In Ancient Rome, an epidemic of cold sores prompted Emperor Tiberius to ban kissing in public ceremonies. Today, cold sores still occur in epidemic proportions.

Herpes has become a bit of a cultural joke. Some sayings about herpes include:

“Glitter is the herpes of craft supplies.” – Demetri Martin

“Unlike love, herpes is forever.” – Anon.

“It’s been said that 1 in 4 people have herpes, and everyone has 4 grandparents, so let’s be honest, your grandmother is probably a dirty skank.” – Jarod Kintz

“Fundamentalists never wonder why, if herpes is sent by ‘god’ to scourge ‘adulterers,’ whooping cough and measles weren’t purposely created to lambaste children.” – Fred Woodworth

Herpes have a variety of names; cold sores, fever blisters, “the gift that keeps on giving,” love warts, the herp, kissing disease.

There are actually 8 different Human Herpes Simplex Viruses.



What is it?



Typically cold sores around the mouth



Typically genital herpes



Chickenpox & shingles



Mono “the kissing disease”



Alternate cause of mono (mainly an issue with people with HIV/compromised immune systems)



Roseola (disease in small children)



Alternate cause of roseola



Found in tumors in people with AIDS

There is currently a vaccine for HHV3, and HSV2 vaccine trials are currently happening in Australia. HHV4 vaccine is currently being researched at the University of Minnesota.

Herpes as we know it refers to HSV-1 and HSV-2. These two viruses have 776,000 new cases in the US each year. The virus damages the skin as it reproduces, creating sores that last about a week. The virus hides inside nerve cells between outbreaks. Some people are genetically prone to getting more outbreaks, and things like low immunity or stress can set off outbreaks. If you have one type, you are less likely (especially to get HSV-1 if you have HSV-2).

50-90% of American adults carry antibodies to HSV-1. If you are already immune, or having outbreaks in one location, it is unlikely, though possible to get outbreaks elsewhere, so wash hands after touching sores. People with active oral HSV-1 shed the virus in salvia about 5% of the time.

16-25% of the US population aged 14-49 has HSV-2 (1 in 5 women, 1 in 9 men). People with active genital HSV-2 shed the virus from the genital area 6-10% of the time with no symptoms. It is very unlikely to get oral HSV-2 from oral sex with someone with genital HSV-2.

Cold sores are usually on the lip (canker sores affect the inside of the mouth and are not caused by HSV). They can appear anywhere on the face, and generally have a warning period of red, irritated skin. Blisters form, rupture, and crust over before healing.

Genital herpes outbreaks are usually preceded by tingling in the genital region. Sores last 2-4 weeks and are sometimes accompanied by flu-like symptoms. Sores double the risk of transmission of HIV. Genital herpes van lead to miscarriages or premature birth and can be passed from mother to child and be fatal. The risk can be reduced by anti-viral medication and c-section delivery.

Sores can be tested with a cell culture or antigen test to determine if they are HSV. Blood tests exist (PCR, antibody tests), but aren’t recommended by the CDC unless there was a known exposure or if they are symptomatic, since false positives are common and no treatment is needed. The tests can tell the difference between HSV-1 and HSV-2.

Ho or cold compresses, over-the-counter creams and pain medications can help with the symptoms of outbreaks. Antiviral creams (OTC or prescription) or oral antiviral prescriptions can reduce the length of outbreaks if used during an outbreak, or can be taken daily as suppressive therapy.

In order to reduce risk of transmission, don’t kiss, share toothbrushes, glasses or utensils, or perform oral sex while cold sores are present. Don’t touch the sore, or wash your hands afterward if you do. Take antiviral medications to reduce viral shedding. Condoms help, but only partially. SPF lip balm helps prevent cold sores.

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