HERPES! It’s everywhere.
Everywhere, you ask? Yes, it’s got a huge presence across the globe knowingly affecting every continent we can identify.
Multiple studies show that it has a penetration rate of more than 70% amongst the European population.
Its highly likely to be as popular among the Malaysian population and our research papers show a 22.5% increase in the pick up of new herpes infections year on year.
What is herpes?
When we say, “herpes” many of us are thinking about genital herpes, famously known as an incurable inconvenience. But there is more to it than being just a sexually transmitted infection. There are multiple ways that herpes can transmit but genital herpes is usually picked up from sexual contact. Apart from that, herpes can be transmitted when sharing an environment with someone who has the infection as well.
Sharing food and drink can contribute to this. There are also incidences where people pick up these infections following vaccinations for other diseases as well.
This is nothing to be alarmed about though.
How many types of herpes are there?
Herpes is a commonly used term to describe an infection caused by the herpes simplex virus (HSV). In clinical terms, type one and type 2 herpes are often diagnosed and tested for but in actuality, there are eight types of herpes strains known to us.
Let’s start with the commonly occurring oral herpes, which is caused by HSV-1. An estimated 3.7 billion people under age 50 (67%) have HSV-1 infection globally. Oral herpes is commonly referred to as “cold sores” and “fever blisters.” Oral 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).
The less common, but increasingly encountered form of herpes is genital herpes, caused by HSV-2, which is almost exclusively sexually transmitted. An estimated 417 million people aged 15-49 (11%) worldwide have a HSV-2 infection.
The other strains of the virus are usually self-limiting and tend to resolve within a year if they ever do show symptoms, to begin with. This is not the case with type one and two herpes, which is why they take the spotlight more often.
Herpes is a relatively common but mild infection to have. It may be present in your body for years on decades without ever flaring up for you to know that you have the virus.
Ideally, this is where screening tests come in. You get screening tests done regularly, depending on your lifestyle and that picks up an infection. It must be said though that screening tests are not the one all-end all of picking up this infection.
Once again, as with everything, you’d have to consider the incubation period of the virus. We know theoretically that it can take anywhere between two to 12 days but it can be prolonged to weeks at a time.
Some people have a flare of the virus within 48 hours of exposure. Some people pick up the virus but never exhibit symptoms until years down the road.
Herpes is a characteristically clinical diagnosis. What this basically means is that when you present to a clinician and have that checked out, there is a very high degree of suspicion that this could be herpes and that is all that is required in some cases.
Diagnosing herpes is made much easier if you present to your clinician at the time that the rash is present and if possible, we can take a sample from that to be sent for PCR (Polymerase Chain Reaction) studies to confirm the diagnosis. Advanced medical investigative techniques such as this will allow us to differentiate type one from type two herpes regardless of the nature and distribution of the rash.
How would I know if I have herpes?
Ever heard of spidey sense? When Spiderman senses that there is trouble around the corner, he gets more heightened and becomes more aware of his situational surroundings. It can be the same for someone who gets frequent flares of herpes. This is what we call a prodromal sequence. Basically, when the virus is going to flare up, you might have an increased painful sensation in the area, hot flashes, feeling generally uncomfortable, pins and needles or ticklish sensations or in some cases, the feeling of something crawling underneath your skin.
Not everyone develops this “spidey sense”. In fact, not everyone even develops prodromal symptoms. Some people just wake up one day with a new rash or an ulcer or a cold sore and that is how they realise they are having a flare of the virus.
That’s the, ‘oh damn, here we go again’ moment.
What causes an HSV flare?
The virus, once introduced into the body will be surrounded by and be suppressed by your immune system. As you can probably deduce, as long as your immune system is in its best shape, ie you are healthy and taking care of your body; the virus will not be able to flare frequently.
The flares are caused when your immune system falters. This can be due to a number of reasons. Anything from daily stressors, lack of sleep, poor nutrition, weight gain, concurrent illnesses etc may cause your immune system to be distracted from the HSV infection. The moment that happens, the virus will flare resulting in rashes, cold sores, ulcers or blisters on your body.
How and when a flare occurs is really unpredictable. It all depends on how well the body is coping with the virus circulating in it. The above factors contribute to that. It is worth noting that everyone reacts differently to stressors and thus the severity, distribution, and timing of a flare is not something I can accurately predict for you.
What do I look out for in a herpetic flare episode?
As with most viruses, a herpetic flare can be fairly tricky to diagnose. We know type one herpes can present as skin lesions around the eyes, lips, or even the genital area.
