Herpes In The Throat
Named for the esophagus, which is the muscular tube that carries the food from the mouth to the stomach, “Herpes Esophagitis” is the medical term for herpes found in the throat. Any inflammation of the esophagus is referred to as “Esophagitis.”1
This type of herpes is considered an opportunistic infection2 and is typically only seen in individuals with an already compromised immune system. Having a herpes infection in the throat could be an indicator that the infected individual is suffering from a weakened immune system due to another medical condition such as HIV, AIDS, cancer treatment, diabetes, or an autoimmune disorder.3
Herpes Esophagitis is, generally, not suspected and is often misdiagnosed as another gastrointestinal disorder. There are many medical cases reported in which a patient is seen for esophagitis and treated for a variety of other common causes of the symptoms presented and only after treatment failed, several times was herpes identified. This fact makes regular STD Testing in sexually active adults who are outside of a long-term, mutually monogamous relationship increasingly important. Additionally, a herpes infection can be present in an individual without symptoms or with symptoms that come and go.
What Is Herpes?
Because of the relationship of Herpes Esophagitis with Genital and Oral Herpes, it is important to understand the nature and virology of the Herpes Virus as a whole.
Herpes is a type of STD that is a viral infection that affects the central nervous system4 and is caused by two main types of viruses: Herpes Simplex 1 (HSV-1) and Herpes Simplex 2 (HSV-2). HSV-1 is responsible for oral herpes or cold sores whereas HSV-2 is responsible for genital herpes. Both viral strains are part of the Human Herpes DNA virus family and, once an individual is infected, the symptoms will appear at or near the initial infection site.
The HSV-1 virus can lie dormant in a section of nerves located at the base of the neck (dorsal root ganglia) and the HSV-2 virus can lie dormant in a bundle of nerves located at the base of the spine (sacral ganglia). When the virus is activated, it will move through the central nervous system to the skin at or near the point of contact/infection and will appear as a blister, ulcer or sore. The presence of these lesions due to herpes is called “shedding” and is when an individual is the most contagious/at risk of transmitting the disease.5 However, the herpes virus can be active and spread without these symptoms and, therefore, the chronic and asymptomatic nature of a herpes infection should be managed more than any individual or acute episode or outbreak.
Herpes infections can be activated by a variety of triggers which can range from physical or emotional stress, local trauma, fever or illness that result in an overworked immune system, immunosuppressant therapy, exposure to ultraviolet light, or hormonal shifts and imbalances. Overall wellness and support should be a priority for individuals managing a herpes infection.
HSV-1 Oral Herpes
HSV-1 (Oral or Lip Herpes) is the most common form of herpes and is highly contagious. It usually presents itself as a cold sore or fever blister around the mouth or on the lips. The majority of individuals with HSV-1 will not exhibit symptoms but will sometimes have an “outbreak” or “flare up” associated with an illness or circumstance that causes their immune system to be compromised allowing the virus to “activate” within their body. Thus the term “cold sore” or “fever blister.” HSV-1 is generally transmitted through the transfer of saliva, as would occur during kissing, but it can also infect the genitals during oral sex.
HSV-2 Genital Herpes
HSV-2 (Genital Herpes) very often, does not come with any significant symptoms. However, when symptoms do occur, they usually come in the form of painful blisters and ulcers/sores on and around the genitalia and anus. Like HSV-1, symptoms are often dormant for long periods of time and are “activated” by stress on the body’s immune capabilities. Genital herpes is transmitted through the exchange of bodily fluids (vaginal fluid, semen, urine, anal mucous, fecal matter, blood) and any skin-to-skin contact with a mucous membrane (labia, vagina, urogenital, anus, rectum, mouth, throat, eyes, and nose)
HSV-1 on the Genitals
When an HSV-1 infection is localized around the mouth and lips is not considered to be an STD. However, if HSV-1 is transferred to the genitals via oral sex, it is then classified as an STD. According to Johns Hopkins University, 20 -30% of herpes infections found on the genitalia, in recent years, have been found to be HSV-1.6 HSV-1 infections on the genitals, however, have a lower rate of symptomatic recurrence or “flare ups,” than HSV-2.
