“There are two main troublemakers: HSV-1 and HSV-2.”

Scalpelheads, herpes is one of those viruses that looked at the immune system, reviewed the eviction policy, found a technicality, and moved into your nervous system permanently.

Physiologic loophole…

There are two main troublemakers: HSV-1 and HSV-2.

HSV-1 is most commonly associated with cold sores around the mouth, while HSV-2 more commonly causes genital herpes. But apparently viruses do not respect assigned seating. HSV-1 can infect the genitals, commonly through oral sex, and HSV-2 can occasionally infect the mouth.

And these viruses are extremely common. WHO estimates around 3.8 billion people under 50 have HSV-1, while roughly 520 million people aged 15 to 49 have HSV-2.

So statistically, herpes is less of an exclusive club and more like Costco.

When HSV first infects you, it replicates in cells of the skin or mucous membranes.

Your immune system notices this and begins cleaning house.

HSV sees security coming and executes Plan B.

It enters nearby sensory nerves and travels backward toward clusters of nerve cells called sensory ganglia. Oral HSV commonly establishes latency around the trigeminal ganglion, while genital infections typically hide in sacral sensory ganglia. There, viral DNA can remain dormant for life.

Your immune system controls the infection, but it cannot completely eliminate that latent reservoir.

Basically, HSV discovered the biological equivalent of putting your phone on airplane mode during a police chase.

Later, the virus can reactivate. Stress, illness, fever, ultraviolet light and immune suppression are among factors associated with outbreaks, although triggers vary between people.

When reactivation happens, HSV travels back along the nerve toward the skin.

That is why some people experience tingling, itching, burning or pain before the blister appears.

The virus is essentially sending you a calendar invitation.

Meeting: Cold Sore
Location: Your Face
Attendance: Mandatory

You do not need visible sores to transmit herpes.

Read that again.

HSV can occasionally shed from apparently normal-looking skin, meaning someone who feels completely fine may still transmit it. Most HSV infections are actually asymptomatic or unrecognized.

Transmission risk is higher when sores or warning symptoms are present, so avoiding kissing, oral sex or genital skin-to-skin contact during an outbreak or prodrome is important.

Alsooo, condoms and dental dams can reduce risk, although they cannot completely eliminate it because uncovered skin may still shed virus.

There currently isn’t a cure (WTF), but there are very effective antiviral medications, including acyclovir, valacyclovir and famciclovir.

For recurrent genital herpes, episodic treatment works best when started during the warning symptoms or within about one day of lesions appearing. People with frequent outbreaks may instead use daily suppressive treatment, which can dramatically reduce recurrences and can also decrease HSV-2 transmission risk.

HSV-2 genital infections generally recur and shed more frequently than genital HSV-1 infections.

So herpes may have found a permanent apartment inside your neurons.

But modern medicine can make it a remarkably quiet tenant.

And unlike your actual tenants, valacyclovir has never emailed you at 2:14 a.m. because the fridge "sounds different."

Until next Saturday,

Kevin Cutthebull, MD

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