"Herpes" is the name commonly given to a recurring skin infection caused by a strain of the Herpes family of viruses called Herpes Simplex. The infection shows itself as painful skin lesions which start as blisters and then form ulcers and then heal after a few days or a week. Herpes simplex family has 2 members which we commonly refer to rather imaginatively as Herpes type 1 and type 2.

It used to be thought that type 1 people only "above the waist" in the form of "cold sores" and type 2 "below the waist" as "genital herpes . However the truth is that either can affect either place ( with sex play like oral sex type 1 can be transmitted to partners genitals and vice versa with type 2)

It is my understanding that the name " herpes" , describing blistering skin conditions, preceded the isolation  of the herpes simplex virus.  

The herpes family of viruses is large, another very distant member of this extended family is the chicken pox virus called - Varicella  Zoster .

The Herpes family have a habit of causing an initial infection and then when this is over rather than being eradicated from the body some of them travel up to live contentedly and quietly in a nerve origin in the spine. When a person is faced with stimulus like a severe physical or psychological stress the virus wakes up and travels down the nerve to the skin where it causes the painful blisters on the area of skin that its home nerve supplies. This is the mechanism seen with Herpes Simplex as well Varicella  Zoster. Varicella  Zoster is the chicken pox virus which sometimes many years or decades after the initial chickenpox event certain stimulus wakes the virus up and results in "Shingles" sometimes called Herpes Zoster.. The Herpes simplex family cause cold sores and genital herpes.

Herpes viruses are transmitted to a person from direct contact with the skin of someone else who is already infected with the virus, usually when they have an active lesion.

Chicken pox is passed on either by exposure to the fluid of a blister of a person suffering with shingles or active chicken pox or by droplet spread in saliva during the acute phase of chicken pox. ( its important to note that while you can catch chickenpox from shingles and chickenpox form someone else with chickenpox it doesn’t work in reverse – ie you don’t catch shingles from chickenpox)

Herpes Simplex type 1 is often a childhood infection contracted through being kissed by someone with a cold sore. Later that person finds they suffer from cold sores. Others, who may not have been infected as a child, may be infected later by kissing a person with an active cold sore. The virus "gets in" through skin breaks when a person comes in physical contact with someone else who is infected. Generally this contact is with the fluid from an open herpes sore but occasionally there are people we call "asymptomatic" shedders who can infect others even between attacks. ( Isn’t it a tragedy that even kissing can be a health hazard !)

Herpes Simplex type 2 affecting the genitals  behaves the same way – direct contact with an infected person's genital skin may result in an initial infection which can be severe involving swelling of local lymph glands as well as blisters and ulcers which last 1 – 2 weeks if not treated quickly. Earl;y medication can reduce the severity of an initial attack .

After an  initial attack there is a complete recovery. However the virus doesnt go away - instead it  treks up sensory nerves that supply the area of skin that was affected  and it lives in the ganglion (or origin ) of a particular nerve near the spine. Then, when the person is run down or stressed it may be reactivated It travels down that nerve and causes skin lesions in the area of skin supplied by that nerve.

The lesions are initially tiny blisters which then often burst and develop into little ulcers. There is commonly a tingly, burning or even itchy sensation that occurs just before the lesions appear and the sores are usually very painful lasting for about 5 days then clearing up spontaneously leaving no scar usually. The lesions and blister fluid contain lots of viruses and are infectious to others

Can I get Genital Herpes from a partner's cold sore ? 

If you had never been exposed to the herpes type 1 virus ( usually associated with cold sores around the mouth ) and you  receive oral sex from someone who has an active cold sore ( or who is an asymptomatic shedder) you may contract genital herpes.  If you already have the herpes type 1 virus  (you may or may not get cold sores but have been exposed ) then  you should be protected from  getting  genital herpes from your partner through oral sex HOWEVER  I would strongly advise that people  should NOT  give oral sex to anyone when they have a cold sore just in case. And safe oral sex practices are always safest using dental dams if you are not sure. 

