In this feature, we look at the latest scientific facts about the two types of herpes simplex virus, as well as social attitudes toward oral and genital herpes. When many people first tell someone they have genital herpes, they start by comparing the infection to oral herpes, or cold sores.
How apt is the comparison? In spite of scientific facts, the social stigma and emotional attitudes surrounding genital herpes can make it hard to compare it objectively with an oral infection that most people casually accept.
Following the unspoken assumptions of our society, many people still believe there is a "good" herpes virus-HSV- 1, the usual cause of cold sores-and a "bad" herpes virus-HSV-2, the usual cause of genital herpes. In this feature, we take a look at HSV- 1 and 2 to see how alike and different the two viral types really are. We asked leading researchers how the two compare in terms of severity, recurrences, and transmission rates. We asked how often each occurs outside its usual site of preference, and how each behaves in the genital area.
We questioned how much immunity having one type orally or genitally provides against getting the second type.
In addition, we looked at the way our society views oral and genital herpes. What's behind the very different images the two types carry?
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And what can we do about it? In an interview, counselors at the National Herpes Hotline suggest ways to help replace judgmental social assumptions with a healthy attitude. Both types infect the body's mucosal surfaces, usually the mouth or genitals, and then establish latency in the nervous system. For both types, at least two-thirds of infected people have no symptoms, or symptoms too mild to notice.
However, both types can recur and spread even when no symptoms are present. The primary difference between the two viral types is in where they typically establish latency in the body- their "site of preference. From there, it tends to recur on the lower lip or face. HSV-2 usually sets up residence in the sacral ganglion at the base of the spine. From there, it recurs in the genital area. Unfortunately, many people aren't aware of this, which contributes both to the spread of type 1 and to the misperception that the two types are fundamentally different.
HSV-1 is usually mild, especially when it infects the lips, face, or genitals. However, in some cases type 1 can recur spontaneously in the eye, causing ocular herpes, a potentially serious infection which can lead to blindness. In very rare cases HSV- 1 can spread spontaneously to the brain, causing herpes encephalitis, a dangerous infection that can lead to death.
HSV-1 is also the usual cause of herpes whitlow, an infection on the finger, and "wrestler's herpes," herpes gladiatorum a herpes infection on the chest or face.
The range and potential severity of HSV-1 infections lead some experts to view the virus as more risky than usually perceived.
Like HSV-1, type 2 is usually mild-so mild that two- thirds of infected people don't even know they have it. Type 2 rarely causes complications or spreads to other parts of the body.
It is the most common cause of neonatal herpes, a rare but dangerous infection in newborns; however, type 1 causes up to one-third of neonatal infections. The two types do behave somewhat differently depending on whether they are residing in their site of preference-the mouth and face for HSV-1, and the genital area for HSV But both types are quite common, and under most circumstances neither is a major health threat.
That's one reason medical professionals tend to dismiss HSV -2 despite the emotional trauma a diagnosis can cause for a patient. While HSV can be a frustrating and painful condition for some people, in general the virus is less a medical problem than a social problem.
Herpes HSV1 & HSV2
For most of us, genital herpes is no more dangerous than a cold sore. Just how much of a physical problem HSV poses for a person depends largely on three factors. The first is how well the person's immune system is able to control the infection.
Differences in immune response may be the main reason that some people are bothered by frequent cold sores or genital herpes outbreaks while others are not.
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It's also the reason that both HSV-1 and 2 can pose serious challenges for infants, who have a limited immune response; and for people with compromised immune systems, including people with cancer, AIDS, severe burns, and people taking immunosuppressant medications. The second factor affecting outbreaks is how long a person has had the infection.
Over time, recurrences of both HSV- 1 and 2 tend to decrease, for reasons that aren't entirely clear. In the case of oral HSV-1, many of the approximately million Americans who are infected acquired the virus when they were children. On the other hand, almost all of the approximately 40 million Americans infected with HSV-2 acquired the virus as teenagers or adults. In the first year, those who have recurring outbreaks experience an average of four to six episodes.
Over time, as with oral infections, the number of outbreaks usually drops off.
A third factor influencing the frequency of HSV -1 and 2 outbreaks is whether the virus is established in its site of preference. While HSV can infect both genital and oral areas, both types cause milder infections when they are away from "home" territory.
Outside their site of preference, both type 1 and 2 lose most of their punch.
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For example, most people infected with HSV-1 in the genital area have few, if any, outbreaks after the initial episode, far fewer than is typical with either oral HSV-1 or genital HSV According to a study by Wald et al. New England Journal of Medicine,among women with genital herpes, the average number of recurrences per year for those with genital HSV-1 was zero.
Other studies have shown an average of about one outbreak per year Benedetti, Annals of Internal Medicine, Similarly, HSV-2 infection in theoral area-outside its site of preference-very rarely causes problems.
First of all, oral, HSV-2 infections are rare, for reasons discussed below. How herpes simplex virus exits latency 3 April Many of us have experienced herpesvirus reactivation from latency. Suddenly a sore erupts on the lip, festers for a week, then subsides.
Years later, for no apparent reason, it happens again. Did you ever wonder what causes these recurrent blisters? Herpes simplex viruses are associated with latent infections, a type of persistent viral infection that lasts for the life of the host.
Infection with herpes simplex virus begins with intimate contact with an individual who is shedding the virus. Virions enter the oral or genital mucosal tissue and replicate, perhaps producing one or more lesions.
There the viral DNA remains silent until an insult — stress, ultraviolet light, hormonal changes — triggers viral replication. New virions are made, which travel to the epithelial surface, resulting in a lesion.
Shed virus may be transmitted to others. The lesion heals and viral replication ceases until the next insult. There have been many hypotheses to explain how the viral genome emerges from latency. One includes a central role for a viral gene called ICP0, which is known to encode a transcriptional activator — a protein that turns on the production of viral messenger RNAs, the templates for proteins. Both hypotheses have been disproven by experimental data.
New findings indicate that another viral protein, VP16, is crucial for emerging from latency. This protein is a component of the virion and is a very strong transcriptional activator. However, it is produced late in the viral replication cycle. How could a late viral protein be crucial for the initiation of the lytic cycle? Because of this conundrum a role for VP16 in reactivation was discounted some years ago.