How Does Herpes Spread?


There are two types of herpes – Type 1 and Type 2 – also known as HSV-1 and HSV-2. (HSV stands for Herpes Simplex Virus).

HSV-1 is generally thought of as oral herpes and HSV-2 as genital herpes. However, HSV-1 can cause genital herpes. HSV-2 can be found in the mouth as well, but is usually associated with a genital infection at the same time.

Both are pretty common.

The CDC reports that 1 in 6 between the ages of 14 and 49 have genital herpes.

About 1 in 4 do by the time they reach their 40’s.

Oral herpes is even more common. Most older adults have had HSV-1.  About 90% have it by the age of 50. Overall, 50-80% of Americans have HSV-1.

Oral herpes is transmitted by skin to skin contact – such as through kissing or touching.

Genital Herpes is transmitted by contact with the genital area of someone with herpes – whether there are lesions or not. This can be spread by oral, vaginal, or anal sex. Oral herpes in one partner can become genital herpes in another through oral sex. Infections spread more easily from men to women than from women to men.

Can herpes spread even when not seen?

Herpes can spread when not seen. Even when there are no lesions, no tingling, no pain, herpes can still be “shedding”. Just like an old sweater can shed, ulcers can shed too - releasing small amounts of virus that spread to another person. Those who have had symptoms shed virus about 1 in 5 days.

Those who have never noticed symptoms but test positive for herpes antibodies shed virus on 1 in 10 days.

Many people do not know they have herpes. They may have never had an outbreak or never noticed one. They may still pass herpes on to a partner.

Likely, more herpes is spread by contact with someone who is asymptomatic (has no symptoms of herpes) than with someone who has ulcers.

This is because shedding occurs more frequently than ulcers.

What is herpes like?

It is often not noticed. Sometimes it seems just like a pimple.

For others, there are extensive blisters that pop and and leave painful sores. This can last for weeks. Initial infections may be associated with flu like symptoms, swollen nodes, and fever.

Outbreaks often recur but usually less frequently as time goes on. The virus remains inside of nerves, where it resides, but usually is not actively causing any symptoms. The virus will remain latent – sleeping inside of the nerves it infects.

How can I protect myself?

Condoms reduce the risk of catching herpes – but do not eliminate it.

Treatment for herpes can reduce the chance that a partner will acquire herpes. There are drugs which can reduce virus shedding and reduce the chance another partner will catch the virus.

Is there treatment?

Yes, there are medications to reduce (and prevent) outbreaks. There is no cure.

Anything more serious?

Genital herpes has been associated with increased risk for acquiring HIV. This is because unprotected sex can lead to transmission of both. It is also because Herpes breaks down the skin, leaving small wounds vulnerable to HIV entering during sexual contact.

Herpes can lead to serious infections in babies, called neonatal herpes.  It can lead to herpes of the skin, eyes, and mouth,  but also can be disseminated and spread to the liver or can lead to infection of the brain, leading to encephalitis, with seizures and brain damage. This is rare – 1 in 3,000 to 1 in 20,000 births.

Herpes can be associated with miscarriage and can lead to infection during birth. A doctor can prescribe medications to avoid an outbreak during birth or can perform a C-Section if needed when there is an outbreak.

Herpes can lead to more serious , but very rare, neurologic problems.

Herpes encephalitis is a very serious disease, where herpes, usually HSV-1 on the face, travels up cranial nerves to the brain, affecting especially the temporal lobes. This leads to confusion, changes in personality, and changes in the ability to smell. It can lead to death, but is fortunately rare – about 2 cases in 1 million a year.

Herpes is associated with a rare, recurrent meningitis called Mollaret’s meningitis, where the virus enters into the cerebral spinal fluid, causing headaches, fevers, and neck stiffness. This meningitis is usually less serious than other types of meningitis, like bacterial meningitis.

Sometimes herpes can get into the eye which sometimes, but not always, can lead to a recurrent and problematic infection.

Herpes can also infect fingers, especially of health care providers exposed to the virus. This is called herpetic whitlow and can lead to the infection of patients. 

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