HSV-2 on the Lips and Mouth
While it is less common for HSV-2 to infect the mouth and throat than HSV-1, the mouth and throat are lined with mucous membranes that are at risk of infection by HSV-2. The risk of HSV-2 infecting the mouth is increased if there are any existing cuts or abrasions on or in the mouth, or if the person performing oral sex has a weakened immune system.
If an individual contracts HSV-2 during oral sex and then performs oral sex on another partner, that partner is then at risk of contracting HSV-2 from oral sex.
HSV-1 and HSV-2 in the Throat
Either the HSV-1 or HSV-2 strain can cause Herpes Esophagitis, but it is more commonly caused by HSV-1 due to the nature of the HSV-1 strain being more ‘compatible’ with the host environment of the mouth and throat.
As indicated earlier, HSV infections in the throat resulting in Herpes Esophagitis is often an indication of another underlying health condition affecting the immune system, and it should be addressed with a primary care physician or specialist.
Pregnancy and Herpes
If a mother has an HSV-2 infection before pregnancy, or contracts it early in the pregnancy, the risk of transmission to the infant is 1%. However, the risk of a mother transmitting herpes to their baby dramatically increases to 30-40% if the mother contracts an HSV-2 infection during the third trimester.7 This is due to the mother’s body not having built up enough antibodies to protect the baby.8
Pregnant women with an HSV-2 infection are monitored closely by their prenatal care providers, and if an active flare or outbreak is present at the time of delivery, it is likely that the baby will be born by a cesarean section in order to avoid passing the infant through an infected vaginal canal.
Infants infected with herpes at birth are known to have what is called neonatal herpes. It is a very serious condition and can range from rash and blisters on the torso and around the mouth and eyes, difficulty breathing, organ and nervous system failure, seizures and even death. Infants whose infections are caught early can be treated, but the HSV virus will remain in their bodies for the rest of their lives.9 This condition is referred to as congenital herpes.
An infant born to a herpes infected mother can still contract the virus even if no symptoms are present. Additionally, the risk of infection is not specific to vaginal birth. An HSV-2 infection that is contracted late in the pregnancy has a greater risk of infecting the baby en utero. For this reason, it is increasingly important to understand and stay on top of one’s sexual health and to be tested regularly for STDs and STI’s as well as maintaining open and honest communication with healthcare providers and sexual partners.
Pregnant women and their partners are advised to take every precaution during pregnancy when engaging in sexual activity when one or both individuals are diagnosed with either an HSV-1 or HSV-2 infection.
How Common Is Herpes?
Herpes by Gender
According to the World Health Organization, women are more commonly found to have HSV-2 than men. This is attributed to the fact that sexual transmission of HSV-2 is more efficient from men to women than from women to men.10 A controlled test group showed that 55% of women tested positive for HSV-2 versus 27% of men.11
Sexual health and routine STD/STI testing should be a primary focus in healthcare for women in general and any sexually active adult, overall, who is not in the long term, mutually monogamous, STD/STI free relationship.
Herpes by Relationship Status
HSV-2 infections were found to be more prevalent in individuals who were not in a committed, mutually monogamous relationship. By the nature that genital herpes is transmitted through sexual contact, the conclusion can be drawn that the variable of having new and multiple sex partners, in an individual’s lifetime, increases the risk of HSV-2 infections as well as other STDs.
Herpes by Age
The highest rate of herpes infections was found in individuals between the ages of 35-39. This statistic remained true regardless of relationship status, although those in committed, mutually monogamous relationships did show lower rates of infection. The variable of the number of sexual partners and frequency of sexual activity is likely to contribute to HSV infections increasing with age instead of declining, as expected, with the age of the individual. This is because Herpes is a chronic disease and therefore its prevalence increases over time.
Herpes by Race/Ethnicity
HSV infection rates were found to be the highest in black individuals, most specifically, black females with higher rates in those who were unmarried or un-partnered.
