9743 herpes ssr
Sector Summary Report:Herpes
Before the emergence of HIV and AIDS, herpes was the most feared sexually transmittedinfection (STI). Anxiety around herpes stems from it being an incurable, life long infection,about which there is a lack of knowledge and many misconceptions. This sector summaryreport seeks to provide an overview of herpes to health promoters working in sexual health.
particular part of the body, both can infect
either above the neck or below the waist.
herpes simplex virus. These are part of a
group of eight herpes viruses(1) that infect
three quarters of the population have been
infection with HSV-1 (the ‘cold sore’ virus). infected (usually in childhood) with HSV-1
and around 10-20% (2) of the population have
through a minute break in the skin, travels
of HSV-2 is rising due to increased sexual
the nerve until it reaches the ‘ganglion’
(a junction for several nerves supplying an
being infected in childhood thanks to higher
similar in structure and are identical in
area of the body). There the virus will lie
standards of living and hygiene. As having
their modes of transmission and symptoms.
Both cause skin ulceration, especially of
trigger at a later date. Then it will travel
protection against getting genital herpes,
cells; as the virus kills these cells it causes
the tell-tale skin inflammation or blisters.
or lips – known as ‘cold sores’). Classically
shut down replication of the virus but cannot The extent of both infections is hidden
oral herpes is associated with herpes simplex totally eradicate it, leaving virus to persist because in many people the virus does notvirus 1 (HSV-1), with genital herpes linked
reactivate, or if it does, symptoms are mild
enough to go unnoticed. Rates of HSV -1and HSV- 2 infection are considerably higheramong those with high numbers of sexual
“The herpes simplex viruses are extremely
partners, GUM clinic attendees and gay men.
In 2004 around 1,000 gay or bisexual men
common. In 2004 around 1,000 gay or bisexual
were seen in sexual health clinics with their
first episode of genital herpes (with thousands
men were seen in sexual health clinics with
more experiencing recurrences but not seeking
their first episode of genital herpes (with
thousands more experiencing recurrences but
not seeking medical attention).”
inside the mouth and throat, as well as in
or around the nose. In a rare complication
The symptoms of the first or ‘primary’
(such as reddened skin, a tiny pimple or a
break in the skin resembling a paper cut).
(antibodies) against the virus, allowing
blisters are in the urethra. Milder symptoms
The classic symptoms of the first (primary)
spot or general reddening of the skin.
ten days (or longer) after infection. Where
herpes simplex viruses will never lead to
the virus first entered the skin it causes
reddening and possibly an itching, burning,
Blisters may appear on the entrance to or
the site of infection may swell, possibly
particularly painful, especially during a
(often so mild that they are overlooked).
Other areas of the body
appear in the same part of the body asthe primary episode – or a site close by if
The reddening or tingling of the skin are
the virus travels down a different nerve to
thigh, buttocks and groin. Herpes blisters
herald the arrival of blisters. Sometimes
on the finger are called ‘whitlows’ and
tend to decrease over time, but up to four
an episode (3) may abort itself despite the
resulting from touching a blister. A rare
either on their own or in clusters. These
HSV-2 and are detectable in blood tests.
grow, filling with a clear, highly infectious
four weeks. Genital and anal blisters can
the other HSV strain, or, if infected withthe other variant, may experience no ormilder symptoms.
‘suppressive therapy’ for a period of
but several designed to prevent infection
have blisters six or more times a year.
• lack of sleep or being ‘run down’
viral shedding entirely and may itself lead
USA since late 2002. It is only partially
resistance. Alternatively individuals may
virus is reactivated by Ultraviolet light)
vaccinated - at preventing infection with
– if prone to cold sores, apply sun block
strain to begin with, without ever having
used anti-virals themselves. Treatment is
• friction against the skin - including sexual
prescribed for more than six months.
intercourse (reduced by use of lubricant)
• foods containing the amino acid Arginine
Symptom management includes:
To prevent the spread of herpes:
• pain-killing creams or sprays (such as
of the prodromal stage until the blisters
Health impact on those with HIV
In people with HIV, especially those
• Condoms provide a degree of protection
• To avoid spreading the infection to a
widespread and longer lasting. As a result
HIV positive individuals are more likely
to be given suppressive anti-viral therapy
to prevent or reduce herpes episodes.
