An Intimate Affair: Facts, Risks, and The Relationship between Herpes and MS

Editor's Note: The Zostavax shingles vaccine referenced in this article is no longer available for use in the United States, as of November 18, 2020. Shingrix, an inactive vaccine for the prevention of shingles, was approved by the FDA in 2017.

Have you ever felt worried or confused about what might happen if you contracted one of the various herpes viruses – and what impact that might have on your MS?

You’re not alone in that concern. I see this subject pop up on MS forums often enough that I would like to address it in some detail and bust a myth or two about herpes viruses in general. And, since I have one of the herpes viruses myself, I can add a personal touch to the discussion as well.

Shingles (herpes zoster) and herpes simplex virus (HSV) 1 and 2

Okay, so let us take a look at the facts behind two categories of herpes viruses that are prevalent within the US population at large and then address their significance among people with MS. They are shingles (herpes zoster) and Herpes Simplex Virus (HSV) types 1 and 2. There are other types of herpes viruses as well, but I would like to focus on these because a) they are the strains that have generated the most discussion on MS forums, and b) because they share some common traits.

Both shingles and HSV are viral skin infections that are spread mostly through contact with open sores. When either of these infections is dormant, the viral cells reside in either the ganglion of the lower spine or of the cranial nerves. The part of the body that experiences an outbreak determines where the dormant virus will reside in the nervous system.

Shingles (herpes zoster)

Shingles is characterized by a painful rash that usually appears somewhere on the torso, but can also appear on the limbs, neck, face and eyes. It usually afflicts people over age 50 and those who have lowered immune systems. The stripe-like rash will develop blisters, then crust over and heal within ten days.

Shingles can only occur if you’ve already had chickenpox (herpes varicella zoster). If you have not had chicken pox and you become infected with shingles, you will have an outbreak of chickenpox instead.

Herpes simplex type 1 (HSV-1)

Herpes Simplex Type 1 (HSV-1) is the more common of the two, is mostly found on the face and lips, and is colloquially known as cold sores. Because it is so easily spread through casual skin contact, 70-90% of the entire adult US population have the antibodies for this type of herpes virus. Transmission occurs when an active lesion makes contact with a moist area such as mucus membranes, or with broken skin. Because of this, around 50% of new genital herpes cases are Type 1, transmitted via oral sex. It is also possible to contract herpes through shedding of the cells while in a dormant state, but the risk of this is much lower.

Herpes simplex type 2 (HSV-2)

Herpes Simplex Type 2 (HSV-2) is predominantly spread through genital contact. It is so similar to Type 1 that if you have the antibodies for Type 1, not only are you protected from being reinfected with Type 1, you are mostly protected from contracting Type 2 as well.

The link between herpes and MS

Various studies conducted since the 1990s have acknowledged a relationship between the broader spectrum of herpes viruses and active MS, though the connection is not well understood. High viral loads of herpes viruses such as Epstein-Barr and roseola, as well as shingles and HSV, have been found in acute MS cases, but absent in the control groups, leading researchers to conclude that herpes may serve as a viral trigger for a flare.

The disruption of the immune system

The relationship is most often described this way: The nature of herpes viruses involves the potential for reactivation, even after very long dormancy periods. This reactivation causes a chain reaction of immune responses that can provoke an autoimmune attack in people with MS.

In other words, herpes doesn’t cause MS. The two are linked in how they each contribute to the disruption of the immune system.

How to avoid getting shingles and HSV

Zostavax, the shingles vaccine

Zostavax, the shingles vaccine, is a live, attenuated vaccine. It is basically a weakened version of chickenpox (herpes varicella zoster). If you’ve already had a case of shingles, the vaccine can prevent a recurrence. If you’ve only had chickenpox, the vaccine can reduce the risk of developing shingles by about 51%.