Prevalence in the other racial groups included in the study showed significantly lower rates of infection regardless of relationship status but did exhibit the same increase in infection rates with the increase in age.12
Can Herpes Be Cured?
Herpes is a lifelong, chronic, viral infection. While it cannot be cured, it can be treated and controlled. It is crucial to understand that individuals living with a herpes infection can still infect their sexual partners while their condition is being treated and managed even when no visible signs of the infection are present.13 In fact, most individuals infected with Herpes transmit the infection without being diagnosed or having any recognizable symptoms. In the United States, an estimated 50-80% of HSV-1 and 20-40% of HSV-2 infected individuals show no signs or symptoms a Herpes infection.14 The chronic and asymptomatic nature of a herpes infection should be managed more than any individual or acute episode or outbreak.
If you think you may have Herpes, learn more about getting tested for STDs at one of our over 4,000 STD testing centers throughout the United States.
Symptoms of Herpes
A herpes infection is often asymptomatic and has been reported to be present in 50-80% of the population without visible signs. Individuals with frequent or recurrent “flares” not associated with an acute illness are suspected of having a compromised immune system due to a larger medical issue such as HIV (the deadly virus that leads to AIDS), cancer, cancer treatment, diabetes, or an another autoimmune disorder.
Typical symptoms of HSV-1 on the mouth are:
- Painful blisters inside or around the mouth and lips
- Tingling, itching or burning sensation in or around the mouth is often reported before blisters appear
HSV-1 infections largely exist without symptoms. The greatest risk of transmission and infection of HSV-1 are when open sores are present. However, the fact that the virus can be transmitted even when symptoms are not present cannot be overstated, as many individuals with an HSV-1 infection are not aware that they are, in fact, infected.
HSV-1 infections on the genitals tend to have a lower rate of recurrence or flare-ups than HSV-2, but that rate will vary by individual.
Symptoms that typically characterize HSV-2 infections are:
- One or more open sores or blisters on the genitalia and/or anus
- Body Aches
- Swollen Lymph Nodes
- Tingling or pain in the genitals, legs, hips, and buttocks are often reported before the appearance of blisters
In general, the initial, symptomatic, outbreak of HSV-2 is the most severe with any recurrent outbreaks being less severe in nature and longevity. The rate of recurrence of outbreaks tends to become less frequent over time and with proper management. Again, the large majority of HSV-2 individuals often do not know that they are infected and do not show any signs or symptoms and are at risk of transmitting the virus to unknowing sexual partners.15
Regular STD testing is paramount to ensuring the health and well-being of any sexually active adult. Find out more about how STDAware can test for HSV-1 and HSV-2.
- Blisters near the front of the throat or uvula that might burst and cause pain
- Burning sensation in the mouth and throat
- Dysphagia = Pain or difficulty swallowing
- Any of the above symptoms combined with overall fatigue, headache or fever
- In severe cases, neck stiffness or difficulty breathing
Anyone experiencing any of these symptoms can order a complete STD panel from STDAware to test for both the HSV-1 and HSV-2 viral strains along with other STDs. If the test comes back negative, but symptoms persist it is advised to follow up with one’s primary care physician to rule out any other health concerns because there are of other infections that share the symptoms of herpes esophagitis such as strep throat. A throat culture and mouth swab will identify any alternative issues.
Is There A Link Between Genital Herpes and HIV?
Individuals who suffer from a genital herpes infection are 2-4x’s more likely to contract HIV if they are exposed to HIV. Open sores, blisters, and ulcers on the skin or mucous membranes from a herpes outbreak create a more accessible pathway and higher opportunity for HIV to enter the body.
Compounding the risk is the fact that an active “flare” of herpes increases the number of CD4 cells in genital mucosa. CD4 (white blood cells also known as T cells) are what HIV target, invade and destroy. These T cells are responsible for “signaling” the immune response in the human body. When HIV attacks these cells the body loses its ability to recognize and respond to any viruses or bacteria that the body is, subsequently, exposed to.16
Routine testing for herpes and other STDs is prudent for any sexually active individual who is not in a long-term, mutually monogamous relationship. Depending on the state of an individual’s immune system, symptoms of HSV-1/2 may never appear but continue to infect sexual partners without being aware that the infection exists.
