HERPES SIMPLEX VIRUS (HSV1) (HSV2)

 Herpes is a prevalent sexually transmitted infection (STI) caused by the herpes simplex virus. This infection is primarily spread through contact with genitals or bodily fluids. STIs, also known as STDs or venereal diseases, can be caused by bacteria, viruses, or parasites.

Genital herpes can be transmitted through skin-to-skin contact during sexual activity. It's important to note that some individuals infected with the virus may experience very mild symptoms or none at all, yet they can still transmit the virus. Others may suffer from pain, itching, and sores around the genitals, anus, or mouth.

Currently, there is no cure for genital herpes. Symptoms often recur after the initial outbreak. However, medication can help alleviate symptoms and reduce the risk of transmission to others. Additionally, using condoms can aid in preventing the spread of genital herpes. 

@Medical Class 901

Transcript

SPEAKER_03 0:00

What is herpes simplex virus, HSV? Herpes simplex virus known as herpes is a common infection that can cause painful blisters or ulcers. It primarily spreads by skin-to-skin contact. It is treatable but not curable. There are two types of herpes simplex virus. Type 1, HSV1, mostly spreads by oral contact and causes infections in or around the mouth, oral herpes or cold sores. It can also cause genital herpes. Most adults are infected with HSV1. Type 2, HSV2, spreads by sexual contact and causes genital herpes. Most people have no symptoms or only mild symptoms. The infection can cause painful blisters or ulcers that can recur over time. Medicines can reduce symptoms but can't cure the infection. Recurrent symptoms of both oral and genital herpes may be distressing. Genital herpes may also be stigmatizing and have an impact on sexual relationships. Watch this space for more informative videos related to infectious diseases.

SPEAKER_02 1:14

In a world filled with noise, misinformation, and overwhelm, one voice is cutting through with clarity and compassion. Meet the impact of Dr. Chinello Animalu, MD, a pioneering infectious disease expert, professor of medicine at UT Health Sciences Center in Memphis, and the force behind the upcoming show, the Medical Class 901. Whether you're battling burnout, managing your health, or just tired of not having the answers, this space is for you.

