HSV-1 is ubiquitous, and HSV-1 infection is often acquired in the first decade of life by contact with oral secretions. Presence of antibodies to HSV-1 in a general population increases with age and correlates with socioeconomic status (7). By adulthood, 50% of people in the highest social strata are infected, as are 85% of people in lower social strata. Of those who are infected, more than 25% have recurrent episodes, which usually manifest as mucocutaneous herpes labialis. Between symptomatic episodes, HSV-1 can be shed in as many as 10% of healthy persons with a history of cold sores. This shedding spreads the infection. HSV-1 is transmitted chiefly by contact with infected saliva. The mode of transmission is by close personal contact. Aerosol spreading rarely occurs, because the virus is inactivated readily at room temperature and by drying (6).
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