Type two herpes is usually more localised to the genital region.
Basically, any sort of skin changes you see can be a sign of an impending breakout. Redness of the skin, an hot or burning sensation can preclude a herpetic flare. A flare proper is when you develop cold sores, ulcers, blisters or other types of rashes.
How do I get rid of herpes?
Well, to put it simply, you don’t. Type one and two herpetic infections can last a lifetime. This means that the virus will be detected via testing but it does not mean that you will constantly show symptoms of it.
A lot of my clients call it a friend for life. Lovingly, of course.
Basically, even if a herpetic flare is untreated, the entire course of the flare from prodromal symptoms to complete resolution will take about ten days to three weeks. The body is capable of handling such an infection to minimise the effect of it as such.
When we prescribe medications for a herpes flare, it’s usually antiviral tablets or creams. Sometimes a steroid course is necessary. These are all in the hopes of expediting the healing process, not as a cure for the virus. Like earlier mentioned, you can be symptom-free, but still, be having the virus in your body waiting for your antibodies to be distracted leaving it free to flare up again.
Can the virus be suppressed so that I don’t get herpetic flares?
This is a bit of a vague area in terms of therapy. It’s all a bit subjective and as I mentioned earlier, your body is the ultimate determining factor in these flares. It is somewhat not associated with you taking medications.
That being said, if on paper the HSV titres are high, indicating a high viral load in the body, this can be an indicator of an impending flare. Knowing this, we can prescribe antiviral medications with the aim of suppressing the virus activity. The idea is that we reduce the viral load of HSV, therefore helping the body’s immunity better contain the virus.
We usually do this for short durations of time. Not something that can be taken as a lifelong therapy. I know it might not make sense to some of you. You’re probably asking why it is that we can’t just take the suppressive antiviral medications for the rest of our lives and with that, have no flares of herpes? Well basically, we know that having a high viral load is not the definitive factor in determining a herpetic flare. It is how the body is coping with the virus. So ultimately, you can be taking medications for months on end with your body in good shape to contain the virus so that there are no breakouts but that does not mean that the virus is eliminated from your body.
So basically, you’ll be taking a whole load of medications but may have a herpetic flare anyways because the antivirals are not causing the eradication of the virus, but are overworking your other body organ systems and that causes your antibodies to get distracted causing a herpetic flare.
Can my immune system be boosted so I don’t get flares of HSV?
Well yes, but not specifically for herpes protection. Basically, the outlook of a person will reflect the efficiency of a person’s antibodies. All you need to do to keep your immune system in its best shape to fight any virus is to be as healthy as you can be.
This means regular exercise, a healthy well-balanced diet, less stress in your lifestyle and very importantly, getting a consistent good night sleep.
There are general health supplements that can help but bare in mind that these are supplements, not alternative food sources. Ideally, you should be getting all the nutrition required for healthy living from your diet.
Burden of herpes
Basically, it isn’t something that is life-threatening or anything but it is a terribly annoying disease to have because the flares of herpes is unpredictable. When it does flare up, you’d require medications including cream and oral medications as well.
What’s more inconvenient is that you will have to consciously avoid sexual contact or brave the world with your cold sore and deal with it otherwise. In some cases, sores can cause great discomfort or pain, depending on your threshold.
At the other end of the spectrum, there is a possibility of a herpetic flare up taking a sinister turn and leading to herpetic encephalitis. It is estimated to affect at least 1 in 500,000 individuals per year. The mechanism of this is not fully understood, but it is believed that the infection occurs through direct transmission of the virus via nerves from other parts of the body to the brain. In such cases, a person may complain of fever, headache, and lethargy, followed by confusion or delirium. In some cases, some people even develop seizures. This requires immediate medical attention and treatment.
It is important to take note that if you are someone who has frequent flares of herpes, this could be a sign that your immune system is burdened and it puts you at risk to pick up other infections as well. Studies have shown that a person with active flares of type 2 herpes will be at an increased risk of picking up HIV if ever exposed to it.
So there you go, a relatively harmless disease; an annoyance if you may, has a bigger, worse, more vengeful friend it brings with it to the party.
All in All
So all in all, HSV is not a tremendously dangerous infection to have but it can be a severe annoyance and might potentially lead to more sinister infections. It is definitely recommended that you get yourself tested and speak to your clinician about your various options of staying safe and HSV free.
Please always keep in mind that the healthier you are as an overall person, the more efficient your antibodies will be as well and that is the key to keeping these infections at bay.
That said, I hope you don’t catch the virus, to begin with.