out of balance and interfere with the absorption of other nutrients such as vitamins and minerals.

In regard to possible foods to avoid, some people feel that foods that contain high amounts of the amino acid arginine may cause herpes outbreaks. Arginine is found in numerous foods that are eaten on a regular basis; therefore, I do not encourage someone to stop eating foods simply because they contain arginine. However, an individual may want to consider adjusting their diet if she or he is having frequent outbreaks and believes food is a contributing factor. Again, while some individuals believe arginine can trigger outbreaks, there is no clinical evidence to support these claims.

 

Treatment for Oral Herpes

The antiviral medications available in pill form (acyclovir, valacyclovir, famciclovir) have been specifically developed for the treatment of genital herpes. However, it is not uncommon for healthcare providers to prescribe the antiviral drugs to those who have frequent or severe outbreaks of oral herpes. A recent study found valacyclovir to be effective for treating oral herpes in a one-day treatment of 2 grams taken at the first sign of a cold sore, and then again about 12 hours later.

There are two topical antiviral medications prescribed for the treatment of oral HSV symptoms: acyclovir ointment (brand name Zovirax®) and penciclovir cream (brand name Denavir®). Both work to speed up the healing process and reduce the viral activity. These topical drugs are put directly on the lesions themselves, but can also be used at the onset of prodrome.

Other topical treatments for oral herpes are available over-the-counter (OTC), but are not antiviral compounds like acyclovir and penciclovir. Some also contain ingredients that numb the area and induce temporary relief from the discomfort of an outbreak. Unfortunately, some OTC treatments may actually delay the healing time of symptoms because they can further irritate the area with repeated applications. There is only one OTC FDA-approved cream, called Abreva®, which has been clinically proven to help speed the healing process.

 

Treatment for Genital Herpes

There are three antiviral medications that are FDA-approved for the treatment of genital herpes:

Acyclovir is the oldest antiviral medication for herpes. It has been available since 1982 in a topical form (as an ointment) and sold since 1985 in pill form. Acyclovir has been shown to be safe in persons who have used it continuously (every day) for as long as 10 years.

Valacyclovir is a newer drug, and uses acyclovir as its active ingredient. This medication delivers acyclovir more efficiently so that the body absorbs much of the drug, which has the advantage of taking the medication fewer times during the day.

Famciclovir uses penciclovir as its active ingredient to stop HSV from replicating. Like valacyclovir, it is well absorbed, persists for a longer time in the body, and can be taken less frequently than acyclovir.

Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.

 

Episodic Therapy
In this approach, a person begins taking medication at the first sign of an outbreak (or ideally at first signs of prodrome) and continues taking medication for several days, in order to speed healing or even prevent an outbreak from fully occurring. All three of the antiviral treatments mentioned above have been proven to help shorten the amount of time that a person may experience symptoms of herpes. However, keep in mind that results may vary from person to person.

Many people feel the advantages of using medication for recurrent episodes are marginal compared with use in a primary episode. But for others, episodic therapy offers a useful way to manage outbreaks by cutting the length of an outbreak by a day or two, on average. The benefits may be greater for those whose outbreaks tend to last longer.

Also, episodic therapy has its best results when treatment begins at the very first sign of prodrome. If lesions are already present, therapy may offer little benefit. Because the medications differ in their absorption rate and duration of effectiveness, dosages vary with episodic therapy treatment ranging from one to five pills every day for three to five days during an outbreak.

Suppressive Therapy

People with genital herpes who want to eliminate (suppress) outbreaks can take antiviral medication daily to hold HSV in check so that it's less likely to flare up and cause symptoms. For individuals who have frequent recurrences (six or more per year), studies have shown that suppressive therapy can reduce the number of outbreaks by at least 75% while the medication is being taken. Also, for some, taking an antiviral on a daily basis can prevent outbreaks altogether.

While antivirals can be successful in controlling herpes symptoms, researchers also have turned their attention to the important issue of antiviral therapy and asymptomatic shedding. Does suppressive therapy lower the risk of unrecognized herpes reactivation as well as curb recognized outbreaks? One study addressing this question found that women on suppressive acyclovir (400 mg, twice daily) had a 94% reduction in subclinical shedding while taking daily therapy. This type of study has also been done with famciclovir and valacyclovir, with similar reductions seen in both men and women.

Suppressive therapy has been studied in thousands of patients and it appears to be both safe and effective. Because the medications differ in their absorption rate and duration of effectiveness, dosages vary with suppressive therapy treatment ranging from one to two pills every day.

 

STIs

Most people think they would know if they had a sexually transmitted infection (STI) …. wrong!

 

The truth is many of STIs have no signs or symptoms in the majority of people infected. Or they have mild signs that can be easily overlooked. This is why the term “disease” (as in STD) is starting to be replaced by infection (or STI). The only way to know if you have an STI is to get tested.

Many people are confused about getting tested for STIs. For example, you may think your annual medical check-up will include tests for STIs, especially if your healthcare provider knows you are sexually active. The fact is that some providers might test for some infections when you come in for a regular check-up, while others do not test for any STI unless you ask them to.

If you’ve had unprotected sex, have a new partner (or more than one partner), or for any reason are worried you have been exposed to an STI, talk to your healthcare provider about getting tested be tested for these leading common STIs: chlamydia, gonorrhea, HIV, herpes, HPV, syphilis and trichomoniasis. If your healthcare provider feels you do not need to be checked for some of these, you will at least know which ones you were tested for and which ones you were not.

 

How do STD/STI tests work?

