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Defining the differences in types of HSV
For
anyone living with genital herpes – the
most common attempt at disclosure will be to compare the
infection to that of oral herpes or “cold sores.”
There always seems to be an underlying need to somehow
“lessen” the severe perceptions that one may have by
drawing attention to the herpes that is
socially acceptable. Contrary to scientific fact, many
believe there will always be a “good” virus (oral
herpes) and a “bad” virus (genital
herpes).
Based on the various up to date information resources
and the assistance of a licensed healthcare provider, we will explore the two types
of herpes based on varying criteria.
According to The American Social Health Association,
under a microscope HSV 1 and
HSV 2 are virtually identical, sharing
approximately 50% of their DNA. Both types infect the
mucosal surfaces of the body – most often the mouth or
the genitals and then establish latency in the nervous
system. For both types, it is estimated that two thirds
of those infected have no noticeable
symptoms or no symptoms at all. Studies have show that
both viruses can be spread when there
are no symptoms present.
The
primary difference between the two types is their “site
of preference” when establishing latency in the body.
HSV 1 usually establishes latency in the trigeminal
ganglion, a collection of nerve cells found near the
ears. Recurring outbreaks will generally occur around
the mouth or facial region. HSV 2 usually establishes
latency in the sacral ganglion, a collection of nerves
found at the lower base of the spine. HSV-2 recurring
outbreaks will generally occur in the
genital region.
Though this is the most commonly noted difference, it is
not absolute. Either type can reside in either or both
parts of the body and infect orally and/or genitally.
Unfortunately, many are unaware of this and this lack of
knowledge contributes to the ongoing spread and to the
growing number of type 1 genital cases.
With many years of believing that type 1 is only related
to oral herpes, many people are not aware that type 1
can and is being contracted both orally and genitally.
So many people are under the presumption that there is
that “Good versus Bad” virus and with
these beliefs social stigmas are thriving. While the
“Good Virus” is believed to be “just a cold sore” –
society has that euphemism to hide behind and don’t have
to acknowledge that cold sores are indeed Herpes.
Common myths give indication that HSV 1 causes a mild
infection that is at times bothersome, but never
dangerous. The reality is that type 1 is usually very
mild when affecting the lips, face or genitals. There
has been speculation that type 1 can occur
spontantiously in the eye “ocular herpes”
however, herpes never occurs spontaneously, it has to
come from somewhere - either moving along the trigeminal
nerve top branch or autoinoculation. Ocular herpes can
be very serious and could potentially lead to blindness.
In some very rare cases, herpes has spread to the brain
causing herpes encephalitis, an extremely dangerous
infection that can result in death. These are however,
Very rare! Herpes can be spread to the finger “herpetic
whitlow”. Herpes is also quite common among
wrestler’s “herpes gladiatorium” (a
herpes infection of the chest or face).
Though society believes type 1 to be the “Good Virus”,
researchers are finding HSV-1 to be more “risky” than
previously perceived. Some medical professionals are
finding type 1 to be a more “significant” infection than
HSV 2 in the neonate and the prevalence of HSV 1 is
severely underestimated. For years it was believed that
90% of people had HSV 1. We know now it is 60%. Even at
sixty percent having type 1 orally and the unknown figures
of HSV 1 genital cases gives indication that herpes is not
a virus to be ignored.
For many years HSV 2 was believed to be a painful and
dangerous infection that affects people with an “active
sex life”. Genital Herpes can infect anyone who has
sex, even if only once. An estimated 22%
of adults from varying backgrounds, income levels and
ethnic groups have HSV 2. HSV 2 is often so mild that an
estimated two thirds of those infected
don’t even realize they have it. Type 2
rarely causes complications and more rarely spreads to
other parts of the body outside of the risk of
autoinoculation that most often occurs during the primary
episode.
HSV 2 is the most common cause of neonatal herpes, a rare
but often dangerous and potentially fatal condition that
affects newborns. HSV 1 is the primary cause of one third
of neonatal infections. You can find
comfort in knowing that both are largely avoidable with
proper education, instruction and testing.