It is estimated that 1 in 6 Australians carry the herpes virus. And other than its potential problems during pregnancy and childbirth ( see below) and ,of course, its  "contagiousness" herpes is, medically speaking, really more of a nuisance than anything else. When it is managed properly it rarely has any serious medical complications associated. However the biggest complication is probably the fall out on a person’s attitude. The stigma attached to the infection is still enormous because of its impact on people’s personal relationships.  

Cold sores – Generally these are diagnosed by looking. Most people cant recall their initial infection as it could well have been when they were a baby, and the first they know of their infection is the appearance of a cold sore. Most patients have made a good guess at the diagnosis of a cold sore before they see a doctor! Because cold sores are mainly only nuisance value confirmation on swab is not always done. However if there is doubt about the diagnosis a swab test can be performed.

Genital Herpes - When people are first infected with the Herpes virus via the genital route they may have flu-like symptoms as well as the lesions and pain. They usually also have enlarged tender groin lymph nodes. The diagnosis is made by a doctor swabbing the lesion, ie. wiping a cotton bud stick over an ulcer in an attempt to gather some virus samples in the fluid. The sample is then sent to a lab for "culture" and identification. That is, the sample is kept and incubated in an attempt to grow more viruses and these are looked at under a microscope for identification. results can be available in a few days if a PCR test is used or about a week or so if the culture test is used .

There is a BLOOD test available that can measure whether someone has ever been exposed to the herpes viruses. However this test is not very specific and not recommended as a screening test. It has little real use currently except maybe in partnerships where one partner is infected and the other not, to find out if the symptom free one has ever been exposed. It is possible to have been exposed to the virus but not get recurrent attacks, and so not be aware you have ever been exposed.

What treatment is available for Herpes ?

It is important to note that so far there is NO cure available for Herpes. Once someone is infected the virus lives inside their body for the rest of their life . Some people get recurrent attacks of pain and skin sores and others may not even be ware they have been infected.

However there are drugs available in Australia which are effective in reducing the severity and frequency of attacks so long as they are taken early enough in the course of the attack. These medications are only available on script from a doctor. The medications are expensive and the Federal  Government has subsidised them through the Pharmaceutical Benefits Scheme .The subsidy only applies  for treatment of Genital Herpes and there are certain guidelines that your doctor will  know about.  For the Pharmaceutical Benefits Scheme subsidy to apply your doctor will  have to write a special "authority" script This is not difficult and only involves a phone call for a release number and can be done during the consultation. Under this subsidy  you will pay around the same as for most other medication  

Remember these medications are not cures.

There is topical ,over the counter creams,  which may  reduce the severity and frequency of Cold sores. Speak to your pharmacist about these.

Research is currently going on looking into the possibility of providing a vaccine against herpes. Nothing is available commercially yet

Rarely there Herpes infections can affect the brain through causing viral meningitis. This infection is very serious but not common .People should be very careful NOT to touch their cold sore and then touch their eyes – Herpes infection in the eye can result in serious scarring and affect vision.

In the past women who had herpes were told they would never be able to have "natural child birth" ………guidelines are not that strict now . Most women with a history of mild herpes have normal vaginal deliveries. The problem is if there is active herpes at the time of delivery. Especially if the woman has had her first attack during pregnancy. The problem is that if the baby passes down the birth canal and comes in contact with the virus which may be present in lesions then there is a real risk of a serious infection for the baby – with potentially nasty consequences. It is very important to tell your obstetrician or midwife of a history of herpes and they can keep an eye on things.

Many people with herpes avoid relationships rather than tell a new partner about their problem

If one partner gets given the diagnosis of herpes there are a million questions that fly around their head – "where did I get it from?" – "hang on I haven’t done anything – it must be them !" .and it needs to be remembered that honesty is crucial. Some people may not be aware they are passing it on or worse still to scared to tell anyone of their suspicions.

We need to educate people on how to minimise transfer and reduce stigma so people can feel more comfortable talk about it .

There are Herpes Support groups- usually run by people who have the condition and understand what other sufferers are going through. I believe there is representative groups in each state. The best way to find them is probably by telephoning the sexual health centre in your capital city. 

Your GP can answer questions and perform tests as can local sexual health centre or family planning association clinics. Please don't try to diagnose yourself. Always seek professional advice and there really is NO need to feel embarrassed. 

www.herpes.com.au