SPEAKER_00 2:03

So we are currently in the Studio 67 in the 901 zip code Memphis. And so our show today, we're going to focus on a very common infection that affects billions of people worldwide and millions of people living here in the United States, the common infection called herpes. I'm almost certain that every adult here has heard about herpes. So today, as your infection doctor, we are going to talk about every single thing you need to know about herpes. And you guys are free to send in questions. You can email questions, whatever questions you have about this show, and I'll be more than happy to answer and address your questions. So let's go. And so today we will be talking about herpes. Yes, herpes. This is something that's so common. I'm sure everyone listening to this show has heard about herpes. Uh, I mean, we're talking about something from the pediatric group that's from children up until adulthood. So um I remember once um I heard someone, you know, complaining about a friend, and and you know, she was like, oh, she's just like herpes, she doesn't go away. And so that really got me laughing. And so we're gonna talk about herpes as that infection that never really, really goes away. So, what is herpes? Herpes basically is a type of virus, it's called the herpes simplex virus, and um, this is an infection that is acquired, you know, early in life by most people. So, for us as kids, um, let me give you guys just a quick scenario. You know, when there's a new baby and people come around, you know, oh baby, baby, everybody's kissing. That is that is how we all get herpes. And so, according to uh the World Health Organization, about 50 to 80 percent of all Americans have herpes, have tested positive for herpes, simplest type one. I'm gonna talk about the different types, and then about 5.7 billion people in the entire world are living with herpes. So, I mean, the numbers are like, oh my god, what is this? But um, it's nothing to freak, you know, to freak out about. So I'm just gonna give you guys a little bit lowdown, and you know, hopefully at the end of this um discussion, people should be comfortable with what herpes is, and you know, it's not something you you know you tell somebody or this person moves like herpes or whatever. All right, so this this stands for HSV, you know, um herpes simplest virus. Um, there are there are commonly two basic types, and um, the one that everybody knows about is called the herpes simplest virus one. So I'm just gonna call it as HSV one. People have heard about cold sores, fever sores, or canker sores. Okay. So in those days, I grew up in Africa, you know, when you know you have malaria or other febral illnesses, you know, people develop sores around their mouth, and you know, they're like, oh, you have a cold sore. Why is it called a cold sore? Because it's something that tends to occur when you know you have a cold or you know you have fevers. We call that in the medical term, febral illnesses. And the main cause of this is actually the herpes type one. And so it's nothing to freak about, it's nothing for people to panic. Like I said, almost 80% of our population here in the United States have herpes. So two basic types. The herpes one is the one that causes the cold sores. Medically, we just call it like herpes labialis because it does a core around the leaves, and sometimes for some people inside the mouth, we call it the buccal mucoscer. The second type is called the herpes two, the HSV type two. This is the one that causes genital ulcers. So this is the one that um kind of I would not use the word worry about, but you know, obviously, if you have ulcers in the genital area, you know, you want to know what is, you know, it could be herpes, it could be syphilis, it could be anything else, we don't know, but um, that's basically what that curse is. So now um in, you know, in the in the last few years or you know, maybe in the last decade or more, where um there's more oral sex practices, we are now seeing the herpes type 1. Remember, that's the one that causes the oral lesions, that is the lesions in the mouth area. So we are now seeing that also causing lesions in the genital area, whereas before um decades ago, the HSV2 is equal to genital and HSV1 equals to oral. But right now we're now seeing HSV1 and HSV2 causing genital lesions. So let's talk about um when we talk about the lesions or the ulcers or the type of presentation that you will see with this type of infection. Like I did mention earlier, the cold sores, you know. So some people, when they're sick, you know, all of a sudden they're having this pain in the mouth, tingling, burning sensation, and then you have these, you know, blisters um forming in the lips or inside your mouth. And that would commonly uh we would consider that to be HSV because of the unique nature of the lesions associated with this type of infection. So let's talk about transmission. So when we say herpes, um when I started off the show, I did talk about you know the babies when you know people come to visit and you know we're giving kisses, we're blowing kisses. So the commonest type of um transmission would be skin-to-skin transmission. What does this mean? Basically, if you come in contact with somebody that has active lesions. So somebody that has the coccer, commonly you're gonna see that around the tip of the lip here, on the you know, and in the angle of the mouth here. For some people, it could be all over the lips, others it could be on the tongue, it could be inside your mouth. So any kind of contact, direct contact with this type of lesion, you can, this will be the fastest way for you to contract um herpes. And so, again, from kissing, you know, any any any kind of you know contact you have with the lesions or the oral microscope can pass that along, including babies. The second commonest mode would be sexual contact, and that would be commonly um true. It could be vaginal, anal sex, or oral sex, anywhere there's lesions. So let's talk about the anal transmission. So if you if there's lesions, if somebody has some ulcers or they have some lesions in their rectum or the anal area that's behind there, and um you have some kind of unprotected sexual intercourse, you would contract this infection. And then the third mode of transmission would be what we call maternal to child transmission. And this will be seen in a