Because the two types have a “site of preference” both can
behave very differently depending on the infected person.
HSV 1 and HSV 2 are quite common and neither pose a
serious health threat when the patient is
introduced to proper information, care procedures and
precautionary measures. Due to the common existence of
herpes in society, many health care providers dismiss them
easily; even considering the long-term emotional effects a
positive diagnosis will have on their
patient.
HSV – though not life threatening, it is stealing the
quality of life of many of those who are infected. At the
same time, many of us who carry the virus, regardless of
location, realize its common place in society and know
it’s nothing more than a “cold sore.”
Outbreaks? And How Often?
The physical problem that HSV poses is primarily based
on the individual and three varying factors. Those
being; the strength of their immune system,
how long they have had the virus, and
is the virus affecting the “normal site of preference?”
Obviously a challenged immune system seems to have a
strengthening affect on many “viruses”
and is the main reason people are bothered by more
frequent outbreaks and the primary reason types 1 and 2
are a greater threat to infants who have limited immune
response. Having a weakened immune system does not cause
the virus to become stronger, it simply makes the body
less able to cope with the virus that is there. This
factor also causes the viruses to greatly affect those
with compromised immune systems due to other illnesses
such as cancer, HIV, severe burns, etc.
How long a person has the virus also plays a large role
in frequency of outbreaks. It is not clear why a
decrease occurs over time. The people with the highest
levels of antibody have the greatest number of
outbreaks. It's unclear why people have fewer outbreaks
over time but it is likely not an antibody function, but
rather perhaps some other part of the bodies immune
system.
It is estimated that 100 million American’s who are
infected with HSV-1 contracted the virus as a young
child. Due to the substantial time of living with the
virus, by the time they reach adulthood only about 5%
will find it to be a medical problem and seek
treatment.
The estimated 40 million American’s infected with the
HSV-2 virus acquired the virus as a teen or as a
sexually active adult. Those infected
will, on average, experience 4-6 outbreaks that first
year, with a decrease in outbreaks occurring over
time.
Due to HSV-1 and HSV-2 having their sites of
preference and though HSV can account
for both genital and oral herpes cases, regardless of
type, both are known to be milder when they are
“outside their site of preference.” You could easily
say the type located in its “site of preference” has
the home court advantage.
An example of this is most people infected with HSV-1
genitally have reported fewer outbreaks if any in a
single year. It is estimated that HSV-1 now accounts
for as many as 30% of all genital herpes
cases in the U.S and 2-5% of the recurring
outbreaks are associated with the
type 1 virus.
HSV-2 oral infections are Very rare
and in those few known cases, recurring outbreaks are
extremely rare.
Spreading the Virus?
One of the most common “haunt’s” of those infected with
genital herpes is the concern of transmitting
to a non-infected partner. At the same time, those
infected with oral herpes show little concern if any at
all of possible transmission.
In reality one type is just as easily transmitted to
their site of preference, and can be spread to other
locations as well. Both types are most contagious during
active outbreaks, however they can be transmitted during
times of viral shedding, when no
symptoms of an outbreak are present. HSV-1 is shed into
the saliva and is likely coming from the mucosa inside
the mouth and on the lips, approximately 18% of the days
on average, of asymptomatic days, in the person who has
intermittent cold sores, when measured by PCR. To date
there is no way of possibly knowing when shedding is
occurring without the constant supervision of trained
researchers.
Typically in the first year of infection with the
HSV-2 genital virus, one will shed
about 6-10% of those days when there are no
symptoms. This of course will decrease over
time as well.
There are always questions of transmittability as it
pertains to those who already have one type of herpes.
As stated by a licensed healthcare provider, "it is true that having HSV 2
protects against getting HSV 1, but there is controversy
about whether HSV1 protects against HSV 2 or not. There
are two large studies with very different results. At a
minimum, HSV 1 keeps the acquisition of HSV 2 more
likely to be unrecognized.
HSV-1 is the most commonly acquired form of herpes and
is typically spread through a social kiss such as that
of a family member. Due to the lack of immune response
in children, new HSV-1 infections
typically occur in childhood.
