Oral herpes, also known as cold sores or fever blisters, and genital herpes are medically the same condition but at different sites. There is a stigma attached to the latter because it’s sexually transmitted. Helen Grange looks at the two prongs of the herpes simplex virus.
It started with what looked and felt like a burning spider bite, “in a spot that was too awkward even for mirror self-examination”, says Pumi, a 31-year-old personal assistant living in Sandton. It turned out to be genital herpes, one of South Africa’s most common sexually transmitted diseases.
Being viral, genital herpes is incurable, and has left Pumi reeling.
“My boyfriend never bothered to tell me he had it, but he has ruined my innocence and left me with such a low estimation of myself. Now, every time my immune system is down, I’m prone to getting another outbreak. I still can’t believe that I have this disease forever,” she says.
In Vicky’s case, a few uncomfortable blisters appeared around her vagina toward the end of last year. “I’ve got no idea how I contracted it. I didn’t know what it was at first. I thought the blisters were an irritation from using hair removal cream and douching after sex. When I had a blood test, the doctor confirmed it was herpes. Apparently I’ve had it for quite some time,” she says.
The genital version of the herpes simplex virus is caused by either type 1 (HSV-1) or type 2 (HSV-2), but mostly by HSV-2.
“Genital herpes is the number one STD at my rooms, without a doubt,” says gynaecologist Dr Thandi Mtsi, “and it can cause a lot of distress when a patient is told it lives in your body forever. Patients break down into tears when they hear that”.
Most people infected with genital herpes are not aware of their infection until their first outbreak, characterised by small red bumps, blisters or open sores on or near the genitals. There can also be a vaginal discharge, fever, headaches, muscle aches, pain during urination, as well as itching, burning or swollen glands in the genital area.
The symptoms can come and go, but the virus stays in the nerve cells of your body even when you’re not exhibiting signs.
Herpes is easily transmitted during sex with an infected partner, especially if he or she is experiencing an outbreak of open sores at the time. The sores heal after two to four weeks, but recur, sometimes within weeks of the last outbreak, particularly when you’re under stress.
“We don’t know why HSV reactivates at particular times,” says Elna Macintosh, sexologist and director of the DISA clinic. “You may recognise trigger factors that contribute to an outbreak. These may include friction due to sexual intercourse, ill health, stress, fatigue, depression, lack of sleep, direct sunlight and menstruation. The triggers differ from person to person.”
At best, drugs can shorten the outbreaks and make them less severe. Left untreated, genital herpes can be passed on during birth, leading to blindness in the newborn (it is one of the leading causes of blindness in newborns). As a result it’s preferable to have a C-section if you’re infected.
To treat her outbreak, Vicky was prescribed Aciclovir cream and tablets. “The symptoms have not reappeared. I’m aware, though, that’s it’s in my system, and that it can break out again at any time,” she says.
Aciclovir was the first effective anti-viral agent and is still available, but it is less convenient than the newer therapies, Valaciclovir and Famciclovir (antiviral drugs in tablet form). “Most people taking antiviral therapy tolerate it very well, and counselling may help you to cope better with recurrent herpes outbreaks,” says Macintosh. “Also, a number of vaccines are currently being investigated, though it will be some years before we know how well they work. Meanwhile, people who make contact with a support group often say this is a turning point in living with genital herpes.
“If your recurrences are frequent, painful and/or disrupt your life to a great extent, oral antiviral therapy can significantly reduce or suppress the symptoms. There is no need for the virus to dominate your life,” says Macintosh.
Oral herpes, caused mainly by type 1 (HSV-1) of the herpes simplex virus, is commonly passed on between children via saliva – on toys, hands or other objects during play or contact sports. Like genital herpes, it can go unnoticed for years, which explains why in many of those infected, the symptoms only present in adulthood.
Cold sores break out on or around the lips, blistering to form angry red swellings that last about four or five days. Aside from feeling crusty and sore, they undermine your confidence because they are so visible to others. As a blogger on coldsoresbanished.com writes: “You are feeling down and depressed anyway – weary and worn out. Then, as if that’s not bad enough, a cold sore bursts out on your lip or mouth and you don’t want to talk, you don’t want to eat and you certainly don’t want to smile!”
Again, once infected, you have it for life – the virus lies dormant in the facial nerves, breaking out occasionally. The triggers are usually stress, a cold, a mouth injury, sun or even a session at the dentist. The good news is that topical ointments are very effective in treating a cold sore if you catch it early, and you can get cheap generics in the pharmacy.
Fenivir is among the most prescribed of these, but there’s a range of others, including Adco-Acycolvir and Acitop (generics of Aciclovir).
There are also disposable patches called Herpatch, a new innovation which has gathered a wide following.
“I always keep a packet of them in my bag. As soon as I feel the tingle of an imminent cold sore, I stick one on. It’s fuss free and works amazingly quickly to avert a blister,” says Phillipa, an office worker.
Pharmacists also recommend regular intake of vitamin C (citrus fruit and broccoli, for example) to help to boost your immune system, as well as tablets called L-Lysine, an amino acid essential to good health.
And along with adequate sleep, stick to a healthy diet: the body heals quickly when it receives rest and good nutrition.
Hygiene during outbreaks is imperative, as you can infect other parts of your body if you touch the sores with your hands. And don’t re-use lipstick or gloss if you have a cold sore.
* DISA Clinic: Call 011 787 1222
* Names have been changed.
Contagious even without symptoms
Genital herpes can be transmitted even if a person has no symptoms, suggesting a high risk of transmission from people with unrecognised infections of herpes simplex 2, researchers have said.
The study, published in the Journal of the American Medical Association, followed about 500 people between March 1992 and April 2008. They took daily swabs of their genital secretions for 30 to 60 days.
In the group that reported seeing symptoms of genital HSV, the virus was detected on 20 percent of days, researcher Anna Wald of the University of Washington told reporters as she presented the findings.
Among those who saw no physical signs, such as warts, sores or lesions, HSV was detected on 10 percent of days.
“When we think about people who have symptomatic genital herpes this means that the virus is present in their genital area on one out of five days,” Wald said.
“In people who have HSV 2 but who don’t have a history of genital herpes, the virus is present on the average of one out of 10 days.” – The Independent
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