Herpes & Immune System | Health Blog

Date: 06/14/2011    Written by: Hiyaguha Cohen

Herpes Can Spread Silently

In the early 1980s, HIV stole the spotlight from other sexually transmitted diseases, dominating the media with warnings to be virtuous because of the possibility of contracting AIDS. But while AIDS only affects about 0.6 percent of the US, its less celebrated relative, genital herpes--otherwise known as herpes simplex virus type 2 (HSV-2)--is far more prevalent.1 In fact, 17 percent of all US adults are infected, and among certain sub-groups the rate is much higher: Unbelievably, for instance, single women of all races between the ages of 45 and 50 have a prevalence rate between 50 and 70 percent!2 Forty-eight percent of all African-American women, are infected.3 And perhaps even more striking than the fact that one in every six people has the disease is the fact that only a small percentage of those infected -- as few as 10 percent--actually know it.

Now a new report confirms that even people who have no symptoms and no clue that they're carrying herpes can, nevertheless, spread the disease.4 The study, just published in the Journal of the American Medical Association, found that people who have herpes but no symptoms shed the virus in genital secretions 10 percent of the days they are tested, meaning they can infect sexual partners on those days. In contrast, those who manifest active herpes symptoms “shed" the virus about 20 percent of the time. Obviously, those with symptoms will likely be more circumspect than those who think they're disease-free, and so it's possible that those without symptoms are actually more likely to infect others.

How can so many people infected with genital herpes not even recognize that they're carrying the disease? For one thing, carriers of HSV-2 can remain asymptomatic for years. In fact, about 40 percent of those with HSV-2 don't manifest symptoms at all.5 Plus, when the symptoms of herpes do appear, they tend to be annoying and uncomfortable rather than catastrophic. The victim may get painful or itchy bumps and blisters in the genital area, lower-back pain, discharge, fever, muscle aches, or headaches, but the symptoms aren't necessarily severe.

As Dr. Peter Leone of the University of North Carolina explains in an NPR interview, “Most folks, if they have symptoms, the symptoms are pretty mild - burning or itching that may last for a couple of days and goes away. So what we see are folks who either get misdiagnosed or they treat themselves, and of course the symptoms go away so they think they don't have anything to worry about."6 Although 80 percent of victims will have subsequent outbreaks, future episodes tend to be even milder than the first, and so many people ignore the symptoms -- and the doctor.

Herpes also gets missed because of its ability to go dormant for months, years, and even decades at a time.7 It is possible, theoretically, for someone to be infected with herpes, have an outbreak, and not have another until 30 years later. Things that provoke an episode include stress, illness, too much partying, and even menstruation. Theoretically, your monogamous and symptom-free spouse of 25 years can suddenly have a herpes outbreak and infect you, even though neither of you had a clue about the herpes at the altar.

If herpes tends to be so minor that it can be missed, what's the big deal about getting infected? Beyond those painful genital bumps and a good dose of humiliation, the more serious consequences include the fact that sores can infect other parts of the body, should an infected person touch a genital sore and then another body part, including the eyes. Infected women who get pregnant stand a high risk of passing the disease to their babies, and infants can die from herpes. Most of all, though, herpes weakens the immune system over time and puts victims at higher risk for diseases like meningitis, hepatitis, and other STDs, including AIDS. Ninety percent of HIV-infected individuals also have an HSV-2 infection. Also, herpes puts women at greater risk for cervical cancer. In other words, you really don't want to get it, spread it, or be exposed to it.

Now that the news shows that herpes does indeed spread even in the absence of symptoms, doctors are urging people to get tested. Dr. Christine Johnston, who directed the study for the University of Washington in Seattle said, "The people who are symptomatic are really the tip of the iceberg. We are not having any impact on the epidemic by ignoring it." Testing involves either a simple blood test for antibodies to the disease, or a culture if there's an active sore.

If the doctor thinks you're having a first herpes outbreak, you may get a prescription for a ten-day course of an antiviral medication that supposedly will prevent future episodes. The doctor will probably tell you that you have to take the pills within three days of your first episode in order for the treatment to work, so in a panic, you may take the meds before getting your test results back. Unfortunately, but predictably, potential side effects include ugly possibilities like kidney damage, seizures, and death. Before taking any medication, make absolutely sure you have the disease, because other conditions, like genital yeast infection look similar.