Getting tested can be quick and easy. Depending on what you are being tested for, your provider may take a blood sample, a swab, or ask you to pee in a cup. Easy! Here's an idea of what to expect:

Chlamydia
How the test is done: Swab of genital area or urine sample
What you also need to know: If you have had oral or anal sex, let your healthcare provider know this also. These sites may be infected, but vaginal or urine samples may not be positive.

Gonorrhea
How the test is done: Swab of genital area or urine sample
What you also need to know: Like with gonorrhea, if you have had oral or anal sex, let your healthcare provider know this also. These sites may be infected, but vaginal or urine samples may not be positive.

HIV
How the test is done: Blood test or swab from inside of mouth
What you also need to know: Confidential and anonymous testing options are available in many clinics.

Genital herpes(no symptoms)
How the test is done: Blood test (drawn from arm or a fingerstick)

What you also need to know: Be sure to ask for a type-specific IgG test (not an IgM test). There are currently several FDA-approved, gG-based blood tests that can give accurate results for herpes. Like any blood test, these tests cannot determine whether the site of infection is oral or genital. However, since most cases of genital herpes are caused by HSV-2, a positive result for type-2 antibodies most likely indicates genital herpes.

It may be necessary to request one of these tests by name from your healthcare provider. ASHA has created a quick reference guide to herpes blood tests, including a chart that outlines and compares the accurate, FDA-approved type-specific blood tests available for herpes simplex antibodies. To determine which test might be best for your situation – or to show your doctor which tests are available (since herpes is not routinely included in STD screenings), you can download and print ASHA's Herpes Blood Test Guide.

 

Genital herpes (with symptoms)
How the test is done: Swab of affected area; if at first negative for herpes, follow later with blood test to make sure.

What you also need to know: Must be done as soon as possible. Testing should be done within 48 hours of an outbreak. The sooner the better for conclusive test results. “Viral culture” tests are not as accurate after 48 hours. A negative culture does not mean that you do not have genital herpes. Many times if a lesion is small or has begun to heal one can receive a false negative test result.

 

Syphilis
How the test is done: Blood test, or sample taken from a sore.

What you also need to know: The CDC recommends all pregnant women be tested for syphilis.

Trichomoniasis
How the test is done: Swab of infected area, physical exam or sample of discharge.

What you also need to know:“Trich” is harder to detect in men than in women.

HPV (genital warts)
How the test is done:Visual diagnosis
What you also need to know: Warts can occur in both men and women.

HPV (cervical cancer)
How the test is done:If Pap test result is abnormal, HPV DNA test and a biopsy may be done
What you also need to know:Pap tests detect cervical cell changes, not HPV. An abnormal test is often caused by HPV infection. No test available for men for these types of HPV.

 

Safer Sex

Once you have decided on your own “safer sex” boundaries, you will need to gather the tools you will need to stick to your decisions. Some of the most common “tools” are included below:

 

Condoms

Currently, condoms are the only widely available, proven method for reducing transmission of HIV and other sexually transmitted infections (STIs) during intercourse. ASHA supports the promotion and use of condoms to limit the spread of sexually transmitted infections and their consequences. Condoms are effective when people use them correctly and consistently. Using a lubricant with condoms makes them both more enjoyable and less likely to break.

There are latex male condoms, polyurethane (non-latex) male condoms, polyisoprene (non-latex) male condom, lambskin (non-latex) male condom and the female condom.

 

Lubricants

A good lubricant (lube) is one of the most important tools in your sexual kit. Lube reduces friction which can cause tiny tears in the skin, which make it more likely for the person to get an infection if his/her partner has one. Lube can also make sex feel better, whether having intercourse, masturbating, having oral sex, or using sex toys.

 

In addition, condoms work better and are less likely to tear when you use lube. Lube can also make oral sex with a barrier more enjoyable for the female receiving it. Women self-lubricate when they are turned on, but many factors may reduce lubrication: alcohol or other drugs (including hormonal birth control, stimulants, antidepressants, antihistamines, chemotherapy), monthly hormonal changes, peri-menopause, menopause, breastfeeding, a history of sexual assault, and other psychological and physical factors. Women may want extra lubrication on the vulva and clitoris during sex as lubrication from the vagina often does not reach these external areas. The anus does not self-lubricate, and you always need to use a lubricant to prevent the very fragile skin of the anus from tearing during anal play or intercourse. Most people like an anal lubricant thicker than those used for vaginal sex.

 

NOTE: Avoid any lubricant with lidocaine or benzocaine, which dull the body's natural defense (pain), which lets you know when something is wrong, including tearing of the skin.

 

Below are types of lubricants you might choose:

Saliva

Oil/Petroleum-Based Lubricants

Natural/Plant-Based Lubricants

Water-Based Lubricants

Silicone Lubes

 

Barriers for Oral Sex:

Barriers used during oral sex can help prevent transmission of STIs. Options include:

Dental Dams (latex)

Plastic wrap

 

Sex Toys

Sharing sex toys (like vibrators, for example) can be risky if they have vaginal fluids, blood, or feces on them. Sharing sex toys without cleaning them or using a condom can potentially expose a person to STIs.

The safest practice is not to share sex toys. If sex toys are shared, a condom should be used. With toys that can be inserted into the vagina or anus, a person may put a condom onto the toy. For shared toys in which the penis is inserted, a condom may be worn. It is important to change the condom before another person uses the toy so that any body fluids or infectious organisms on the sex toy are not passed on to the partner. It is also important to change the condom when moving from the anus to the vagina to prevent possible infection.

When cleaning sex toys, look to see what the manufacturer's instruction recommend. Some may be best cleaned with soap and water, while certain types of materials like silicone are dishwasher safe.

My wish with this column is to provide a load of information about herpes, STIs and other healthcare for a safer sex life, to further pleasure and awareness.