pregnant woman who is in labor and has active herpes infection and giving birth vaginally, and the baby having to pass through the bread canal and pass through, come in contact with those lesions, that child most likely will be born with herpes. In the normal, you know, civilized situation, if a pregnant woman has active lesions, the doctors will do everything possible to prevent the woman giving birth through the vaginal way. But if, you know, unfortunately, you know, she still ends up giving birth that way, and she has active lesions, we will go ahead and start treating that baby just to protect that child from you know acquiring this infection from the mom. So what are the risk factors for contracting this infection? The commonest, you know, again would be skin-to-skin transmission, trying making sure that you know you avoid contact with somebody that has active lesions. And just for general, it doesn't have to be herpes, you know, you don't want to start kissing somebody that has ulcers or wounds all over their mouth. That's just not nice. Yeah. So just kind of stay away, you know, if you know somebody has lesions in their mouths or inside their mouths or their lips or anywhere like that. Another um would be low immune system. So for when we talk about immunocompromised people, what does that mean? It means your immune system is not up to par. This could be from other infections such as HIV, it could be from medications, for instance, people that have lupus rheumatoid arthritis, that have cancer, that have to take chemotherapy or biologics, you know, any kind of medication that um affects the immune system basically would lower your immune system. And so this puts you at high risk category of those that can contract um herpes. Again, bear in mind that almost 80% of the adult population here in the United States have um herpes, so it's not like a death sentence or anything. So, what is one unique thing about this virus? It stays with you, there's no cure, it lives with you permanently. Okay, so but it's not something that bothers you, you know, every single day. So I'm gonna talk about the symptoms and how we go from here. So, commonest symptoms. Now we've talked about 80% of the population having herpes. So the question would be Dr. Nemalu, like everybody, you know, so does that mean that everybody is walking around with herpes or something like that? No, not exactly. So, but let's talk about the common symptoms you're gonna see. Um, it comes in stages. The first stage is what we call the prodromal stage. What does that mean? There's nothing, you know, there's no lesions, there's nothing, you just don't feel too well. Um, it could be fevers, you could have some lymph nodes, um, swelling. It just could be, you know, that you have some tingling perhaps around the um mouth area. It could be the for women, the vaginal area, or for both men and women, it could be in the anal area. So this could last for a couple of days. There's nothing non-specific, and bear in mind also that for some people it could be completely asymptomatic. What does that mean? It means that there's no symptoms, okay? And that would be the majority of people. So now let's go from that prodromal stage, which is that initial stage where there's no rash, there's no ulcers, there's nothing, it's just that you kind of feel like something's you know off somewhere. And it could be anything, right? We're in the flu season, it could be the flu, it could be COVID, it could be anything, it could be fatigue, right? It could be medication, so nothing in particular. So there's nothing that will point to you at this point and say, hey, you know, that you have herpes. So the next stage would be the blister formation. Now at this point, you start seeing very tiny blisters. What are blisters? Those are rashes that kind of contain fluid, clear fluid. It almost feels like you know, tiny rashes that has water, like you know, very clear fluid, you know, within them. And so that's what we call um blisters. They will begin to appear in the area of infection. And I need to mention to you guys when I did talk about the infection never goes away. So, where does it stay in the body? It goes to hide in our nerve fibers along the spinal cord, okay, and it will lay dormant. What does that mean? It stays there, it will stay there for years, sometimes for 10 years, 20 years, 30 years, 40 years. It does not disturb you until something happens to your body or to your system, and then it comes back up. And so when it when it happens, we'll talk about the different stages. Then, you know, you can say, you know, that this person has um active um herpes infection. So the next stage would be the blisters that start busting open. This is a time that please stay away from anybody you see with this kind of lesions in their mouth, in their genital area, in the vagina, in the in the rectum or anul, um, in that area. This um, one of the major things that will help us as healthcare providers, you know, suspect this is the type of pain. You know, we have different types of pain, but the pain that's associated with this is often described as burning sensations. So it comes with itchy, very burning pain. You feel like somebody has just you know lit your area, your mouth, down there, up there, anywhere, lit on fire. So it's kind of very unique. And then after that, you have the crusting phase. And these are things that will last for a couple of days, right? And uh, for people who are immunocompromised, um, it could be really, really, really painful. Um for most times, for most um of these patients, you end up going to see your doctor, and then from there we go into the healing phase where you know it's crossing and it's beginning to heal, the lesions are healing, and you know, it might take you from a place of you know completely miserable to you're still uncomfortable, but you're you know, you're not um you know back to normal. Um so for everybody, they their degree or um symptoms you know varies from person to person, but for most times it's really very uncomfortable, and most patients that have this who end up you know calling their doctors or going to see you know their doctor, pharmacy, or whoever their healthcare provider is. So um we will talk about the different stages again um in a minute. So we're gonna take a short break and we will come back. This is Medical Class 901 with Dr. Chi.