Pro-active and pre-emptive treatment of herpes and any other STD is the best way to maintain sexual health and long-term relationship satisfaction.
Treatment of Herpes
While there is no cure for herpes, there are a variety of daily suppressive therapies and antiviral medications that can treat and suppress herpes outbreaks, which will, in turn, reduce the risk of transmission to sexual partners.
Individuals who test positive for Herpes will be prescribed medication based on personal medical history and existing medications. Common prescriptions for herpes include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Severe cases may be treated intravenously.
Depending on the state of an individual immune system, the use of one of the antiviral medications mentioned above will typically begin to clear an outbreak within a few days or weeks when used correctly.
Systematic antiviral drugs, by in large, control the signs and symptoms of a herpes outbreak but they do not cure or eliminate the virus. Topical antiviral drugs should not be prescribed in tandem with oral or systemic antiviral medications.17
Suppressive treatment has a 70-80% success in reducing the frequency and severity of a herpes outbreak. With proper care and treatment, active flares/outbreaks are often reported to be less frequent and even disappear over time.
Recurrent outbreaks should be treated within one day of physical symptoms appearing, and a medical provider should provide a prescription with instructions on how to begin medication once symptoms appear.
Clients that purchase an STD test through STDAware and have a positive result are eligible to schedule an appointment with one of STDAware’s medical professionals at no additional cost and may qualify to receive a first free treatment.
Frequent flares in individuals without an immune disorder are suspected of persistent low levels of specific antibodies, specifically IgG1 and IgG3, which are the particular type of antibodies that would respond to HSV type infections.
An antibody is a type of protein found in the human body and produced by the immune system in response to antigens (any foreign organism introduced to the body such as viruses and bacteria). In a healthy body, certain levels of antibodies are always produced and work to fight off any antigens.
Research and studies are currently underway for how to increase IgG1 and IgG3 levels in humans as part of various types of disease treatment.18
Currently, there is no vaccine proven to prevent or guard against herpes, but clinical trials are underway.
The best way to avoid a herpes infection is to abstain from any sexual encounter without first being tested. Any sexually active adult who is not in a long-term, mutually monogamous relationship, should take charge of their sexual health by being tested prior to sexual activity with a new partner. It is wise to request that your partner is tested at the same time. STDAware offers a full panel of STD testing as well as individual tests. To find out more about the STD testing options provided by STDAware, click here.
In a consenting relationship, where it is understood that one or both parties have a herpes infection, it is advisable to avoid any sexual contact during an active outbreak of oral or genital herpes. It cannot be overstated that the herpes virus CAN be transmitted even when there are no visible signs or symptoms. Using barrier protection like a condom or dental dam can reduce the risk of contraction and transmission of herpes.
Other preventative measures include:
- Not sharing toothbrushes, drinks or mouth guards with infected individuals
- Washing hands regularly, especially after touching infected areas
- Staying on top of regular exams and follow-ups with primary care physician and/or specialist
- Avoiding having multiple sexual partners
- Reducing the number of sexual partners in a lifetime
- Responsible use and management of an infection with medication and good communication with sexual partners
- Avoiding sexual activity during an active outbreak or flare
Condom use does not guarantee that an STD, such as Herpes, will not be transmitted. This is due to the fact that condoms may not cover all of the areas that are or could become infected. Condoms does provide a significant protection against STDs that are transmitted through the contact of genital fluids but does not eliminate all risk.
To read more about condoms, click here.
The number one preventative measure that can be taken is to be tested before engaging with a new sexual partner. Having comprehensive test results ensures that if one or both individuals are positive for either strain of the herpes virus, they can seek treatment before a sexual relationship begins.
