Dear Science,

Herpes. It’s annoying. It’s ubiquitous. I’ve heard that 80
percent of people have been exposed to HSV-1 (the usually oral kind)
and 25 percent have HSV-2 (the usually sexual kind). Is this comparing
apples to oranges? What percentage of people have what?

What is asymptomatic shedding? How does that work? Are virus
particles somehow coming out of the nerves? I’ve heard that it can
spread from the whole “boxer-short area,” so how effective are condoms
in stopping the spread?

Why is there no vaccine? Is it that it’s super hard to make one,
or that herpes isn’t deadly enough that there’s a giant perceived need?
I think you mentioned one being worked on in Seattle—how is that
going? Thanks!

Distressed By The Herp

Science finds the entire family of herpesvirus to be
charming. These guys are huge, the viral equivalent of a
big-rig RV—basically the biggest virus your body is ever likely
to meet. When they park themselves inside one of your
cells—generally an ultra-long-lived nerve cell—it’s akin to
a Wal-Mart parking lot just before the start of a nearby NASCAR race.
The awnings roll out, a huge pile of kids sprawl all over, and the
virus fires up its own barbecue and starts cooking.

You, dear reader, have pleasantly introduced us to herpes simplex
virus types 1 and 2. HSV-1 loves the mouth, HSV-2 loves the
genitals—but they can be convinced to swap places. Did you
know there are eight types of herpesvirus? Number three is chickenpox,
four and five cause mono. Six and seven cause a childhood illness with
the creative name “sixth disease” (as in this is the sixth damn thing
your kids got—after measles, mumps, chickenpox, and the
like—before they were old enough to do something about it on
their own). Herpesvirus 8 causes Kaposi’s sarcoma—the spots that
appear in someone with advanced AIDS.

Here’s the rub. Almost everyone on the planet has at least a few
herpesviruses lurking within them. While we tend to get sick initially,
eventually the virus settles into our cells and our immune systems make
peace with the situation. We don’t feel sick. The virus slowly
churns out copies of itself—to infect the next generation of
people. That’s your asymptomatic shedding. Condoms help, but beware of
the boxer-short area. Somewhere around 20 percent of New Yorkers have
HSV-2, 60 percent have HSV-1. The overwhelming majority has no
symptoms.

A vaccine was developed for the chickenpox-causing member of the
family, and a huge trial for a vaccine against HSV-1 and
HSV-2—organized right here in Seattle—just ended, with
the data undergoing analysis as you read this column.

And, while most of us barely notice our lifelong infections with
herpesvirus, some new data found a connection between Alzheimer’s
disease and HSV-1. Pucker up! recommended

Droolingly Yours,

Science

Send your science questions to
dearscience@thestranger.com

Jonathan Golob is an actual doctor.

16 replies on “Dear Science”

  1. Good article on HSV. Nice to see one without stigma.

    It’s not just 20% of all New Yorkers that have HSV-2, it’s 20% of ALL Americans. What’s more, 1 in 4 women are infected as well. What’s more 90% of people have no idea that they’re infected. There’s a way to test too, it’s called an iGG specific serological blood test. The problem is that the American government (and other governments) doesn’t recommend testing. Once people realized just how common this little virus is, the stigma would be gone because it’s just everywhere. It’s just so mild that 90% of people are oblivious to it (but still spreading it). So in reality, you’re actually safer with the 10% who know they have the virus because they know what to look for in terms and to protect you. It’s the ignorant 90% running around that are spreading it.

    The stigma on HSV-2 is stupid. All that this little virus is are a few bumps and the occasional itch but because it’s on the “boxer short” area it’s sooooo shocking. It’s wild how society talks so much about sex but once your “boxer short” area isn’t pure anymore we stigmatize it and make fun of it and it’s just the worst thing in the entire world.

    What’s more, the vaccine that just finished Phase III testing is called Herpevac. But it does nothing for you if: a) you’re a man, b) you’re already infected with HSV-2, or c) you already have the HSV-1 virus (which 50% of Americans have by the age of 10). Also, it’s only effective in 73% of the women that are left after all that. That doesn’t leave too many people!

    So either they need to stop testing for this disease and stop classifying it as an STI, or test EVERYONE. And get to work on a preventive AND a therapeutic vaccine for this thing, rather than pumping out pills (Valtrex) that make $1.3 billion a year but don’t fully suppress outbreaks and shedding.