SPEAKER_03 16:38

What is herpes simplex virus, HSV? Herpes simplex virus, HSV, known as herpes, is a common infection that can cause painful blisters or ulcers. It primarily spreads by skin-to-skin contact. It is treatable but not curable. There are two types of herpes simplex virus. Type 1, HSV1, mostly spreads by oral contact and causes infections in or around the mouth, oral herpes or cold sores. It can also cause genital herpes. Most adults are infected with HSV1. Type 2, HSV2, spreads by sexual contact and causes genital herpes. Most people have no symptoms or only mild symptoms. The infection can cause painful blisters or ulcers that can recur over time. Medicines can reduce symptoms but can't cure the infection. Recurrent symptoms of both oral and genital herpes may be distressing. Genital herpes may also be stigmatizing and have an impact on sexual relationships. Watch this space for more informative videos related to infectious diseases.

SPEAKER_00 17:53

Welcome back to Medical Class 901 with Dr. Chi. I am Dr. Chinello, animal infectious disease specialist, and in today's segment, we are speaking about herpes. Herpes. Yes. Alright, so um all right, so we were talking about herpes, um, two types, the HSV1 that does cause the oral lesions, and then the HSV2 that is responsible for genital lesions, um, basically HIV HSV1 and 2. All right, so there are two types of infection. Like I did mention earlier, when one contracts this infection, you might have a few days of flu-like symptoms, which are what we call non-specific. Um, it could be anything, it doesn't necessarily mean you have, you know, that points to herpes. Then after that, um, you go into the different types of infection. So the first type of infection is what we call the primary infection. And this basically, you know, means the very first time you acquired herpes. And this could be, you know, from childhood. Like when I speak to a lot of adults, they're like, I don't remember, you know, ever having this. And absolutely, and that's because most of the infections might be acquired during childhood. I did talk about the kisses, you know, the new babies, and when aunties and uncles come to visit, and everybody's like, mwah, mwah, mwah, mwah, mwah, that's the fastest way to transmit herpes. And so when you're asking a 50-something year old, have you ever heard herpes? Like, oh, hell no. You know, but that's because that's something that probably happened in childhood. So let's talk about the primary infection. That's the very first time that you have um acquired this infection, and it will come with the non-specific symptoms. And for some people, you could have the rash and the blisters that we talked about, um, that heals and then goes away, and then it lays latent. Latent or dormant basically means that it just stays completely inactive. And they stay, this could last for years, many, many years, for decades. We are talking about people, you know, in their 70s, in their you know, 60s, 70s, like, you know, so you it could stay there for the next 20 years, for the next 30 years, for the next 40 years, and then you know, you have the second stage, which is called the reactivation. And so the reactivation, again, is now when you have another episode, you know, from that very first episode you had, which could be in childhood or during your adulthood. Some people, if it's something that was acquired in adulthood, you will certainly remember because you know it comes with um, you know, very painful burning blisters, and you know, usually most people, most adults are gonna remember this. And so from this page, we the the reactivation phase usually is brought on by stress. So when we talk about stress, what is it? It could be that you have a cold, right? It could be that you had a fever, it could be that you're going through a lot of emotional stress or something that has lowered your immunity. Perhaps you were introduced to some new medications, some biologics, it could be chemotherapy, any kind of medication that does, you know, attack the immune system. It could be, you know, a transplant, somebody that had maybe kidney transplant, liver transplant, and you've been placed on immunosuppressive medications. These are all things that could cause a reactivation of this infection. Mind you, that um this has been laying dormant for many, many years, 10 years, 15 years, 20 years, 25 years, 30 years, and then out of nowhere, it just you know pops up and you remember, oh my God, I had this, you know, when I was in college, or maybe when I was in high school or something like that. Um, then other traumas like dental extraction, that's like you go to the dentist and it toots, or you know, you have your teeth removed or whatever. And in a lot of cases, they Trigger is unknown. It just happened. Like, you know, you can't pinpoint any particular, you know, incidents, you know, of trauma, of you know, emotional stress or fevers or anything else that brought this on, but then you go, um, you know, you're all of all of a sudden you have these blisters, these very painful blisters showing up in your oral lesion or in the vagina for women or in the anal area. So um, cold sauce, like I said, everybody, you know, for most people, they've had that. It's called cold sauce because it tends to occur when you have a cold or when you you know when you have fevers and and stuff like that. Very difficult to eat or drink when you have these lesions, they're so painful. They they're very like we call it very burning pain. You just feel like somebody, you know, lit that part of your body on fire, and it can last anywhere between you know seven to fourteen days. And um, so some let's this would take me to let's talk about treatment, right? So now we have somebody that has these lesions. How can we tell? So, what do you do? Like I said, because it's usually something that's very painful, um, you're gonna end up going to your