Disseminated infection (when the virus
• drying blistered skin with a hair dryer
• Sex toys used on more than one person
affects organs such as the brain, causing
should be covered by a fresh condomwhen used with each new sexual partner.
• tannin in cold, wet tea bags held to the
Impact on HIV transmission
• ice held to the blister eases pain (ice
should not be placed directly on skin.
positive people with herpes are more able
• applying lemon balm (Melissa) cream.
The following can transmit herpes, if they
Although genital ulcers were once believed
involve contact with skin that is shedding
The herpes viruses cannot survive outside
so cannot be spread through toilet seats,
• unprotected anal or vaginal intercourse
‘cold sores’). This may be attributable to
or a decrease in the proportion of people
takes place when the virus is being ‘shed,’
i.e. released from the skin of an infected
• sharing sex toys without covering with
tingling in the skin until after the blister
clear fluid inside the herpes blister carries
a lot of virus and is highly infectious.
• flannels and towels may cause the virus
occurs, when virus is present in skin that
from a herpes blister. Alternatively, the
virus can be cultured from blister material.
The virus can also be present in the saliva
Two to six weeks after infection blood tests
of someone with a ‘cold sore’ and, if used
as lubricant, carries the risk of transmitting
screening is of limited use as the majority
days in the year. Shedding is believed to
have antibodies to one or both viruses.
Wherever it affects the body, HSV-1 causes
but the virus itself is not – it is in nerves.
severity, and reducing viral shedding.
HSV-1 traditionally is a facial infection
currently are the anti-viral drugs Acyclovir,
the area it is classically associated with.
given in tablet form (or intravenously if
an episode is very severe, as experienced
against one of the herpes simplex viruses
of Acyclovir for cold sores do not contain
• Herpes pushes up HIV viral load
(1) Others in this group include varicella zoster virus
A herpes diagnosis can have a psychological
(the cause of chicken pox or shingles), Epstein Barr
impact disproportionate to the condition’s
virus (glandular fever), cytomegalovirus – or ‘CMV’
(another cause of glandular fever) and the virus
recently identified as responsible for Kaposi’s
load. High viral load is linked to increased
Sarcoma, the skin cancer associated with AIDS.
it is and that those with it are a medical
oddity (when in fact most of us are infected
(2) HSV-2 prevalence in the UK is estimated at around
5% (and rising), lower than most developed nations.
• Herpes skin disruption facilitates
with one or both herpes simplex viruses).
(3) Other terms for an episode of herpes such as
The fact that herpes is sexually acquired,
‘attack’ or ‘outbreak’ are seen by some as causing
In HIV positive individuals HIV is present
in their herpes blisters, allowing contact
(4) For more on the connection between HIV
between HIV and an uninfected person.
anxiety and depression (doubly unfortunate
transmission and herpes (and other STIs)
Blisters may also bleed, allowing contact
as stress itself can trigger recurrences).
see the 2000 Sigma Research briefing paper The facilitation of HIV transmission by other
The following points may be useful in
sexually transmitted infections during sex
reassuring and allaying fears:
Peter Weatherburn, Chris Bonell,
Ford Hickson and William Stewart - available
to download from www.sigmaresearch.org.uk
Written by Richard Scholey
attaches itself to CD4 cells, so increased
indistinguishable infections, yet no stigma
blisters of HIV negative people furtherenhances risk of HIV transmission. Also,
• The primary episode will usually be the
worst – recurrences are less severe and
The STIs causing ulceration (syphilis and
transmission; herpes more so, as syphilis
• Support is available around disclosing
ulcerative STIs is related to increased risk
HIV positive individuals are more likely tohave more frequent, widespread and longerlasting herpes blisters. They also shedherpes virus for longer. On a populationlevel, all these factors facilitate the spreadof herpes and, in so doing, that of HIV.(4)
The HIV and sexual health charity for lifeWebsite:
www.tht.org.uk THT Direct:
0845 12 21 200 Registered office:
52-54 Grays Inn Road, London WC1X 8JU Tel:
020 7831 0330 Email:
Terrence Higgins Trust, November 2005. Terrence Higgins Trust is a registered charity no. 288527. Company reg. no.1778149. Registered in England. A company limited by guarantee.
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