  2. Amen for an article that, like the first poster noted, de-stigmatizes this incredibly benign condition.

    Yes, it’s a nuisance when you first get encounter the virus, but like the article says, eventually your body adjusts, develops antibodies, and you don’t feel sick. When the virus wakes up – usually a sign that you’re under some kind of stress – the symptoms are so mild, that unless you know you have this virus, you could mistake it for something else.

    A common cold is worse.

    In my opinion, it’s not the virus that keeps spreading. Ok. Yes, technically it is, but eventually the virus becomes a non-issue. What is really viral and in a sick way is the stigma attached to this virus, because it signifies either kissing or sex. “Ewe!”

    C’mon people… get a grip.

    And I wholeheartedly agree with the first comment above regarding Valtrex: stop pumping $$ and advertising dollars into a medicine that doesn’t fully suppress the virus and get to work on an attenuated vaccine, or a simple, cheap, home test that would allow hsv+ carriers to check when they are shedding.

  5. Science didn’t answer the question about the effectiveness of condoms.

    Condoms cut male to female transmission during vaginal intercourse in half. Condoms don’t reduce female to male transmission during intercourse by a statistically significant margin. I haven’t found studies of other transmission vectors.

    Herpes is sort of like mono, but with 10 times the stigma. Lots of people have had it, and you can pass it through things other than sex. Type 1 (mainly oral) can be passed through sharing food or kissing, even not on the lips. Both types can be transmitted through non-genital skin. It’s common among wrestlers, who spread it skin to skin.

    The main way herpes can be dangerous is when babies get it. DO NOT KISS BABIES!!! Herpes can be fatal in infants. Babies are also at risk to acquire herpes during birth if the mother gets herpes during the third trimester of pregnancy. If the mother has an earlier herpes infection, the baby is usually protected by mom’s antibodies.

    Why do I know all this? I have HSV-1 and HSV-2. Get tested, but don’t worry about it too much. That’s like never kissing because you might get mono. STDs are always a calculated risk of sex, just like deadly accidents are a calculated risk of walking down the street. Don’t run onto the freeway; but don’t live the rest of your life afraid to go out the door. Don’t use condoms to avoid herpes. Use condoms to avoid HIV (which they protect quite well against).

  6. I guarantee the unlike what “sex educator” says in the initial response, sometimes HSV 2 is incredibly painful and horrific, not just a “few bumps and a little itch” in “the jockey shorts area”. That actually sounds like HSV 1, which does not take hold in the genitalia as well as the mouth. I have treated people in the ER for the pain of a serious HSV2 outbreak, and you had better hope your immune system remains intact if you have this virus. It ain’t pretty- I have seen more than one person weeping from their pain with nasty blistering nodules all over their groin area.

    If you have a chance to use the methods available to prevent transmission, do so! (Use condoms, avoid sex during outbreaks, use naturopathic supplements to try to stop asymptomatic shedding when you are a carrier, etc.) Do your own research!

    And speaking of the other herpes viruses, I have also treated the elderly for the consequences of having chicken pox at a young age- shingles are extremely painful too and can lead to post herpetic neuralgia with pain continuing for years- all you parents avoiding vaccinations for chicken pox should remember this as well.

  7. When most people think herpes, they think a daily battle with large very bad looking sores all over a person’s genitals. Which is why people are “certain” that if they’re infected then they will know right away. This is simply not the case.

    Generally, an individual’s primary outbreak is most uncomfortable. And yes, some people do get large blistering sores that first time which are quite painful but this only about 10% of the infected population. Typically it is only the primary outbreak which involves this sort of discomfort and subsequently outbreaks become minor nuisances involving itching (often mistaken for yeast infections) and small bumps after that first outbreak.

    However the large majority do not get these sorts of symptoms, which is how people are so unaware that they are infected and how the infected population has risen to 1 in 5 Americans. Sometimes a person who does not know they are infected does infect someone whose immune system is more vulnerable and that is when the more painful symptoms do emerge. That person ends up getting diagnosed and feeling like a leper while people who are infected but have no idea because of their mild symptoms run around making jokes about this virus.

    I cannot emphasize enough this is merely a nuisance virus wrapped in misinformation with a silly stigma attached because it happens to involve the genitals.

    And the chicken pox vaccine will not prevent against herpes zoster (shingles) later in life. All the chicken pox vaccine will prevent you from getting is chicken pox. The herpes zoster vaccine however is recommended this year for all individuals +60 and I would highly recommend this vaccination as shingles can be quite painful.

