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Q. Is there a cure for herpes?
A. There’s currently no cure for herpes. The herpes treatments we have—the antiviral medications valacyclovir, acyclovir, and famciclovir—are effective at treating the outbreak and preventing shedding so that you may not get your partner infected, but we can’t cure herpes. We can’t get rid of the virus itself.
It remains unclear exactly why it’s been so difficult to develop a herpes vaccine against HSV-1 and HSV-2. We have a vaccine against the varicella-zoster virus, the virus that causes chickenpox and shingles. Varicella-zoster is also a herpes virus, so you’d think if we can develop a vaccine for that, it would easy to develop a vaccine against herpes simplex virus (HSV). There have been a few candidate vaccines that have been tested, but those vaccines did not show any efficacy at all. In general, they just didn’t offer much protection against the acquisition of HSV.
There was one vaccine that had some efficacy against the acquisition of HSV-1 genitally in women, but overall the efficacy wasn’t good enough to promote the vaccine being given to people on a regular basis. Additionally, the immunity was very short-lived. When they followed individuals in the study, they found that the immunity waned over the course of a year to a year and a half. You’d probably have to get repeat boosters every few years. It just didn’t make sense to promote its use in the general population.
There’s some thought that it has to do with how we acquire HSV and the way the virus replicates. We get it on either the skin or mucosal surfaces of the body through skin contact or sexual contact, and it replicates very rapidly. That means it evades a lot of the primary immune responses that we have. By the time our immune system starts to respond to it, the infection has already been established.
That’s a little different than varicella-zoster, with which you get infected primarily through breathing in droplets of the virus. That triggers an immune response fairly quickly, and the virus replicates much slower. Essentially, your immune system has time to kick into gear before the infection is established. But the overall message is, we don’t know why we can’t create an effective vaccine, and people are still working on it.
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How many people have herpes?
It’s hard to nail down the exact prevalence of the herpes simplex viruses—so HSV-1 and HSV-2—because most of the numbers are based on small clinics or health department clinics that will do surveys every once in a while of who’s infected. HSV-1 is extremely common. In fact, around 65 to 70% of the world’s population has been infected. Herpes simplex virus-2 (HSV-2), on the other hand, varies between about 15 and 25% of the adult population. Specifically, within the United States, about 15 or 20% of the population between the ages of 15 and 50 have been infected with HSV-2 according to surveys that have been conducted.
How to prevent herpes
A big part of this is knowing your partner and whether they’ve had or been treated for herpes before. Condoms can be helpful, although they’re not 100% effective because they’re not covering all of the skin in the genital area or elsewhere on the body. Still, using condoms and practicing safe sex is always a good idea.
If you or your partner has herpes and you have an active outbreak, you want to avoid sexual contact because you’re more likely to spread the virus. Individuals that are in long-term relationships in which one partner has herpes, and the other does not, the partner with herpes can talk to their healthcare practitioner about going on suppressive therapies that can help turn down how much the virus replicates and is spread. It’s similar to what we do for people who have multiple outbreaks per year. People who have six or more will often be offered prophylaxis to slow down or reduce the number of their outbreaks.
For sexually transmitted infections (STIs) in general, standard medical advice is that people should get tested at least once a year if they’re single or not in a monogamous relationship. The more partners they have per year, the more we suggest that they should talk to their physician about getting tested more frequently. But it’s worth noting that when people get tested for STIs, we typically test for HIV, syphilis, gonorrhea, and chlamydia. We don’t recommend that people get screened for HSV infection. The tests have a high false-positive rate, which can cause a lot of anxiety. We only test people for HSV when there’s an active outbreak because then we can check for the virus itself within the ulcer.
It may sound surprising, but I would only test someone for herpes if they have an active outbreak, and that’s in line with guidelines from the Centers for Disease Control and Prevention (CDC). The CDC suggests that we do not routinely test people with antibody-based tests because of the high false-positive rate.