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HSV-1 and HSV-2

There are two types of herpes simplex virus, HSV-1 and HSV-2. These are very similar in many ways, and both can cause either oral herpes or genital herpes. They do, however, prefer to live in different areas, and they follow different patterns of reactivation. For this reason, it's useful to find out which type you have, by asking your health care provider to request this information from the lab test that is done to diagnose your herpes.

Genital HSV-2

HSV-2 accounts for about 2/3 of new genital infection, but is responsible for 90-95% of recurrences. About 90% of those who have HSV-2 infection do not know that they are infected (Fleming, 1997).

Genital HSV-1

This infection is often transmitted from the mouth of one person to the genital of another,through giving and receiving oral sex, HSV-1 causes about 1/3 of new genital infections (about 75% of new genital infections in college students), but only recurs about once every other year, after the first year of being infected.

Oral HSV-1

HSV-1 causes the vast majority of oral herpes ("cold sores" or "fever blisters"). About 60% of the US population over the age of 12 is infected with HSV-1 virus.However, only about one third of people who are infected recall ever having any symptoms.

Oral HSV-2

It's rare to find someone who has oral HSV-2, but it can happen. After recovery from a possible first episode, such an infection is of little consequence in most cases, since oral HSV-2 is not likely to reactivate and cause signs or symptoms.

Viral Type and Sites of Preference

Whether and how often you have recurrences depends to a great extent on which type of HSV you have. If your primary episode is caused by HSV-1, for example, there is a 50% to 60% chance you will have a recurrence in the first year. By contrast, if the primary episode is caused by HSV-2, the chance of a symptomatic recurrence in the first year is 90%. And perhaps more important, people with genital HSV-2 are likely to have not just one but several recurrences in this and following years. Why is this? Researchers don't fully understand it, but they know that type 1 and type 2 have definite sites of preference. Scientists suppose that each viral type is triggered by certain events or chain reactions that may be specific to the body site where they're found. In any case, HSV-1 causes the overwhelming majority of oral-facial herpes, and a person with HSV-1 latent in the facial area is much more likely to have recurrent outbreaks on the facial area than a person with HSV-2 in the same place. However, HSV-1 does account for an increasing percentage of genital herpes infections-anywhere from 30% to 50% depending upon the population studied. In addition, a first episode caused by HSV-1 is just as severe as that caused by HSV-2. However, people with HSV-1 genital herpes are likely to have only a few outbreaks, not only in year one but in later years as well.

Can you believe that there are health care professionals that believe that oral herpes is "the good kind of herpes" and genital herpes is "the bad kind of herpes" - I read this the other day and was floored. I've also had people write to me and say that their health care professional doesn't seem to think that it matters which type you have. Well, it's really none of their concern and patients have a right to know if they have genital hsv-1 OR genital hsv-2 if they want to.

It is possible to find out which type you have from a culture. All the doctor has to do is instruct the lab to do the extra typing test if they wind up being able to actually grow it in the lab. And it is possible to know whether the outbreak you are experiencing for the first time is a true primary outbreak.

If you have a positive result on your herpes culture and a negative result on a type specific herpes antibody test (that's a blood test for herpes) then that means that your body has not had a chance to build up antibodies which means that you probably caught herpes from your most recent partner. Now, if you have more than one partner you may still have difficulty trying to figure out who you contracted your herpes from. And if you have had more than one partner in your lifetime and both the culture and the blood test come back positive for herpes, then you may never know who you contracted herpes from. And to be honest, at this point I don't think it really matters who you contracted the herpes from, ya know?

If you've ever had a cold sore OR a fever blister then you have herpes too. Lately I've come across many people that don't want to believe that what they have is actually herpes. They are willing to admit that they get "cold sores" OR have had "cold sores" in the past but they won't acknowledge that they have herpes. Oral herpes is even more common that genital herpes.

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