Herpes

Description

Herpes is an infection caused by the Herpes simplex virus (HSV). There are two types.

Type 1, also known as VHS-1 or commonly "cold sore", mainly infects the mouth, but can also be transmitted to the genitals and the anus.

Type 2, also called HSV-2 or commonly genital herpes, manifests itself mainly on the genitals: penis, scrotum, vulva, vagina, anus, but can also be located on the thighs or buttocks. It is very rare that it is transmitted to the mouth.

According to statistics from the World Health Organization (WHO), in people under the age of 50, worldwide, 67% (3.7 billion) of people are carriers of type 1 and 11% (417 million) of people carry type 2.

Transmission

Herpes type 1 or type 2 is transmitted:

During oral, vaginal and anal sex with or without penetration.
During intimate contact (skin to skin) with an infected person with or without lesions.
During childbirth, from parent to child in rare cases.

For there to be a probability of transmission, it is necessary that

the virus is active* on the carrier's skin
an entry point on the non-infected person (small lesion, open wound, mucous membrane) and
direct contact between these two areas.

* Chances of transmission are higher during skin rashes. There can also be transmission of the virus in the 24 to 48 hours before an outbreak (when symptoms are present) or during the period of asymptomatic excretion. The period of asymptomatic shedding is when the virus is present in the skin, but not enough to cause noticeable symptoms. This period is not so frequent. We are talking about 3% of the days in the first year when the virus is transmitted (about 10 days per year) and 1% in the following years (about 3 days per year).

Symptoms

It is possible that there are no symptoms and that the infection goes unnoticed.

During the onset of symptoms, mainly there will be more recurrences in cases of HSV-2 than of HSV-1.

Herpes is characterized by more or less frequent eruptions (flares or episodes). The first flare accompanied by symptoms is often diffuse, painful and long. However, it may go unnoticed for some people. The presence of vesicles (pimples) is often accompanied by fever (reaction to infection by a virus), with body aches and headaches.

The flare-ups sometimes take the form of:

Small painful lesions (vesicles, blisters, ulcers or small craters) on or near the genitals (penis, testicles, pubis, vulva, vagina, anus), thighs or buttocks. They can also be located in other places on the body depending on where the virus entered the system.
Painful cold sore on the mouth, in the case of HSV-1. These “cold sores” can also be found at the genital level in the case of genital HSV-1.
Burning sensations when urinating or localized where the lesions appear (pimples).
Pains and/or aches
Fever
Headaches

In some cases, there will be up to more than 6 outbreaks per year, and in others a few episodes in a lifetime. The number of recurrences varies greatly from person to person.

Lesions are announced by warning signs (prodromes) :

o Tingling sensation

o Redness

o Burning sensations

o Blisters

o Itching sensation

o Sensations of electric shock

Then appear local pain, vesicles (pimples) and then scabs.

It is recommended that pregnant people tell their doctor about the presence of the herpes virus. Adequate medical monitoring can thus be carried out.

About 12 weeks after first exposure, the person develops antibodies specific to the herpes virus and becomes less likely to spread it to other parts of their body.

Even though these symptoms may be present during recurrences, the following episodes are generally shorter, less painful and the vesicles are less diffuse.

Following transmission, the virus reaches a nerve ganglion in the spine where it is latent. This means that it is not active on the surface of the skin. When latent, the herpes virus is not transmissible. It can reactivate. When the virus reactivates, this is what we call “recurrences”. The virus will then travel through the nerves (usually always the same ones) to the surface of the skin. The virus is usually always located in the same area of the body.

Prevention

From the first symptoms of an episode of herpes, the risk of transmission increases sharply. Certain factors favor the onset of episodes:

o Stress or lifestyle

o Sun exposure

o Fever, or other problems affecting the immune system

o Menstrual periods

o Wounds or injuries

o Dental surgery

It is advisable to be vigilant and to be able to consult a doctor quickly. Oral antiviral treatment can be given for prevention in order to promote the healing of lesions, reduce the number of recurrences and minimize the probability of transmission.

