ASHA’s Kathy Lafferty reflects on nearly two decades of educating the public and health professionals alike on HSV
Over a period of many years working in call centers focused on sexually transmitted infections (STIs), I have answered many questions for callers dealing with genital herpes simplex virus; in fact, most calls to ASHA’s STI Resource Center involve herpes questions. Callers frequently ask about symptoms, but sometimes the inquiries are as basic as “What is herpes?” To give callers some perspective on herpes, I usually ask if he or she is familiar with oral cold sores, which most people seem to be. I tell them that oral herpes is generally transmitted by kissing, often acquired in childhood from a family member with a cold sore. I explain that genital herpes is also caused by herpes simplex virus (HSV), but a genital infection relates to sexual transmission and this aspect alone is impactful on people.
Some callers think that genital and oral herpes are caused by completely different viruses, so I address the issue of two different strains of herpes simplex, with HSV-1 usually infecting the mouth and HSV- 2 most often experienced as a genital/anal infection. When callers ask about the symptoms of genital herpes, I tell them it is a skin outbreak which can look like other skin conditions, and that the severity of the outbreak varies with individuals. Sometime callers mention that they have read HSV is transmitted by skin to skin contact, so they worry about harboring the infection at numerous skin sites. I explain that HSV infects mucous membrane skin like the mouth, genital and anal area and that herpes does not infect other, thicker skin areas unless there is a cut or break that allows the virus entry.
If the caller has a specific symptom they are anxious about, like a rash or bumps, I tell them that the most accurate way to diagnose a suspected outbreak is through a culture done with a sample taken from a lesion. If the symptoms have gone away or if a caller wants to know if he or she is infected I recommend a HSV type-1 and type-2 antibody blood test. I explain that the most accurate tests are those known as type-specific HSV blood tests, as opposed to some older, non-specific tests that aren’t as reliable. Sometimes callers think that because HSV can be diagnosed with a blood test, the herpes virus is in their blood. Some callers even want to know if they can donate blood after being diagnosed. I let them know that HSV is not in the blood and that the test is simply looking for antibodies the immune system produces against the virus, not the virus itself. [See Ask the HRC in this issue for more on HSV blood tests. Ed.]
Callers with genital herpes are often concerned about spreading the virus to other areas of their body, such as their mouth or eyes. I explain that this is difficult to do, especially once antibodies have developed. I mention that if this were a common problem, then millions of people with oral herpes would be spreading it to their genital areas! I would recommend that if they touch a lesion, just wash their hands. Another concern is nonsexual transmission of herpes to, for example, a family member. I explain that the herpes virus does not live long outside the body and is not known to be transmitted from objects such as towels or toilet seats. Many callers have read about the term “shedding” as it relates to HSV. I explain to callers that while herpes symptoms involve a skin outbreak, HSV actually resides in nervous tissue. With genital herpes, for example, the virus is established in the sacral ganglia, or nerve roots at the base of the spine. (In people with oral herpes the virus is in nerve tissue at the top of the spine, called the trigeminal ganglia).
Periodically, the virus travels back up the nerve or nearby nerve to the skin where the person was infected. It “sheds” off the skin. When this happens, there is sometimes an outbreak and symptoms. I then explain about “asymptomatic shedding” which occurs when the virus travels up to the skin, but there are no symptoms. I explain that it is estimated this happens about 10%-13% of days during a year. It is believed that the longer a person has herpes the asymptomatic shedding may decrease. I discuss that condom usage may reduce the risk of transmission and also that medication (such as Valtrex taken daily) may help. I would encourage callers to discuss their concerns about treatment with their health care provider.
Hopefully by providing callers with factual information they gain a better understanding of herpes simplex virus. Also addressing caller’s emotional concerns and common misconceptions the anxiety level they may have is hopefully lessened by the end of the call. I encourage callers to go to the ASHA website for additional information as well reviewing the publications information on herpes simplex.
--Kathy Lafferty is ASHA’s longest-tenured health communication specialist. Connect with her and other ASHA staff through the STI Resource Center hotline at 919.361.8488 or online.