Drug companies are working on an anti-herpes vaccine, and one can only imagine the side-effects possible once that hits the market. A safer bet is to make sure your partners are disease-free, as best you can. If you already have an infection, the usual advice for keeping your immune system strong applies. Get enough sleep, eat well, take immune system boosters and stay on the sunny side of life. And take comfort in the fact that you're hardly alone!

1 “AIDS Pandemic." Wikipedia. 4 June 2011. http://en.wikipedia.org/wiki/AIDS_pandemic
2 Flatow, Ira. “Even Without Symptoms, Genital Herpes Can Spread." 15 April 2011. NPR. 2 June 2, 2011. http://www.npr.org/2011/04/15/135442942/even-without-symptoms-genital-herpes-can-spread
3 “Analysis of National Herpes Prevalence." 22 April 2010. Centers for Disease Control and Prevention. 1 June 2011. < http://www.cdc.gov/std/herpes/herpes-NHANES-2010.htm>.
4 Harding, Anne. “Symptom-Free Herpes Contagious 10% of the Time." 12 April 2011. Health.com. http://news.health.com/2011/04/12/symptom-free-herpes/
5 “Herpes Symptoms." The Complete Herpes Information Center. 2 June , 2011. http://www.globalherbalsupplies.com/herpes/symptoms.htm
6 “Even Without Symptoms, Genital Herpes Can Spread." 15 April 2011. NPR. 4 June 2011. http://www.npr.org/2011/04/15/135442942/even-without-symptoms-genital-herpes-can-spread
7 “Med Help: STDs." 4 June 2011. <http://www.medhelp.org/posts/STDs/Herpes-dormancy/show/318477>

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    Submitted by Guest on
    June 22, 2011 - 12:13am

    at least 30 years ago I heard from a friend that the Smallpox vaccine is effective against Herpes too.

    Submitted by Guest on
    September 9, 2011 - 6:47pm

    This article has so much misinformation, I don't know where to start. First of all, oral herpes (HSV1) is, technically speaking, more dangerous than genital (HSV2).  Stating "infants can die from herpes" is quite dramatic. It's only a potential problem if the mother becomes infected with the virus for the first time late in their pregnancy. Even then, it's a small risk of passing it on. Very rare. Genital herpes absolutely does NOT put women at greater risk for cervical cancer. Let's put this myth to bed. Cervical cancer is related to HPV, a completely different virus. Finally, HSV antiviral medication reduces viral shedding and transmission, but it does not prevent outbreaks. Taking it during a first episode does not prevent future outbreaks. Another myth. And seriously, do you know how rare it is that it would cause kidney damage, seizures, and death? Come on! "A safer bet is to make sure your partners are disease-free, as best you can." Have YOU had a type-specific igg blood test for HSV? Have you ever asked a partner to be tested? Odds are the answer is no.

