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Herpes Simplex / Cold Sores

I gets a lot of requests for sexually transmitted disease testing, thankfully usually from people who are feeling well but just want to have regular screening done to make sure they are safe.  The typical STD's that we can test for are HIV, syphilis, gonorrhea, chlamydia, and hepatitis.  If you look at that list to though, you noticed that there is a big one that is missing.

Herpes virus infections have been around since at least the ancient Greek times and are not going anywhere.  There is a lot of confusion and misinformation out there about them as well.  Enough that I was once fortunate enough to meet a nurse who had written a book after working in an STD clinic for several decades about herpes called "The good news about the bad news".

I want to try to clear up a few things just for everybody's well-being, but if you really wanted to get into some of this, I think the CDC has some good FAQ's.

- When most people hear "herpes" they are thinking of herpes simplex virus, but there are multiple other viruses in the herpes class, including Chicken Pox/Shingles (varicella-zoster), Mono (Epstein-Barr virus), and Cytomegalovirus (CMV).  One common link between all of them is that once you have them, to some extent they are with you forever and tend to recur when your immune system is suppressed.

- Herpes Simplex Virus (HSV) causes two main types of symptoms - oral lesions around the lips (herpes labialis), which most people call cold sores, and genital lesions, which most people have names for usually involving curse words.  There are some other things that can happen from HSV including skin, eye and brain infections, but they are much less common.

- There are two main types of HSV:  HSV-1 and HSV-2.

- Somewhere between 50-90% of people have HSV-1.  You probably got it through skin-to-skin contact when you were a kid with someone who didn't even have any lesions because you don't need to have them to spread the virus.

- Somewhere between 15-25% of people have HSV-2, which is only transmitted through sexual contact.  In the research, you've got about a 10% chance of catching it after having sex with someone who has it, though that risk is higher if they are having an outbreak.

- Oral herpes (cold sores) are generally only caused by HSV-1, but genital herpes can be caused by either HSV-1 or HSV-2, usually transmitting HSV-1 through oral sex.

- A first outbreak of either type is usually pretty painful blisters around the genitals, rectum or mouth and clear up within about a week.  Thereafter most flare ups are not as bad and are typically brought on when your immune system is weakened, either due to physical stress like being sick or not getting enough rest, or mental/emotional stress.  Most people who catch HSV will have a first outbreak within 2 weeks of acquiring it.

- Unfortunately, there is no reliable way of knowing if you have HSV unless you have skin lesions.  The blood tests to determine if you've ever been exposed to the virus are not reliable and multiple national groups (AAFP, IDSA, CDC) have recommended not ordering these tests for screening purposes because of how unreliable they are as screening tests for asymptomatic people.  From my experience, this testing causes more anxiety than it alleviates due to the uncertainty around it.

- We are able to swab lesions to confirm them through viral DNA testing, but most of the time, it is a clinical diagnosis as it has been throughout most of history.

- In and of themselves, herpes outbreaks are annoying but not dangerous.  The average one takes about 5 days to go away without any treatment, but treating it does clear it up about 2 days sooner.  There are numerous different regimens out there - I usually lean towards a high dose of medication for a shorter amount of time.

- Most people will get fewer outbreaks over time but for people who feel like they get them frequently, we can offer daily suppressive therapy to reduce the outbreaks.

Here is some more information for you about herpes including how we treat it and how to keep it under control.
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