doctor, to your you know, PCP, primary care provider, to the pharmacist, you know, to somebody to kind of be like, hey, you know, I'm having you know these very painful lesions. Very hardly um would you have those symptoms of herpes for the first time and you don't run to the doctors just because it comes with lots of pain. So what do we do? How can the doctor tell? There are certain tests that we do for this type of infection, but for some of us, you know, for instance, your infection doctors who've been trained in this, we can recognize the rash and we would not necessarily have to do any blood tests. We can tell immediately that this is herpes and start you on treatment immediately. Now, um, or the doctor could draw some blood tests and do what we call a PCR test, a polymerase chain reaction test. And what it does is just that it's a blood test that will go to the that would test the body, see if you have um any of these, any of the herpes in you. The other kind of things you can also break uh one of those um blisters, we'll do a swab and send it to the lab and also check and see if it, you know, if it comes back positive for HSV1 and two. Now, your doctor most likely is not gonna sit down, you know, twendling their thumbs and waiting for the next, I don't know how many days for your test to come back. Most times we're gonna go ahead and do what we call prehensive treatment where we actually start you on the treatment. Why is this important? Because the medications we use they work best within the first 48 hours of the onset of your symptoms. So if you wait and come to the doctor maybe after seven days or eight days, um, it probably would not work. So we always encourage people um to come earlier. But like I said, it's something that will literally chase you off your couch to your doctor's office because it's really very painful. So, how do we treat this? This is a virus, and so we use antiviral medications, okay? Not antibiotics. So, one of the questions um I will always get from my medical students would be can you use antibiotics? No, sir, you cannot use antibiotics because it's it's not a bacteria, it's a virus. So we use antiviral medications. So there are certain conditions where um the antiviral, are we gonna give you pills or we have to admit you to the hospital and then start you on the IV medication? So a cyclovir is the antiviral that we would use in severe cases. We give it intravenously. And so when somebody comes and they are really very sick, or now they have something like blurred vision, because herpes, let me let me note this. Um, what are the complications of herpes, right? It could just be this rash that comes, retreat it, and it goes away and you're and you're back to normal, everything is good, you know, you're going your merry way. But for some people, like the category of you know, people I talked about, like your immunocompromised patients, or you know, people that the system, their blood um, have some other medical issues going on, you know, maybe you know, HIV or something else, we will have to treat that very aggressively. So if someone with uh with herpes comes and they're complaining of blurred vision, we will freak out as doctors because there's something that's called hepatic keratitis. And it just means inflammation in the eye that can lead to blindness if it's not treated. It can also go to the brain and cause meningitis. Yes, meningitis that will kill if it's not treated. Okay, and it's a very, very severe infection that is literally becomes a matter of life and death situation. And so those will be the cases that we will admit immediately to the hospital and start the intravenous um cyclove here. Now, for other people, we can put you on some like Valtrex, you know, some oral pills that you you know, we again we want to start as soon as possible to halt what we call the viral replication. And so um depending on what you know what your symptoms are, we will begin you know treatment either with IV, which is intravenous treatment, or we can do oral oral treatment. For most people, you're gonna get better in a couple of days, and then hopefully you will remain symptom-free for decades to come. But if again something happens, you're under a lot of stress, or something else, it could come back quickly, and then just remember to come back to your doctor and we will take care of that. And please avoid for you as an individual, for people around you. This is something that is so highly transmissible, meaning you can you can transmit from one person to another very fast. So stay away from you know kissing or any kind of intimate setting, you know, no sexual practices for women if you have lesions in the vagina or in the cervix, no sex till you know these lesions heal, so you don't transmit it to you know somebody, uh, you know, and then from that person to the next one. So uh my message to you guys is herpes is very is it's a very common infection. Up to 80% of population here, the adult population in the US have it. Almost um 5.7 billion people worldwide have herpes, and it's nothing to be ashamed of. I want to talk about real quick about the stigma that's associated. You know, people like, oh, she has herpes. Oh my lord, she's promiscuous. No, it doesn't mean that person is promiscuous, promiscuous, absolutely not. You could just be your first encounter, or you you don't even need to have any kind of personal, you know, thing with somebody. It could be from your auntie giving you a peg as a baby, and that's how you ended up with herpes. So, no judgments. This is a no-judgment zone. Do not judge. Um, you know, and if you go to your doctor, if you're not sure, just ask them to test you for it. So hopefully, I've been able to kind of address what herpes, you know, means. So when somebody says, Oh, she's nagging like herpes, now we kind of understand what that means. So thank you for your time. And this is Medical Class 901 with Dr. Chi.