Herpes is once again in the news, and the news is a bit discouraging. A U.S. Centers for Disease Control (CDC) release this week noted that one in six Americans between the ages of 14 and 49 have genital herpes, and close to one in two black women are infected. Even more frightening, nearly four out of five people who have genital herpes have not been diagnosed and may not know they have the infection.

Genital herpes is an infection caused by a sexually transmitted virus. It most commonly infects the genitals, but it can occur in many areas. I've also seen it on bottoms and backs. It is usually spread by someone who has infectious herpes sore, but it can be spread even when the virus is dormant and no lesion is present because the virus can still be shedding. Herpes is a strange virus. It actually lives in the nerve endings, close to where the infection first started. Future outbreaks will always be in this same area, whenever the virus gets reactivated. There is no cure for herpes, and stress, illness, or sunlight can cause an outbreak. Some people have only a few outbreaks in their lifetime. Others have them as often as every month.

When herpes outbreaks are on the mouth, we call it oral herpes, and this form is usually caused by herpes simplex I. You can get it from normal contact with family and friends, such as kissing or close skin-to-skin touching. It's not genital herpes and it's not sexually transmitted. It can, however, be spread to the genitals.

Does It Matter If It Is Herpes Type I or Type II?

Not really. We don't normally do tests to check if it is Herpes 1 or 2, because we know by the location, especially if it's recurrent. While it's technically possible for a Type 2 sore to infect the lips, it won't thrive there and recur. It thrives and recurs in the genitals. And a Type 1 case is possible in the genitals, especially transmitted by oral sex, but it won't generally thrive there either, so there tend to be fewer outbreaks if you do get Type I genitally. Types 1 and 2 are a lot alike at the DNA level but are still different viruses that do best in their own locations. They both are very contagious.

How Herpes Is Spread

Herpes is transmitted from direct contact with someone who has a sore, which is also called a lesion. Someone who has dormant herpes with no open sores can also transmit it. This is called asymptomatic shedding. For example, you know that your partner has herpes, so you avoid having sex when he has a lesion. But suddenly you develop a herpes sore in your genitals after having sex with him when he did not have a herpes lesion. This is possible, because a person can be shedding virus in the absence of a lesion about 10 percent of the time. Many women know before they are about to have a herpes outbreak because they get a little tingling feeling in the area where they typically get their outbreak. Remember, too, that you don't need to have intercourse to catch herpes, because touching a lesion, such as the penis touching the outside of your labia, can transmit the virus.

Myths

Don't fall for the myth. Herpes cannot be caught from dry surfaces like toilet bowls.

Treatments

There are medications that suppress the virus, but there is no cure today. The suppressive medications, which must be taken daily, can reduce and even eliminate herpes outbreaks and asymptomatic viral shedding. That can greatly reduce anxiety about having and spreading genital herpes, and most women find they have few, if any, side effects. There is also a vaccine in the works that shows promise, but it is still some years away.

Health Issues and Herpes

Herpes sores are uncomfortable, even painful, and people feel embarrassed about having them. But in a healthy person with a normally functioning immune system, they aren't dangerous. Herpes doesn't cause fertility problems or affect your general health. One important health issue to be aware of is this: if you have a genital herpes outbreak when you are going to deliver a baby, you should have a cesarean delivery instead of a normal delivery. A newborn baby can contract a herpes infection from an infected birth canal. Because a newborn does not yet have a fully functioning immune system, infection can have serious consequences. Luckily, a cesarean delivery can prevent this from happening. Medication can also be used in pregnancy to suppress outbreaks at the time of delivery. One other vitally important health issue is that a herpes sore can make you more susceptible to HIV. People with genital herpes are two to three times more likely to catch HIV.

Condoms Decrease But Don't Entirely Prevent Herpes from Spreading

Using condoms can prevent sexual transmission of herpes, as long as the condom entirely covers the sore. Your best defense is to use condoms every time you have sex--that's every time, until you are in a committed, monogamous relationship in which you've both been cleared of STIs by tests.