Condom use, internal or external, and/or the use of dental dams are recommended during sexual intercourse, particularly during a herpes outbreak.

Transmission can occur when the affected area is in contact with damaged skin (micro lesion, wound, mucosa), so contact areas should be limited (thighs, pubis, buttocks, scrotum, perineum).

During a first contact with lesions due to genital herpes, it is possible to adopt reflexes to limit transmission:

Avoid touching your eyes after contact with a lesion (ocular herpes)
Wash hands with soap and dry them well
Always keep the area of skin with lesions dry
Leave areas of injury exposed rather than covered with a bandage to promote healing
If the care requires contact (changing a diaper, for example), it is advisable to temporarily cover the area of the rash with a bandage to limit the possibilities of transmission.

To avoid transmission during childbirth, a caesarean may be considered. Rigorous medical monitoring and taking antivirals from the 36th week helps to reduce the likelihood of transmission.

Myth that circulates: you can contract herpes by contact with everyday objects.

False: One does not contract the herpes virus through kitchen utensils, a handshake, bath water, the use of the same bath towel or toilet seat.

Screening and treatment

Routine screening for herpes is not indicated in the STBBI screening guidelines. In the presence of lesions (pimples), samples can be taken within 24 to 48 hours of the onset of symptoms to make the diagnosis. A blood test can confirm the result in some cases.

There is no cure or vaccine for herpes. The treatments aim to accelerate the healing of cutaneous flare-ups, to limit the frequency of episodes and to reduce the probability of transmission.

There are two different methods for taking the treatment. The first is the episodic intake which consists of taking the treatment at the first symptoms according to the instructions of your healthcare professional. The second method is taking it in suppressive/continuous mode, which consists of taking the treatment every day.

The main objective of taking medication is to reduce the intensity and discomfort of herpes outbreaks, to reduce their frequency and to limit transmission.

Regular treatment with antivirals will prevent the virus from multiplying in the body, but cannot make it disappear from the nerve ganglia. Note that stopping treatment may cause a herpes outbreak.

HIV and Herpes

Herpes can play an important role in the transmission of HIV.

Skin lesions (ulceration, vesicles, crusted wounds) on the genitals are exit and entry points for the HIV virus or other infections.

A person living with HSV-2 is two to eight times more exposed to HIV infection, depending on the frequency and intensity of the lesions since the lesions (pimples) are entry points for HIV.

As with any infection or injury, immune cells, including CD4, are sent to the affected area. There is then an influx of cells carrying HIV or susceptible to get infected.

In the case of an HIV-positive person, contact of infected cells with HSV proteins has the effect of increasing their rate of replication. The viral load then increases in the genital or anal fluids involved in the injured area.

The probability that a person co-infected with HIV and HSV-2, without symptoms, transmits HIV is estimated to be 5 times greater than an HIV-positive person who is not infected with herpes. A person co-infected with HIV and HSV-2 is also exposed to more intense and frequent outbreaks.

Good to know

People living with herpes type 1 or type 2 are carriers for life, but the virus is not transmissible all the time.

There are only three times when there is a risk of transmission:

When there are lesions(symptomatic period).
When there are warning signs also called prodromes (itching, tingling, redness).
During the asymptomatic excretions. This period occurs when the virus is active in sufficient quantity on the surface of the skin to be transmitted, but not present enough to cause symptoms. We assure you, this period rarely occurs. We are talking about 3% of the days in the first year when the virus was contracted (about 10 days per year) and 1% in the following years (about 3 days per year).

If two partners are carriers of the same type of herpes virus
(VHS-1 or VHS-2), there is no risk of surinfection.

Even without apparent symptoms, it is possible to transmit herpes. Herpes has direct impacts on the couple's relationship, and psychological, affective, social and sexual effects, which influence behaviors. Do not hesitate to talk about it with your healthcare professional; prevention and early treatment greatly reduce the impact of herpes infection on daily life. Info-Herpès project services are available for support and information.

Symptoms of herpes (cold sores, for example) in a partner do not indicate infidelity. The virus can be latent for sometimes several years before reactivating in the skin.