When people discuss herpes transmission, they usually mean spread of the herpes simplex virus, which is usually called HSV I and HSV II. These can occur on or around the mouth and on or around the genitals, and actually, either type may occur in either area. There are other herpes viruses, and noted ones cause things like chicken pox. Unlike HSV I and II, the chicken pox virus can be spread by air transmission, though it is more common for people to pick up chicken pox by direct exposure to the fluids that leak out from chicken pox blisters.
Herpes transmission of HSV II and I tend to occur most commonly by coming into skin-to-skin contact with an infected person who has an active infection. Touching the “outbreak” area and herpes blisters can cause transfer of the virus, especially if contact occurs in areas with mucous membranes. These include the genitals, the mouth, the inside of the nose and the area around the eyes. Thus a person with a herpes cold sore who kisses someone else on the face could transfer the infection, if any of the virus reaches the mucus membranes or if it gets direct access to the blood stream from cuts or eruptions on the face. Sexual intercourse of any kind, when people have herpes outbreaks on the genitals are not advised, since these will greatly increase herpes transmission risks.
Even prior to presence of blisters or cold sores most people go through a “warning” period. Skin may tingle or feel numb or itchy. These are called prodromol symptoms and it is possible for herpes transmission to occur during the prodromal symptom period. Any thought that an outbreak may occur or evidence of these early symptoms suggests minimizing skin-to-skin contact with others.
It used to be thought that herpes transmission could not occur unless people were in the pre-outbreak stage or had an active outbreak. This has been shown not to be the case in some people. Even when no outbreak is present, some people may shed the virus at all times and might transmit the virus without an active infection. Other times people have so few symptoms they may not realize they have an infection, especially with genital herpes, and they may engage in sexual intercourse and unknowingly pass the virus onto others. The best defense against getting herpes on the genitals is to avoid sex of any kind during active outbreaks, and to use condoms at all times to prevent possible infection when outbreaks aren’t present.
There are a few other herpes transmission methods. Contact with infected fluids from herpes blisters could go from the hands to the eyes or nose, and people can infect themselves or others this way, transferring genital herpes to the eyes or mouth and then experiencing recurrent infections there. It’s best to make sure to wash hands after touching an active outbreak area, since this will kill the infection. This may harder to do when herpes occurs on the mouth, since people often touch their face. It’s a good idea to remember to avoid touching the mouth if cold sores are present.
Lastly, mothers with active herpes outbreaks may transfer the infection to babies during labor. This can be very challenging for newborns who have few resources to fight off disease. If a woman has herpes she should be tested for potential infection at time of labor. Doctors may recommend a Caesarian section if an outbreak is present.