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Despite its commonality, genital herpes remains a poorly understood and, thus, a greatly feared virus. Based on recent data, the U.S. Centers for Disease Control estimate that one in every six Americans is infected with herpes simplex virus type 2 (HSV-2) – the most likely cause of genital herpes. Because HSV-2 is a highly contagious, incurable infection that lasts a lifetime, it is no wonder that herpes invokes fear among those who have it and those who don’t.

Herpes simplex virus is among the many diseases caused by the herpes virus, a viral family with five different strains causing many ailments, including cold sores, chickenpox and shingles. Herpes simplex is the most common strain and has two variations:

  1. Type 1 – mostly associated with cold sores around the mouth
  2. Type 2 – generally infects the genitalia, sacrum, buttocks and thighs

Although they are separate strains, these two types of herpes are known to overlap.

Signs and Symptoms

Herpes simplex has a fairly predictable presentation. Initially, the affected tissue may exhibit pain or tingling a few days before an outbreak, and then a blister or cluster of blisters appear on a red base. Eventually, the painful, itchy blisters erupt and ooze a virus-rich liquid. The blisters form scabs after a week to 10 days, ending the most contagious phase of the disease. From start to finish, outbreaks typically last between two and three weeks.

After initial infection, the herpes virus typically becomes dormant in the nerves and only recurs following a stressor. Stressors initiating a herpes outbreak can range from a minor infection such as a cold, a trauma or sun exposure to an emotional or environmental stressful event. Managing HSV usually consists of maintaining a healthy immune system and minimizing stress for outbreak prevention.


Herpes simplex is spread through mucous secretions. A person’s first outbreak, which usually occurs two to 20 days after exposure, is called primary herpes. All subsequent outbreaks are called recurrent herpes. Unless spread to other locations, recurrent herpes typically occur in the same place as the primary lesion, where the virus has taken up residence in the affected nerve root.

Because herpes simplex viral strains I and II often overlap, it is important to be attentive for preventing cross-contamination. The primary vehicle for overlap is acquiring genital herpes through oral sex with a partner who has an active cold sore. However, HSV also has the potential to spread to different areas of the body through casual contact. Touching a cold sore with the finger can infect other body parts touched by that contaminated finger, such as the eyes and genitals.

5 Useful Facts

One of the most common sexually transmitted diseases in the United States, HSV-2 is an incurable infection that lasts a lifetime, causing recurrent and painful genital sores. Due to its high prevalence, bodyworkers are likely to have clients with this virus or be infected with HSV-2 themselves. Hence, knowing about and being able to communicate some basic facts about herpes can help reduce transmission and ease the fears of therapists and their clients. Touching on viability, transmission and infectivity, the following five facts are extremely useful for the purpose just described:

  1. There is no cure for genital herpes. Although it is possible to go long periods of time between flare-ups, the herpes virus does not ever fully leave its host. The virus hides in the dorsal root ganglia of the spine waiting for a trigger (illness, stress, hormone changes, sunburn) to resurface. While conventional and natural medicines might help shorten the length of an outbreak or prevent future ones, they cannot eliminate HSV-2 from the body.
  2. Herpes can be transmitted in the absence of visible lesions. The likelihood of transmitting herpes is very low when the infected person is in remission. However, there are three stages of herpes when contagion is most likely. HSV-2 can be transmitted during the prodromic phase (usually characterized by pain or tingling several days before an outbreak), during an active outbreak (when there are actual genital herpes lesions/blisters present), and as the person recovers from an outbreak (skin cells that shed off of healing blisters). Because the virus is capable of shedding at the skin’s surface, there is a small chance of transmission during periods of remission. All it takes to catch herpes from another person is skin-to-skin contact with live virus. No sore or break in the skin is necessary. For bodyworkers, this means that frequent hand-washing is essential.
  3. HSV-2 can spread beyond the genitals. Although the chance of transmitting HSV-2 to areas other than the sacrum, thighs, buttocks and genitals exists, it is not very common. However, HSV-2 can spread to non-genital regions of your own or someone else’s body. The virus can spread by touching the infection and then transferring the virus particles. Besides the genital region, the mouth, fingers and eyes seem to be the most vulnerable. This risk increases:
    • When the recipient’s immune system is compromised
    • If there is a tear or break in the skin allowing easier access for the virus to gain entry
    • During the first herpes outbreak, before the body has time to build up sufficient antibodies (for spreading elsewhere on the person already infected with HCV-2) (This possibility serves as another reminder for massage therapists to frequently wash their hands, and never touch their face while working.)
  4. In those with an active outbreak, avoid touching their hands. Because HSV-2 can spread beyond the genitals, the hands are the most likely vehicle for aiding transmission. This is especially true during the prodromic phase, the actual outbreak or as the lesions heal (all of these describe the most infectious periods), because the affected area is likely to be itchy – and hands are used for scratching.
  5. The herpes virus may survive for days on contaminated linens. Most herpes infections are contracted from skin-to-skin contact. Thus, transmission via inanimate objects such as toilet seats or massage linens is unlikely. However, the virus can persist outside of the body – facilitating additional modes of transmission. The length of HSV survival outside the body is hotly debated. Most sources claim that HSV dies quickly once exposed to the air. Unfortunately, under the right conditions, there is a possibility the virus could survive longer. As published in the August 2006 edition of BMC Infectious Diseases, German researchers found that HSV-2 can survive outside the body for up to seven days. Because of this potential, a bodyworker’s linens must always be treated with universal precautions, infection control guidelines designed to protect workers from exposure to diseases spread by blood and body fluids – especially for those with herpes. This also means that the face pad used with an infected client may function as a source to pass HSV to your next client. The hypothetical heartiness of HSV marks yet another reason why it is imperative to provide clean, fresh linens for each client.

An Infected Client

Knowing a client has a history of herpes mandates a discussion about its transmission. Explain to the client why it is undesirable to receive massage during a herpes outbreak or when pre-blister signs are present. Sometimes, circumstances will make working with a client with a herpes outbreak unavoidable. In these instances, massage therapists are best advised to steer clear of the client’s hands as well as the outbreak area.

Until a cure or vaccine for HSV is developed, all healthcare professionals in close contact with their clients must take steps to prevent its spread. While some bodyworkers may only apply universal precautions to clients known to carry the HIV or a hepatitis virus, knowing about herpes’ level of contagion justifies using universal precautions for every client entering your practice.

There is a lot to know about herpes to completely understand this virus. However, the facts listed above help give bodyworkers a more solid picture of its viability, transmission and infectivity – issues that directly impact a massage therapy practice.

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More Information:

Massage and Herpes Precautions