Update: "Recent research indicates that HSV 1
is probably not more easily acquired than HSV 2. And
now, the average age of acquisition of HSV 1 is in the
teens, rather than childhood" according to a
licensed healthcare provider.
By the time that child reaches adulthood, they will be
one of 50% of American’s living with HSV-1.
By the time a person reaches the age of 50, they will be
one of 80-90% of those who carry HSV-1.
Nearly all HSV-2 infections are encountered after
childhood when they began having sex. Those who have a
prior infection of HSV-1 have an acquired immune
response that lowers – but will not eliminated the risk
of acquiring HSV-2. According to some studies, a
previous infection of HSV-1 reduces the acquisition of
subsequent HSV-2 by as much as 40%.
A prior infection with HSV-1 orally greatly lowers the
risk of contracting type 1 genitally. Studies have shown
that the majority of HSV-1 genital cases are occurring
in those with no prior history of HSV of either type.
In the absence of prior oral infection, HSV-1 can be
spread to the genital area, usually through the practice
of oral sex. In some countries, genital HSV-1
accounts for more than half of their entire genital
herpes cases.
Some researchers have stated that a prior infection of
HSV-2 genitally will protect against infection of HSV-1.
Another common question is – If you have genital HSV-2
will your partner contract it orally
through oral sex? The answer is most probably not! About
98% of all HSV-2 infections are genital.
If you have HSV-1 genital can you give
this to your partner through genital sex? The answer is
Yes! Though the risk is reduced due to the infection not
being located in its “site of preference” which means
there is far less shedding and much fewer outbreaks.
So now the question is “If HSV is so easily spread from
oral to genital, then why are people not taking stronger
precautionary measures?” This is due largely because of
the social stigma’s that are associated with “the bad
virus”. It is all a matter of public education and
social acceptance. Many times there is no convincing
that person who has a history of cold sores that the
lesions have nothing to do with a “cold” but are in fact
herpes, because “they went away!” The nearest thing to a
cold that is linked to oral herpes is the fact that a
challenged immune system will on occasion lead to an
outbreak. These cases will typically occur during times
of colds or flu’s. The symptoms associated with the
primary infection of HSV that includes flu
like symptoms often leaves room for
this misconception.
Health care providers, researchers and other informed
people can offer as much data and information on the
differences between HSV-1 and HSV-2, but reality is that
as long as society chooses to remain the judge and jury
with their opinions and remain locked in the belief that
genital herpes is “the bad herpes”, there is little that
can be done to begin to erase the social stigmas or
alter the mindset of those who choose not to become more
educated.
Regardless of all efforts being made, the common belief
that “oral sex is safe sex” will also
continue. Should unsafe sexual practice continue without
proper precautions and testing, Americans could see the
numbers of genital herpes increase. On the flip side of
that coin, the new NHANES data shows a considerable
decrease in HSV 2 infections from about 22% to about 17%
so the broad scale efforts into STD awareness must be
working.
Because an infection is associated with the genitals and
through the act of sex, regardless of how sex is
portrayed on television, viewed by society or practiced
by as many as 98% of adults, there will always be
something “taboo” about any virus that
is associated with sex, period.
We can only hope that one day, through the continued
efforts of concerned organizations, the walls of social
stigma and a judgmental society will
begin to fall. Today living with the virus and realizing
that you are indeed a part of a majority rather than a
minority can offer you the first step to emotional
freedom.
Regardless of location, herpes is herpes is herpes. It
is only a “cold sore” and is a virus
that is treatable, controllable and in many cases
avoidable even with a partner who carries the virus. By
taking the time to become educated, learning your body,
your triggers, your symptoms, etc. you can take control
over your life and the virus.
It is all a matter of how proactive and educated you
choose to be.
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information in printable version,
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*This
information has been provided with special thanks to Dr. H
of
Herpes.org,
The American Social
Health Association,
Centers For Disease
Control
and input from many who live with the Herpes virus.
Herpesonline provides services free of
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Resource Network and
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