Herpes is a virus. The herpes virus can barely be considered alive. It is little more than a strand of DNA (Deoxyribonucleic Acid), the code of life, safely hidden inside a shell of protein. On its own, a herpes virus cannot reproduce or do much of anything—until it infects us. When the herpes virus comes in contact with areas that are receptive, like the genitals or mouth, the virus invades the epithelial cells (skin cells) in that region. Then, the DNA of the herpes virus is released into the skin cell. At that point, it quite literally takes over.
It directs the cell to make more herpes virus and, when they have made enough copies to damage the cell so severely that it bursts, millions of the newly formed viruses are released infecting more cells, eventually causing an ulcer.
Herpes hides in your nerve cells.
While the virus is infecting skin cells and causing pain and ulcers, it also begins to attack the nerve cells in the same area. When the virus enters the nerve cell, it not only reproduces but it moves up the nerve to a bundle of nerves in the neck region of the spine called the dorsal root ganglion. Once it is in the nerves, it is essentially protected from being attacked by the body’s immune system. Nerve cells can never be replaced.
That is why when nerves in the spine are damaged people become paralyzed. Since nerves cannot reproduce themselves easily, the body is careful not to bombard them with all the weapons it has to clear infections. All the inflammation that is caused by the battle to eliminate infections elsewhere would be disastrous if that occurred with nerves. There is no sense clearing an infection if nerve cells that could never be replaced are destroyed in the process.
The herpes virus is essentially protected from an attack by our immune system as long as it hides out in the nerves.
Unfortunately, that leaves the virus in a perfect position to sneak back out when the immune system is suppressed in any way. That is how the virus can cause recurrent infections, especially during times of stress, illness, or any condition or circumstance that makes our immune system less vigilant.
How common are HSV-1 and HSV-2?
Worldwide (in 2012) nearly one half billion people were infected with HSV-2 between the ages of 15 and 49—and the number rises with age and the number of life partners. More women than men have herpes (14.8% versus 8% global prevalence, respectively). In the US, the number of people infected has been dropping. The percentage of people with a positive blood test for HSV-2 has declined. In people age 14 to 49, 21% were positive in the early 90s. By 2010, that number dropped to about 16%. Unfortunately, the improvement has been seen mostly in the white population “with stable rates in black populations, resulting in worsening racial disparities such that for every one white man, four black men are infected, with similar ratios for women.”
The reasons for this might be that access to information, education—and the medication that can reduce the risk of transmission—has not been made available to all equally.
In the United States, the prevalence of HSV-1, which accounts for the vast majority of oral herpes, has dropped 29% among 14–19 year olds, from approximately 42% to 30%, over the past 30 years. As a result, adolescents and young adults may experience their first exposure to HSV-1 with the initiation of sexual activity, including oral sex.
How can it be that some people do not have symptoms?
Approximately 80% of people with an infection have no symptoms they recognize. For those who experience severe or frequent outbreaks, that is difficult to understand.
The fact is most people have an immune response that holds the disease at bay—in terms of causing symptoms, that is. They are still infected and still able to transmit the disease, but the symptoms either do not occur or are so subtle that they go unnoticed or undiagnosed. Herpes can cause such minor complaints that they are ignored.
Also, the symptoms may disappear so quickly that they are dismissed, or never seen in time by a doctor, or a doctor does not recognize how minor herpes can be even when seen. This is true of oral and genital herpes.
Nevertheless, the people who have what we call asymptomatic herpes can still transmit the disease. They can do this because they can still “shed” the virus from the skin even without having a sore or a symptom that they recognize as herpes. Asymptomatic shedding occurs from the mouth in those with oral herpes, from the anal and genital region in those with genital herpes, and even from tears in people who have had herpes of the eye.