FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

HERPES CAN IRRITATE, BE SPREAD AFTER BLISTERS ARE HEALED

Question: My husband gets frequent cold sores that are a nuisance more than a real health problem. Four months ago I had burning with urination and genital discomfort. My doctor prescribed an antibiotic for a urinary tract infection without examining me. My symptoms persisted so I followed up with my gynecologist, who diagnosed me with type 1 genital herpes. I'm taking Valtrex and have no obvious sores, but I do have some mild itching. Is it common to pass herpes when no obvious blisters are present, and is it also common to have mild irritation continually?

Answer: The herpes virus family is a large one. The most common member of this family is called Herpes Simplex Virus type 1 (HSV 1). It causes most cases of herpes infections of the mouth and lips but can also sometimes cause genital herpes infections. Likewise, other members of the family, particularly Herpes Simplex Virus type 2 (HSV 2), which usually produces genital infections, can sometimes infect the area in and around the mouth.

HSV 1 usually strikes for the first time in childhood, where it produces a sore throat, mouth sores and often the typical "fever blister" on the lip. Subsequent attacks are less severe and characteristically produce a single blister or a cluster of small blisters on the lip. These attacks are often brought on by physical or emotional stress. In children a common stress is mild illness that produces a fever -- hence the name "fever blister." These attacks clear up in a few days without any specific treatment.

Though 85 percent of the world population has immunologic evidence that they have had an HSV 1 infection, only about 20 percent actually have apparent cold sores. The rest of us just carry the virus. You see, our immune system doesn't kill the HSV infection. Instead, it just holds it in check. When the conditions are right, the virus will seize its opportunity to replicate and produce the characteristic viral blister. Though, as I mentioned earlier, HSV 1 produces cold sores most often, about 30 percent of us will have these blisters on the genitals, as you do.

HSV 2 is a subtly different member of the herpes family that is present in 20 percent of the population. This, remember, is the strain that causes genital herpes most often but can also cause oral lesions. As you can see, these distinctions are subtle. They are of great interest to the virologist but of little importance to the rest of us as there is no major clinical difference in the type of health problems the two strains cause.

Up to 90 percent of the cases of herpes infections are spread by individuals who have no obvious sores. We doctors call this "asymptomatic shedding of virus." What this means is that any time you kiss, share eating utensils or have intercourse with someone, you are at risk of contracting a herpes infection.

Today we don't have medicines that will kill the HSV viruses that cause these infections. Instead, the drugs now on the market, like the Valtrex you take, only reduce the severity and frequency of attacks. The drug hampers the ability of the virus to replicate and, thereby, limits the amount of tissue that is damaged by infection.

You have some persistent mild burning or discomfort even though the genital skin appears healed because the virus sets up its permanent residence within the nerves supplying the area of the initial blisters. This causes some reaction in the nerves that you perceive as your mild symptoms. These will subside with the passage of time, but it doesn't happen overnight.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.