All Explanations About Herpes And The Best Steps To Prevent This Disease Attacking

For most people, the diagnosis of genital herpes (Herpes Simplex Virus 2 or HSV2) is a shock. For others, a diagnosis may be confirmation of suspicions they have about their own health or their partner’s behavior. Seeking to answer questions about how patients contract the condition often leads to finding fault and then blaming each other. Living with herpes is something that may initially require some psychological adjustment for some patients. It doesn’t have to mean the end of your sex life or that you have to stay single for the rest of your life.

First HSV2 and HSV1, more commonly known as cold sore viruses, are only two of a related group of seven viruses known to infect humans. Others include the Varicella-Zoster virus, commonly known as chickenpox and shingles. The diagnosis of infection with HSV1 or 2 can be made with a blood test known as the Western Blot test; The advantage of this test is that patients who do not have active lesions can be diagnosed by the presence of antibodies to any of the strains. The accuracy of this test is only 90-95% depending on the lab involved. Several cases have occurred where patients were diagnosed with false positives or false negatives. The most accurate diagnosis is with the doctor taking the top of the new lesion, taking a swab from the base of the lesion and the laboratory growing a viral culture from it. Extracting a viable swab from the lesion can be very painful for the patient.

HSV2 has traditionally involved infection in the genital area, with the virus resting on the sacral nerves at the base of the spine during periods when the patient has no lesions. HSV1 has traditionally involved infection around the mouth and nose and is inactivated in the trigeminal nerve in the neck during the inactive phase of the disease. Current epidemiological studies in the Western World show the incidence of HSV2 in about one in eight people, or 12% of the population. Only one in five of those with antibodies has been diagnosed.

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In fact, in a room of forty people, five had HSV2 but only one knew they had it. Further three out of five may have isolated symptoms once or twice. It will seem so insignificant that they mistake it for a pimple, an infected hair follicle or a boil. The last of the five is someone who has never had symptoms and probably never does. For this patient, and three other undiagnosed patients, accusations of infection (usually followed by accusations of infidelity) from partners were often met with accusations of reciprocity and mistrust. A conservative estimate of the world population with HSV1 antibodies and the ability to infect others is about 90%. Of these, about 45% are symptomatic. If you’ve been diagnosed with one of these infections, it’s very likely that you caught it from someone who didn’t know they had it themselves.

People have accepted the message about safe sex and changed some of their practices, believing that only penetrative sex requires safe sex. Sexual health specialists now report that half of new HSV diagnoses in clinics have been microbiologically confirmed as genital HSV1, in the general population it is now estimated that 20% of all genital herpes infections are actually HSV1. On the plus side for infected patients, when the HSV virus does not live in an ideal host environment (i.e. genital HSV1 infection, oral HSV2 infection), infections are generally documented to be milder and less common.

Another mistake that many patients make, is to assume that they are not contagious during the dormant phase or are asymptomatic of their illness. Studies have shown that even when partners who are clinically discordant (ie one positive and the other negative) use what is recognized as the gold standard of treatment to reduce risk to partners, the transmission rate over a 12-month period is still 10%. This infection control management involves using condoms during all sexual intercourse and abstaining from sex completely during the symptom-positive phase of the partner. Interestingly, sexual health experts report that if one partner remains negative for 10 years in a clinically misaligned partnership, they are much less likely to contract the disease after that time. It is thought that they have either natural or acquired immunity/protection that has not been identified by science.

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A true primary infection of HSV2 can last for up to ten days, it involves a systemic response, where all the glands in the body are swollen, much as if the patient has influenza, as well as the obvious genital burning, itching, pain with urination or complete inability to urinate. Many patients think they are presenting with a primary infection, but, severity of symptoms indicates to the physician, this is in fact a recurrence. In these cases the patient’s primary infection would have been asymptomatic, but, for some reason, they have become run down and their immune system is not responding as it did when they were first infected. These and subsequent recurrences of HSV2 are usually around five days in duration, unless there is a serious immune system deficiency. In this case, the treating physician should refer the patient for further testing.

Because HSV transmission requires skin-to-skin contact and viral shedding to occur, typically an infection of HSV2 is specifically confined to the genitals. Affected areas include the vulva and labia in women and penis and scrotum in men, due to penetrative intercourse being quite localized. Where a patient has been infected with HSV1 on the genitals, the area is usually larger and vesicle distribution more extensive due to oral sex skin-to-skin contact covering a more extensive surface area of the genitals. Both viruses may be treated effectively with anti-viral drugs.

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As stated earlier, each virus has its ideal host environment. For the patient infected with HSV1 on the genitals, this means subsequent infections are usually less virulent, and in some cases may only ever recur once or twice in their lifetime. For the patient infected with HSV2 on the genitals, the incidence of recurrence can vary greatly. Recurrences are related to the health of the immune system. Triggers may include stress, poor diet, lack of sleep, sunburn and in some women, their menstrual cycle. During the first year of infection, the number of recurrences may range from one to twelve, with an average being four to five.

During subsequent years the immune system responds better, the patient learns what will trigger a recurrence and usually tries to avoid it. Eventually most patients can experience as few as one to two recurrences per year. Also, as the patient learns to better recognize the symptoms of an impending recurrence, they are able to administer anti-viral drugs earlier. This can minimize the length and duration of the attack, and possibly prevent lesions altogether. It is important for the patient to remember that despite avoiding a recurrence, they are still shedding the virus and they are still potentially infectious to their partner.

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Maintenance doses of anti-virals may be taken daily to reduce the number of recurrences. Up to 50% of patients on these therapies report an absence of recurrences in a 12-month period. Where this therapy is discontinued, patients almost certainly will experience a recurrence within three weeks. This is generally followed by a reduction in the number of annual recurrences. There are a small number of female patients who have required this maintenance therapy with anti-viral drugs continuously since they first became available, over 15 years ago, in earlier forms. As recurrences reduce in frequency and severity, most patients eventually come to terms with their diagnosis. For some, this is never the case, sexual health physicians report that they need to refer between 10-20% of their patients for further psychological counseling. This is in spite the fact that they are very experienced with the disease counseling required for this diagnosis.

What is important, regardless of how well patients appear to cope with the initial diagnosis, is ensuring access to information. This can be obtained readily and anonymously from, or these sites contain up to date facts and also links to other sites. These provide names and contact details of support groups, local clinics and sexual health specialists. Although HSV2 is a lifelong infection, with the right management and care it is not necessarily symptomatic, nor should it impede the patient from enjoying a loving and long-lasting, secure relationship.