Psychological Impact and Support
60% of patients diagnosed with a Herpes infection stated that they were “devastated” by their results. Testing positive for a herpes infection can result can significantly impact personal and sexual relationships, and individuals who are diagnosed with this virus should take care to seek support and management options.
Significant compassion exists, at least in the United States, for the widespread nature of this STD and its implications and consequences on sexual relationships and health.
One of the best measures for dealing with a positive herpes diagnosis is to feel empowered by becoming educated and understanding treatment and risks. The following topics should be discussed with a healthcare professional/specialist:
- The facts about HSV-1 and HSV-2, with emphasis on recurrent episodes, transmission risk with or without symptoms
- Suppressive therapy options for individuals experiencing a first episode of genital herpes and in preventing symptomatic recurrence
- Treatment options for acute flares/outbreaks to reduce the severity and duration of the episode
- Importance of informing current and previous sex partners about genital herpes and informing future partners before initiating a sexual relationship
- Potential of HSV-1 & 2 transmission even when no symptoms are present
- The importance of avoiding sexual relations during an active flare/outbreak where physical symptoms are present
- The inability of suppressive treatment to assist individuals who area also suffering from and HIV infection
- Proper use and effectiveness of condoms
- Importance of testing sexual partners even if symptoms do not exist
- Risks associated with Herpes and Pregnancy
- Risk of HIV infection for individuals who have an existing HSV infection and come into contact with the HIV
The sexual partners of those diagnosed with HSV will also benefit from these discussions and counseling as well.
As mentioned previously, herpes cannot be cured, but it can be controlled and managed. Proper well checks and communication with primary care physicians or specialists along with sexual partners can significantly increase the control of the disease as well as the mental and emotional wellbeing of the affected and their partners.
Responsibility to Report STD Infection
With the rise in STDs reported around the world, it is increasingly important to maintain healthy and mature communication around sexual activity, behaviors and any risks. Having open and honest conversations with sexual partners may be awkward, but it is critical to ensuring health and wellness both in and out of the bedroom. Beyond the obvious reasons of not wanting to contribute to the spread of disease, personal relationships and reputations can be severely damaged for both parties.
Taking responsibility of sexual health and finding ways to have mature conversations about sexual history and STD status with any sexual partner(s), is not only a medical health and ethical responsibility but also a legal one. In some states, knowingly engaging in sexual activity when infected with HIV and some other STDs is considered a criminal offense. To learn more about the laws and potential penalties involved with STD transmission, click here.
Once an open discussion is started between sexual partners, proper measures can be taken to safeguard the health and happiness of both parties. Individuals may opt to seek treatment and counseling together or separately, but it is advised to seek support in any form it can be found or made available. For some people, it helps to have the conversation in the presence of a medical professional, so that they can answer questions and direct the conversation towards how to treat and cope with the diagnosis.
If physical safety is a concern, consider reaching out to the National Safety Hotline before having the conversation and getting advice: 1-800-799-SAFE or visit their website at http://www.thehotline.org/
There are two type of Herpes. HSV-1 (typically responsible for oral herpes) and HSV-2 (generally responsible for genital herpes). HSV-1 has increasingly been reported as being found on the genitals in current medical reports, and HSV-2 is, inversely, being found on, in and around the mouth, although less often than HSV-1. This means that Herpes is, more often, being transferred through the act of oral sex.
Herpes is a lifelong condition that cannot be cured. But with proper treatment and management, it can be controlled, and the frequency and severity of active outbreaks can be reduced. Just because there are no physical symptoms of an HSV-1 or HSV-2 infections does not mean that it does not exist or that it cannot be transmitted.
Taking charge of sexual health and maintaining open and honest communication with all sexual partners and well as medical healthcare providers is critical in identifying and appropriately addressing any STD.
All sexually active individuals who are not in a long-term, mutually monogamous relationship are urged to be routinely tested for STDs before engaging in sexual activity with a new partner. Responsible and regular STD/STI screening reduces the risk of further spreading disease and increases the ability to properly address any issues before sexual risk has taken place.
Take the first step in maintaining your sexual health today.