By the time we reach our senior years, 1 in 3 of us will have developed shingles at least once, most of us after reaching the age of 60. The vaccine has been approved for people over age 50 and recommended for those aged 60 and older. Studies show that the older you are, the more severe a case it will be. If you are concerned about taking a live vaccine, talk to your neuro first. If you are taking steroids or have an otherwise weakened immune system, you probably shouldn’t have the vaccine. As we MSers already know, we each must weigh the risks and benefits of disease-modifying therapies, vaccines, and alternative therapies before making a decision. Do your homework and consult the professionals.

Antibodies and avoiding skin contact with active herpes ulcerations

Unfortunately, there is no vaccine for HSV. Two things can protect you from contracting herpes: already having the antibodies, and avoiding skin contact with active herpes ulcerations. To find out whether you are already infected, ask your doctor to do the blood test that will show whether you are positive for the antibodies. Most people who are positive don’t know they are and have never had an outbreak.

If you have HSV-1 or -2, you can protect your uninfected partner from getting it by: 1) taking an antiviral drug such as acyclovir every day, 2) refraining from both oral sex and genital penetration during outbreaks, and 3) being open to using condoms and mouth dams during dormant periods if your partner prefers it.

Facts about HSV you might not know

HSV-1 and -2 are skin viruses. They are included in the category of sexually transmitted diseases (STDs) because they can be spread through sexual contact and infect the skin of the genitals. But unlike other STDs such as gonorrhea and syphilis, which are bacterial infections, and HIV/AIDS, which is viral, HSV cannot be spread by an exchange of blood or other bodily fluids. Herpes Simplex Virus can only be spread through skin contact with an active lesion or shedding of viral cells during a dormant period. Another distinction between HSV and other STDs is that HSV does not cause organ damage or death. It is not a progressive condition. It is a harmless skin virus much like chicken pox, shingles, and roseola. It causes discomfort during an outbreak, but does no other harm.

Things not to worry about HSV contraction

Besides the harmlessness of the virus as described above, bear in mind that HSV is very common. Most of us already have the antibodies for it. If you do and you’ve never had an outbreak, your antibody-positive status means you will not become infected if you come into contact with an active herpes lesion.

If you are HSV negative, become infected and have an outbreak, that primary outbreak will likely be the most severe one you will ever have. Symptoms last from 7-10 days. After that, you can keep it dormant by taking an antiviral drug. This drug will also reduce your viral load and make you much less likely to pass it on to someone else.

On the other hand, things to worry about HSV contraction

Okay, so you’re an MSer, and that means you want to avoid possible triggers for a relapse. We know that viruses can trigger relapses. But we don’t all relapse when we contract viruses. So having herpes might not impact your MS at all. If you’re HSV-negative and also one of the unlucky people that gets mowed down by every cold virus you pick up, however, then you might want to take extra precautions to avoid getting the herpes virus.

1. Get a blood test to find out if you are positive or negative for HSV antibodies.
2. If you are positive, then you don’t have to do anything more. You can’t get re-infected.
3. If you are negative and you get involved with someone with herpes, then ask your infected sex partner if they are taking an antiviral drug. For maximum protection, use condoms and mouth dams, and refrain from sex during outbreaks.

On a personal note

I have Type 1 genital herpes. I contracted it genitally from my partner’s facial cold sore. As I mentioned earlier, this is exactly how a large number of new cases occur. My primary outbreak was severe. It did not cause an MS relapse. In the seven years since, I have had no additional outbreaks. I took Tysabri for a year, and although it is an immunosuppressant, I did not have a herpes outbreak. I take acyclovir twice a day. I have not infected any partners since becoming single, and that’s without using any protection other than the antiviral drug.

Fact: The risk of transmission for dormant HSV-1 while taking an anti-viral drug is only 2%.For some perspective on that number, consider the fact that the risk of dying in a car accident every time you get behind the wheel is also 2%.Fact: Using a condom/mouth dam in addition to an anti-viral reduces that risk to near 0%.  

Further information and resources

For more information about HSV, see Adrial Dale’s “The H-Opp” materials at: http://herpesopportunity.com/. Sign up for the mailing list to get a free download of the herpes fact sheet and e-book.

For further details about shingles, chickenpox, and vaccines with live attenuated varicella zoster, see information provided on the Centers for Disease Control (CDC) website.