    Submitted by BaselineFoundation on
    September 12, 2011 - 12:24pm

    Dear Unnamed Guest Who Chose Not to Leave a Name: That’s quite an indictment – not just a comment, but a full-fledged indictment of both the blog and the competence of the person who wrote it. And as such, it deserves a detailed answer. So let’s take the accusations in your comment on one-by-one. Your first example of “misinformation” is that HSV1 is more dangerous than HSV2. So what? The article isn’t about HSV1; it’s about the fact that HSV2 is spreading “silently” with the vast majority of infections undiagnosed. You might as well attack the herpes.com article you refer to as being “misinformed” because it doesn’t acknowledge that HIV is more dangerous than HSV1. But then, that’s not what their article is about, is it? And demeaning the article for not stating that fact would be rather silly, wouldn’t it? Next you comment on the risks involved during pregnancy. As you state, “It's only a potential problem if the mother becomes infected with the virus for the first time late in their pregnancy. Even then, it's a small risk of passing it on. Very rare.” Really, I’m sure this would come as a surprise to the CDC, which states in its Morbidity and Mortality Report on Sexually Transmitted Diseases that, “The risk for transmission to the neonate from an infected mother is high (30%–50%) among women who acquire genital herpes near the time of delivery.” (http://www.cdc.gov/mmwr/PDF/rr/rr5511.pdf) Stating that a 50% risk is “very rare,”  as you do, would actually qualify as “misinformation.” That said, even women who have had herpes before pregnancy and have a flare-up or silent infection at the time of vaginal delivery have about a three percent chance of infecting their babies. And even a three percent chance of infecting a baby is probably more than most women would care to risk. Next you state, “Genital herpes absolutely does NOT put women at greater risk for cervical cancer. Let's put this myth to bed. Cervical cancer is related to HPV, a completely different virus.” Really? A study published in the Journal of the National Cancer Institute concluded, “HSV-2 infection may act in conjunction with HPV infection to increase the risk of invasive cervical carcinoma.” (http://www.ncbi.nlm.nih.gov/pubmed/12419786). It’s possible that in the end that conclusion may not stand the test of time. But I think it’s a bit disingenuous to call it a “myth.” And now let’s turn to your last accusation of misinformation in which you object to the blog’s assertion that a ten-day course of an antiviral medication supposedly will prevent future episodes. In fact, you definitively state that an antiviral regimen “does not prevent future outbreaks.” But in fact, the same CDC report cited above references three separate studies to conclude, “Suppressive therapy reduces the frequency of genital herpes recurrences by 70%–80% in patients who have frequent recur­rences.” I’m not sure that a 70%-80% reduction of recurrences qualifies as “another myth.” And as for kidney disease, you might want to check out Valtrex’s own information site on which they state, “Valtrex can be harmful to the kidneys, and these effects are increased when it is used together with other medicines that can harm the kidneys. “Come on, now.” Check it out. In conclusion, you use the word “myth” several times when referring to the blog, but I’m not sure you know what the word actually means. In fact, all statements in the blog are supported by existing evidence. I’m not sure how that qualifies as either “myth” or “misinformation.” In the end, though, I am sure that none of the facts we have stated today will change your opinions. So, with that said, let us agree to “respectfully” disagree. Hope that helps.  

    Submitted by Guest on
    August 7, 2012 - 9:16pm

    I loved your answer to this article.
    This guy seems like an idiot.

    Submitted by PA_1 on
    August 27, 2012 - 8:16pm

    The person who commented may not have looked at the big picture in re: pregnant mothers - while it may be true that transmission risk is much higher ONLY during initial outbreak(then diminishes severely, as noted), whether it's HSV1 or HSV2 actually means very little. The HSV (Type 1 or 2) is transferred from the mother's vagina to the baby. Thus, genital herpes becomes, quite often, oral or ocular herpes(although possibly genital), but it's completely irrelevant where it lands: HSV infection is enough to kill a baby. It's no surprise that this hasn't occurred to the commenter: most people don't realize that either type can occur in either location and that there isn't a "good herpes" and a "bad herpes". They merely have historically preferred locations. Thus, "Oral Herpes" is not HSV1; Oral Herpes can be HSV1, HSV2, or any of the other 6 known human herpes viruses. "Oral" merely describes the location, not the type. HSV1 prefers an oral location, but other types can occur there and HSV1, in turn, can occur anywhere on the body (see: Herpes Gladiatorum, an HSV1 strain which has evolved to live on ANY skin, regardless of mucous & moisture). In fact, up to half of new genital herpes infections are now HSV1, not HSV2. Now I, too, have deviated from the actual subject of the article: HSV2(and 1, as well) is spreading like wildfire, unchecked... and most likely by people who've no clue they even have it. This is what's most important and undoubtedly the reason the article was written - herpes, of either type, must not be swept under the rug as some innocuous non-issue; it truly matters. People need to get more educated. The fact that this debate even occurred, even among those who assuredly have done their homework, is clear evidence of how much misinformation is floating around out there about HSV of all types. More public education needs to be done; more studies need to be done; more testing and conversation between partners absolutely needs to be done.

    Submitted by Helen on
    May 18, 2013 - 2:15am

    A general answer to baseline foundation's answer from someone who has both a science degree and a life-time of writing up science in a way people can understand - you are guilty of the very serious crime of sensationalising, making sweeping statements and creating absolutes where there are none. The result is an article that reads well and is very entertaining (and sensational) but is very misleading.
    Shame on you for such bad writing and reporting.

    Submitted by Herpes victim on
    November 16, 2013 - 11:41pm

    Can you mention the references . Some sentences sound wrong or weird . We need references for these information that herpes can make the immune system weaker .hsv2 lead to eye infection .

    Submitted by BaselineFoundation on
    November 22, 2013 - 1:38pm

    All references are listed at the bottom of the article. 

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