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Herpes Simplex

Herpes Simplex

Rebecca Fitzgerald (Dermatologist) gives expert video advice on: How does someone become infected by herpes simplex?; Is there a treatment available for herpes simplex?; How can I prevent transmission of herpes simplex? and more...

What is "herpes simplex"?

Herpes simplex is one of the herpes viruses. Herpes viruses can live in nerves. The virus never leaves the body. It just becomes latent, and then, sometimes reactivated. When it is activated you'll get a blister or sore in the distribution of the nerve that's harboring the virus. When it's latent you won't see anything and won't even know that you have the infection.

What are the different types of herpes simplex?

There are different serotypes of the herpes simplex virus. At one point in time it was really thought that herpes simplex virus 1 was an infection that we commonly saw above the waist and that herpes simplex 2 was more commonly an infection that we saw below the waist. But there's been a lot of reports of both in both locations. So, although it is more common to get herpes simplex virus 1 in the lip or on the face and to get herpes virus simplex 2 as a genital infection that does not always hold true.

How does someone become infected by herpes simplex?

You can get infected with the herpes simplex virus by exposure to the virus; through small, microscopic breaks or cuts in the skin that you weren't even aware of. In particular with genital herpes, we think that most of that transmission, or that a lot of that transmission is even in the absence of an active virus. At one point in time we felt it might be safe to have sexual contact when you had no active lesion; that it was unlikely that you would pass on that infection. Now we know that the viral shed rate is quite high and often that infection is passed on when the patient has no symptoms at the time of contact.

How does a dermatologist diagnose herpes simplex?

Herpes simplex has a very, very characteristic look with little multi, very tiny multiloculated blisters on sort of a red base that looks like a hive. The interesting thing is that because it infects a nerve when that virus is activated it will cause that lesion in the same exact place every single time. So, if you get a sore that comes out, takes a week or so to go away and then comes back at some later date in the exact same spot and again resolves after a week or so, that clinically through that history and clinical appearance it's a diagnosis. That diagnosis can be confirmed by culture, but it can be made clinically.

Is there a treatment available for herpes simplex?

There is no cure for herpes simplex virus. We can, however, sort of help control the activation of that virus. So, there are medications available that will allow you to have less episodes of active infection than you would have otherwise had. For instance, if you would have had twelve cold sores this year and you stay on this therapy maybe you would just have two or three. There is not, as yet, a cure.

Could I have herpes and not show any symptoms?

Absolutely. In fact, the vast majority of women that have herpes have no symptoms. It's a cervical infection, they can't feel it, they can't see it, they don't know they have it, and then they pass it along. That is not uncommon. Even in males, you can have an infection with blisters that occur, activation and blisters that occur so infrequently that you don't think of yourself as "infected". But you are indeed infected with the virus whether you have an active blister or not. And it can be passed on to a partner whether you have an active blister or not.