Campus Chronicle

Issue date: 2/25/08 Section: Pulse

Dr. George

Is it true you can get oral herpes on your genitals? How can you tell the difference? Is one worse than the other?

Not only is it true that you can get oral herpes on your genitals, but there is a pretty fair chance (approximately 20 percent) that you have already been infected with the herpes virus on your very own genitals! At least there is if I'm correct that someone who is asking that question is active in that moral cesspool known as "college life." On the other hand, maybe not…

HSV 1 was generally considered the "above the belt herpes" and HSV 2 the "below the belt herpes." It turns out that things are not that clear cut.

We have had our eyes opened a lot in recent years regarding the spread of Herpes Simplex Virus 1 and 2 (HSV 1 and HSV 2). Once thought to be a minor role player in the cast of that big musical "STDs For You and Me," herpes turns out to be the most common agent of genital sexually transmitted infections. It's probably only the luck of the draw that only a small percentage (10-20 percent) of those exposed to herpes virus "down there" ever get the painful blisters.

Furthermore, most, if not all, of us carry HSV 1 in our mouths. Yet relatively few (20-25 percent) people get the painful "cold sores" either in the mouth or around the lips. Given the fact that oral to genital contact is so prevalent (some say it is part of every polite sexual encounter), it makes sense that genital HSV 1 would be common. Because turnabout is fair play, oral HSV 2 is also seen in approximately 15 percent of people with cold sores. The presence of antibody to the viruses proves that loads of asymptomatic persons have been "exposed."

We once believed, but no longer do, that to spread the virus, one must have an active outbreak of either oral or genital sores. Frankly, I can't imagine why someone with a genital outbreak would be remotely interested in sex, but that's me. It is still believed that this is the primary means of spread. It has been well established, however, that one can be an active virus shedder, and therefore contagious, even when no outbreak is present. In other words, "can't tell by looking."

Every once in a while a latent virus becomes active years after the exposure. In such cases there are all sorts of questions about fidelity to answer. Most of the time, the initial outbreak soon follows exposure. First episodes are the worst, sometimes accompanied by fever, aches, and just feeling sick. Although at this point, herpes is forever, later outbreaks tend to be less severe, heal faster and are without generalized symptoms.

Reactivation of both HSV 1 and HSV 2 tend to be somewhat individual. Common triggers include stress, concurrent illness, sleep deprivation, sunlight, minor trauma and menstruation.

Viral swabs of open sores can identify the type of HSV virus, and in general terms only, HSV 1 prefers the oral membranes while HSV 2 prefers the genital skin. There is some suggestion that HSV 1 in the genitals, and HSV 2 in the mouth are less likely to produce as severe, or recur as often, as their counterparts.

Neither oral nor genital herpes sores are fun, but neither are they leprosy or the plague. Life goes on and you needn't wear a scarlet "H" on your breast. With time, (at least for genital sores) outbreaks get to be less traumatic. As usual, my advice is to always wear a party hat (condom) whenever you go to a party, for this and other reasons. I don't have an answer for the oral spread issues but I defy anyone to use those hideous oral dams and attain orgasm. Be careful tenderfeet, it's a jungle out there.

Dr. Ralph and Dr. George are Emergency Room physicians with the University of Illinois at Chicago's Medical Center.

As with all medical advice, consult your physician before beginning any regimen or if symptoms persist for more than five days

Send your anonymous questions to pulse@chicagoflame.com

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