Is Herpes Forever, & Can It Be Treated?

Dr. Christine Johnston explains:

Kiss and tell?

More than half of the global population (and most adults) carry a herpes simplex virus infection, yet up to about 90% of infected people don’t know they have it, because symptoms are absent or mild.

Meet the (herpesvirus) family: the term “herpesvirus” refers to a broader viral family, but the condition commonly called herpes is mainly caused by two related viruses, known to their friends as Herpes Simplex Virus Type 1 (HSV-1) and Herpes Simplex Virus Type 2 (HSV-2).

• HSV-1 usually causes oral herpes with cold sores around your mouth
• HSV-2 more commonly causes genital herpes, although either virus can infect oral, genital, finger, or eye tissues

Here’s what happens, step by step:

• Infection: the virus enters through microscopic breaks in your skin or mucous membranes such as the mouth or genitals and hijacks cellular machinery to replicate.
• Initial symptoms: most infections produce no symptoms, but some cause fluid-filled blisters that rupture into painful lesions, and severe initial infections can trigger fever, muscle aches, and headaches.
• Immune response: your immune system tries to eliminate the virus like other viral infections, but herpes is difficult (almost impossible) to clear completely.
• Nerve cell invasion: HSV infects nearby nerve cells and travels along axons to nerve clusters called “ganglia”. HSV-1 typically establishing latency in the trigeminal ganglion in the skull and HSV-2 in the sacral ganglia near the base of the spine.
• Dormancy: in these ganglia the virus becomes dormant, shutting down replication so the immune system can’t detect or eliminate it.
• Reactivation: the virus can periodically reactivate (sometimes triggered by illness, stress, or other unknown factors) traveling back down the nerve to your skin.

Transmission can be sneakily hit-and-miss, insofar as the virus spreads through direct contact when it is actively shedding from your skin or mucous membranes, even though many infected people remain unaware of their infection, due to its oft-asymptomatic nature.

How serious is it? Usually, not very. For most people, herpes causes sores during flare-ups, but doesn’t lead to serious long-term health problems.

Can we cure it? Not as yet, but antiviral drugs such as acyclovir and valacyclovir mimic components of viral DNA and inhibit viral replication, reducing symptoms and lowering HSV-2 transmission risk by about 50%.

The good news: over time, your immune system develops stronger control over the virus, so outbreaks and viral shedding usually become less frequent.

Looking forwards: scientists continue pursuing vaccines and cures, including approaches using gene editing technologies like CRISPR, but the virus’s ability to hide in nerve cells makes eradication challenging, to say the least.

For more on all of this, enjoy:

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Take care!