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Herpes: more common than you'd think

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Herpes may have a bad reputation, but it's not the end of the world, says Dr Derek Freedman.

What is Herpes?

When you say "herpes", most people think of genital herpes and think of it being acquired sexually, often leading to feelings of guilt and remorse; it can even leave the person feeling soiled. But most people have herpes on the mouth -- a cold sore. Genital Herpes is really a cold sore in a less obvious location!

What causes Herpes and mouth sores?

A virus: Herpes Simplex (HSV), which is extremely common. Most people catch it at some time or other but only 5--10pc of those who have the virus develop the sores. Most who have sores will have them on their mouth; a few will have genital sores. The rest carry the virus silently with no blisters or sores, or with such small lesions that they go unnoticed.

Can the silent carrier transmit HSV?

Yes -- most people catch the infection from a silent carrier. Few have sex with sore genitals, unless they are extremely randy, careless or drunk!

How many people have it?

It is estimated that about 70pc of the normal population have a Herpes virus of one sort or the other, but only 5--10pc of these show any signs or symptoms. In fact you could be considered unusual if you do not have a Herpes virus!

What do you mean by a Herpes virus of one sort or other?

There are two types of Herpes virus: type 1 and type 2. Type 1 is the one that usually causes mouth sores and ulcers, while type 2 is most commonly associated with genital lesions.

So, does type 2 cause most genital Herpes?

No -- in Ireland and Europe only about 50pc of genital Herpes is caused by type 2: the rest are caused by type 1.

As you can imagine, contact between the mouth and genitals is increasingly popular. Interestingly, in the US, over 80--90pc of genital Herpes is caused by type 2. I can hardly imagine that this is a reflection of less O-G sex in America, but most likely reflects a greater awareness of the risk of infection from oral cold sores.

Does it make any difference which type of virus you have?

Not a lot -- the two types grow and recur slightly differently on each site. Type 1 favours the oral site and recurs more commonly on the mouth. Type 2 favours the genital site and recurs more frequently on the genital site. So if you have HSV type 1 genital Herpes, there is only a 10--12pc chance of recurrence, but if it is type 2, there is a 50--60pc chance of a recurrence.

What do you mean by recurrences?

For those people who show signs and symptoms of their Herpes infection, there are two types described: the first episode -- a primary infection -- and a recurrent infection.

The primary infection is the first outbreak of the virus on the skin or mucous membrane. There is an acute and painful reaction, with blisters that develop into sores, then crust over and heal up.

The whole episode can take 20--25 days. This is especially so in girls where the area of skin involved is quite large and can be very sore and painful; it can interfere with basic functions like going to the toilet.

You might have a temperature, and feel flu-like symptoms; in bad cases there may be neck stiffness

and headache. You feel unwell

and incapacitated.

The good news is that this only happens the first time you have an outbreak, and in fact some people never have this acute episode at all. It is so severe as there is no immunity to the virus, so the first outbreak is florid.

Some people who have already been infected with one type of HSV, for example HSV 1, and are then exposed to the other type, only have a mild attack or a "modified primary episode".

Recurrent episodes are generally much milder events -- usually only 20pc as sore and extensive as the first episode, just a couple of blisters and sores that will last 5--10 days.

It is often so mild that a lot of people would not recognise it and would be unaware that they have a recurrence. Often it is put down to "thrush" -- whatever that is! Thrush is a very non-specific, unhelpful term.

If a doctor or your medical advisor is to give you good advice and treatment, they must make a definite diagnosis first, and this means more than an examination, it means taking tests.

If you're worried you might have an STI, contact St James's Hospital GUIDE clinic on 01 416 2315/416 2316. Treatment is free of charge


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