What can you tell me about "genital" herpes in the throat? Every once in a while I see a reference to oral sex and the possibility of transmission. However, I see nothing on dealing with this aspect of the disease. What are possible complications, treatments, things to avoid, etc.?

M.

From your description, I would say you are referring to oral herpes rather than genital herpes. Genital herpes is an infection of the genitals that results in painful, somewhat itchy blisters that rapidly burst to form ulcers. There can be a variety of other symptoms, including fever, headache and even a stiff neck. Oral herpes is a similar infection, except that it involves the mouth, the lips and the throat. There are usually no complications of throat infection. Rarely, there can be significant problems with swallowing, and very rarely there can be breathing difficulty.

In both oral and genital herpes, recurrences are common. The recurrent outbreaks are similar to the first infection, except they are usually milder. Recurrent oral herpes usually involves just the lips, with the mouth and throat involved to a much lesser degree.

Genital and oral herpes are caused by two viruses called herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). HSV-2 causes more than 80 percent of the cases of genital lesions, with the remainder caused by HSV-1. For oral herpes, the proportions are reversed. Roughly 70 percent are caused by HSV-1 and the remainder by HSV-2. Because HSV-2 causes most cases of genital herpes, it is sometimes referred to as the "genital herpes virus." However, this is a misnomer because each virus causes disease in both areas. By "genital herpes of the throat," I assume you are referring to oral herpes caused by HSV-2.

Does it matter which virus infects where? Not much. When HSV-1 causes genital herpes, the genital symptoms can be less severe than with HSV-2. Also, people with oral HSV-1 who then get genital HSV-2 usually have a milder genital illness than people who weren't previously infected with HSV-1. Most people have been exposed to HSV-1 by adulthood, so most of the adult population is relatively immune to reinfection with that virus.

Herpes is a relatively contagious infection that is usually passed by direct contact. Someone performing oral sex on a person who has genital herpes can get oral herpes. The reverse is also true -- the recipient of oral sex can develop genital herpes if the partner has oral herpes. To complicate the picture, a person can be contagious even when there are no obvious sores. However, the highest risk of transmission occurs when sores are present.

To prevent the spread of the virus, avoid direct oral or genital contact with someone who has herpes, especially if open sores are present. For genital contact, condoms should decrease the risk of spread, just as they do for HIV. I do not advise kissing someone intimately or performing oral sex when one has open oral herpes sores, but the risk of transmission is probably low if no sores are present. I cannot say that the risk of transmission is ever zero.

As to treatment, there is no known cure. Herpes is never gone from the body and can always recur. However, during an episode, especially a severe one, treatment can decrease the symptoms. Acyclovir (Zovirax) and two newer drugs, valacyclovir and famciclovir, speed recovery a little, especially if taken early during the episode. In someone who has frequent recurrences, these drugs can be taken daily at low doses to minimize, though not totally prevent, future episodes. Many factors go into the decision to begin ongoing suppressive therapy, including the severity of the illness, the frequency of recurrences, and the cost of the drugs, which can be quite expensive.