Karen, a 28 year old single woman, had an itch at the corner of her mouth on the right. A day later, she noticed tiny bumps. She thought at first they were pimples, but they were in an unusual location and in a streak pattern, and they didn’t have whiteheads. A few days later, she got similar tiny red bumps on the tip of her right index finger.
Her doctor told her she had herpes. She was shocked, and said it couldn’t be true.
No Sex
“How can I get herpes when I haven’t had sex in over four months?” she demanded. “Can a person get herpes without sexual contact?”
The first response might be, “Karen just didn’t want to admit she had sex.” But Karen was forthcoming about her sexual activity, and did not deny having sex often, just not in the last four months.
Karen’s Possible Exposure
Karen had not even kissed anybody, or been kissed, either. The only exposure she could recall was stopping at a cosmetic counter at a department store on an impulse, and letting the clerk apply makeup to her face.
Meet the Herpes Family
Herpes is a family of viruses. It includes chickenpox, Epstein Barr virus, Cytomegalovirus, and the viruses that cause shingles and Kaposi’s tumor. When talking about human infection with “herpes,” most people are talking about Herpes Simplex viruses (HSV-1 or HSV-2). (Herpes can infect animals, too, but generally without producing symptoms.)
The Herpes family members are large, as far as viruses go. They’re classified according to where they hang-out when they are inactive or latent. Herpes simplex viruses “hibernate” in nerve cells usually. Other herpes viruses reside in white blood cells when latent.
Herpes Simplex Types
Old textbooks said HSV-1 infected above the waist and HSV-2 infected below the waist, mostly the genitals. If that was true one time, it’s not anymore. Either virus can infect either location, although in fact most herpes infections around the mouth are HSV-1. The two types are almost identical. Some sources say HSV-1 genital infection has longer symptom-free periods than HSV-2.
How They are Spread
Virus laden body fluid is moved from the infected person to the uninfected. The viruses can enter through mucous cells (mucoepithelia) or through breaks in skin, even imperceptible breaks. The virus can travel through adjacent nerves to ganglia (nerve terminals) where they can and usually do reside for the person’s lifetime.
The Viruses
HSV-1 infection is usually spread mouth-to-mouth, as in kissing. Many experts say it can also be spread by inanimate objects, if the object has recent saliva from an infected person.
HSV-2 infections are usually spread by sexual contact. Lesions (sores) from herpes can occur directly on genitalia or anywhere around genitalia, including anal areas. Oral genital contact can result in oral HSV-2 infection.
In children, the dominant herpes infection is HSV-1 because children are more likely to be kissed by well-meaning infected relatives than to have sexual interaction. HSV-1 is a common cause of “cold sores.”
Back to Karen
The lipstick Karen tried could have been just recently used by a person with herpes infection on the lips. This is possible, many experts agree, but must be rare.
Karen could have had HSV-1 infection as a child, and just didn’t recall it. Her current problem could be re-activation of a latent infection. However, she denied ever having “cold sores.”
Karen also could have inadvertently touched a contaminated towel, or shaken hands with someone with the virus on his hands. Karen admits she often puts her hand to her mouth as a reflex when she is concentrating. There are probably many other possibilities, too.
What to Do
People who use lipstick need to be aware of the possible risk using opened lipstick tubes. Even buying tubes that are not sealed poses a potential risk. And, of course, as your mother probably told you, keep your hands off your face.
Dr. Richard Hunt, University of South Carolina
American Social Health Association
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