Medical Information What is Herpes Simplex Virus (HSV)? Herpes is an extremely common virus that is poorly understood and has had the unfortunate history of becoming a social stigma. It is spread through direct skin to skin contact, that is directly from one infected site, or sore, to the site of contact. As an example; if you have a cold sore on the mouth and kiss someone else facially you can spread that cold sore. If you kiss them genitally then it can spread to the genital region. The same applies to genital herpes: a sore may be transmitted to genital or facial regions through direct contact. The actual herpes virus itself is derived into two segments known as Human Herpes Virus 1, (HSV1) and Human Herpes Virus 2, (HSV2). HSV1 is a viral infection that manifests itself in the skin and nerves, and can be visible as cold sores. It's primary area of infection is facial, usually around the mouth and lips. This type of virus can commonly be passed to the genital region. HSV2 is very similar to HSV1 except that it's primary area of outbreaks occur in the genital region. HSV2 is also more painful, and visible when outbreaks occur. Both HSV1 and HSV2 are very similar genetically and are viruses, which hide within the spinal ganglia and nerves of the human body. Once inside the spinal ganglia the virus cannot be defeated by the human immune system. This usually causes emotional concern, as it is permanent. When the human immune system is at a low or weakened state the virus tends to re-attack and forms in blisters that can last days to several weeks. A person may contain and pass one or both viruses. Symptoms of HSV Visible sores on the face or genital region, which may be combined with itching, burning, tingling, muscle aches, headache and swollen glands or flu-like symptoms. The first outbreak is usually more severe then subsequent outbreaks. Areas of infection include the facial region, legs, back of the legs, buttocks, and genital area. The skin in the area of infection may appear red and sensitive and shortly afterward blisters or bumps may appear. These infected areas can look like a pimple or a water blister depending on the individual. The blisters will break after time and new skin tissue will form healing the infected area. Rarely do they leave a scar or permanent mark. Many individuals experience an itching or tingling sensation prior to an outbreak. These sensations are called prodromal symptoms and individuals are contagious and can pass on the virus during these stages. An individual that has a highly active immune system may not display or know they have herpes. When the immune system weakens or is at a low point (such as times of high stress) then that individual may experience their first outbreak. Otherwise herpes may go undetected for a long period of time. Or the first outbreak may have been so mild it may have gone unnoticed. How Many Have It? Don't be afraid you are not alone. Statistics show that the numbers may be as high as 1 in 4 persons having herpes. Generally the current agreed upon statistic in many books and publications is 20% or 1 in 5. Some people have primary infections so mild (subclinical) that they remain unaware of their infection their entire lives. Testing for HSV The best method for diagnosing genital herpes is a viral culture test taken from an active sore as soon as possible after the sore appears. A viral culture test also produces a typing assay which will distinguish between HSV1 and HSV2. An enzyme immunoassay (EIA) test taken from an active sore will diagnose herpes but not identify the type. In Toronto if you need testing done we recommend contacting the Hassle Free Clinic. These are trained professionals that deal with this type of infection on a daily basis: Hassle Free Clinic 66 Gerrard Street East, 2nd floor (Gerrard and Church) Toronto, Ontario M5B 1G3 Men's Number - (416) 922-0603 Women's Number - (416) 922-0566 Or contact your family Doctor, a local walk in clinic, or a recommended Dermatologist. Western Blot Blood Test In the absence of an active sore there is one and only one accurate blood test available for diagnosis: the Western Blot (WB) test. The WB test will distinguish between HSV1 and HSV2 but will not indicate the location on the body of the infection. Approved for use in Canada in 2001 the WB test is not covered by OHIP. The WB test is best performed after at least four months from the point of exposure or infection. MDS Labs in Toronto offers the Western Blot, contact them toll free at 1 (877) 849-3637 for details of lab locations. Treatment Various drugs are available for treatment and can be taken as a suppression technique (constantly to prevent outbreaks or partner infection) or symptomatical which is applying medicine when you feel prodromal symptoms. The most common drugs in use today include Acyclovir, Famvir and Valtrax. Other Herbal remedies have been known to help as well as keeping a healthy diet, staying fit, and keeping a positive attitude. Our self help group brings up the various drugs, side effects, and herbal remedies as topics on a consistent basis and you would be best to attend a meeting as well as discussing the various approaches with your Doctor. As herpes is a virus it affects each differently so an open forum where a group is discussing the different impact it has had on them as individuals can provide valuable insight to yourself. It can also help provide a very positive atmosphere in which to discuss your feelings. Click here for a list of the next self help group and up coming special events. Transmission Risk Transmission is caused by close oral, anal, or genital contact, including intercourse, masturbation, and kissing, which allows for the transfer of bodily fluids. Herpes is a very weak virus and does not live outside the body for very long. So transmission through toilet seats and towels is usually impossible. The virus is usually passed through direct contact of skin areas. The human body also goes through phases of asymptomatic shedding where the virus particles are shed with no outward symptoms. The American Social Health Association (ASHA) believes asymptomatic shedding may occur up to 5% of the time. For more information please contact us directly or your Doctor. Key Information You have a greater chance of passing on the virus to a partner around your first few outbreaks. You can pass on the virus even when you have no visible signs of a sore - this is called aysmptomatic shedding, when the body sheds the virus without showing signs and occurs several days throughout the year. You can pass the virus from one part of the body to another by touching the sores and then touching another part of your body. Herpes does not cause AIDS, but can make you more susceptible to catching AIDS to weakened immune system or open sores while having intimate relations. Herpes does not have a cure as of yet, so you will have to tell a partner eventually. Please call us and attend a self-help session which can prepare you for this event. Condoms don't always protect a partner, herpes can and does effect areas outside of what the condom covers.