  8. I forgot to respond to this part — HSV-1 and HSV-2 can both infect the genitals and you are correct that HSV-1 recurs much more minimally on the genital area initially. However over time HSV-2 outbreaks become increasingly mild as well until a person averages one or two minor, mild outbreaks (as described above) per year.

    The true “pain” associated with HSV-2 and genital herpes that I witness on a daily basis is the psychological trauma of being diagnosed because so many people have bought into the stigma that herpes is dirty/unclean/bad/promiscuous. By attaching those words and those associations to a silly little virus, the subsequent diagnosis hits many people like a freight train and can cause feelings of alienation, humiliation and depression. All for what? A ridiculous virus that’s mainly harmless, except in newborns.

  9. Asymptomatic shedding of the virus occurs when there is no visible outbreak. Thus, it’s possible to contract herpes even if you don’t see sores! Even more reason to use protection & be aware of your/your partner’s STD status.

  10. Chicken pox *is* herpes zoster, the vaccine might wear off after 60 some years; but it is the same virus for chicken pox and shingles.

  11. I swear to god if one more person says stigma I am going to pee in my herpes-infested boxers. STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA STIGMA FUCK

  12. Thank you for posting this article and also thank you to all the people who posted such informative comments. When I found out that I had HSV-2 (after an excruciating first outbreak on my 19th birthday) I went completely insane. I felt it was so unfair that this had happened to me because all of stigma attached to herpes – “dirty/unclean/bad/promiscuous” – was simply something I never identified myself as. I’ve had less than 5 sexual partners yet I landed myself with the ‘leper’ sign stuck to my genitals while other MUCH more sexually active people are allowed to parade around with their ‘clean’ bodies – getting away with unsafe sex like nothing else.

    I realise now that this little virus merely causes inconvenience in intimate situations due to the lack of education and understand people have. Since my first outbreak the virus hasn’t bothered me at all – and it’s not life threatening.

    People need to cut us some slack. We deserve equal (safe) sex opportunities too!

  13. Science – you did not go into detail as to WHY there are no HSV-1 or 2 vaccines. I recently attended lectures on this for my masters work in Microbiology and Immunology so I can partially explain.

    Most vaccines prevent disease NOT infection. For example: you still get infected with Diphtheria as an infant but thanks to the vaccine, the toxin it produces is unable to enter your cells and wreak havoc. Therefore, you never even notice it and its cleared out by your immune system.

    Now, for herpes viruses, this wouldnt work. Since it Integrates into your Own DNA you would need to prevent infection. Each HSV integrates into the DNA of different cells and manifests as different diseases. HSV-1 and 2 are particularly hard to treat as they are in neurons and we need those, that is why our immune system “lives with it” instead of destroying those cells to destroy the virus. As of yet scientists do not understand how to prevent DNA viral integration or prevent infection with a vaccine.

    Now, the chicken pox vaccine also does not prevent infection, but it does prevent most manifestations of disease. This was economically advantageous to develop since school-age kids miss an avg of 1-3 wks sick with it- and their parents miss work taking care of them. That’s a lot of work missed. HSV1 and 2 cause almost no work days missed therefore its not advantageous economically to develop this vaccine.

  14. Oh also – the chicken pox vaccine (Varicella) and the Herpes Zoster vaccine are the Exact same vaccine as they are the Exact same virus. Its just packaged differently and the doses are different since one is for children and the other is for older adults.

    The reason the Varicella vaccine probably will not prevent shingles is due to waning immunity. By getting Zostavax you are essentially boosting your immunity to control the virus so that it does not activate and begin replicating itself again. There have been epidemiological studies showing that contact with school age children (reservoirs of active virus) has the same boosting effect as the Zoster vaccine.

  15. While people are all being very groovy here about it not being a “big deal”, please try not to tip over into an attitude of “so many people have got it, so why worry?”. Because that might lead into people feeling that it’s not a big deal, so why mention it?

    For me, I don’t want to get infected by anyone with *anything*, including the common cold, if I haven’t been advised and assessed my risks first. And I’m sorry, an infection that has an appreciable impact on my immune system, that I can infect other people with, and that will give me recurring outbreaks for years subsequently is most definitely something I want to be advised about and avoid.

    So, no, I don’t think people with herpes are particularly unclean – I’ve had more than one partner with herpes – but I don’t want “no big deal” to turn into “who cares?”

Comments are closed.