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Herpes

There are two types of herpes simplex, HSV-1 and HSV-2. HSV-1 (also known as cold sores or fever blisters) commonly infects the mouth, lips, and occasionally the skin of the trunk, arms, and eyes, but can also infect the genital area. HSV-2 commonly infects the genital area and may include the legs and buttocks, but can also cause infection on the mouth and lips.

What is Genital Herpes?

Genital herpes is a sexually transmitted infection (STI); it is spread from one partner to another during intercourse, oral sex, or other skin-skin contact. Genital herpes is a lifelong infection that can affect the vulva, surrounding skin, anus, and cervix in women. In men, it affects the penis, anus, and surrounding skin. Herpes infection may cause symptoms that return again and again (called recurrent symptoms), or it may cause symptoms that appear only once, although the virus continues to live in the body.

Herpes Symptoms

During a first episode of herpes, the most common symptoms are pain, tingling, burning, and itching but other symptoms such as fever, headaches, muscle aches, and swollen glands can usually precede the first outbreak. Small blisters form and break open into painful sores, which heal completely after about 2 to 3 weeks. After a first outbreak, the herpes virus remains hidden in the nerve roots. Recurrences may start with the same feelings of pain, tingling, burning, and itching, but there are usually fewer sores, and the outbreaks don’t last as long.

However, you or your sexual partner can have genital herpes and not know it. In fact, most people who are infected have never noticed symptoms.

How Herpes is Spread?

If you or your partner has herpes, the virus can be present in the genital area, whether or not sores are present. This situation, called viral shedding, happens most frequently during the first year after infection, but it can occur at any time. An uninfected person can get herpes if he or she has sex with someone who is shedding the virus, even if no sores are present. Using latex condoms for every sex act is good protection. However, the virus is sometimes present in skin not covered by condoms, so using condoms does not guarantee protection against infection.

Diagnosing the Infection

If you have blisters or sores, your clinician can swab the area for a sample to send to the lab. If the sample contains HSV, it can be identified as HSV-1 or -2. In people with or without sores, a blood test can show the presence of antibodies to HSV-1, HSV-2, or both.

If you are diagnosed with herpes and your partner has never had symptoms, your partner may want to get tested to see if he or she actually is infected; if your partner has herpes and you have never had symptoms, you may want to get tested.

Treating and Preventing Outbreaks

There is no cure for herpes. However, there are medications which are used to shorten outbreaks, prevent recurrences, and decrease the frequency of viral shedding. There are two ways to treat this infection. One way is to treat each episode. Discuss with your clinician the possibility of a refillable prescription to keep on hand for you to take as soon as you feel pain, tingling, burning, or itching. The other method is to take medicine daily to help prevent outbreaks; this approach is recommended if you have frequent recurrences (six or more a year). Recurrences get less frequent as time goes by; so each year, you and your clinician should discuss whether you should continue taking daily medication.

Don’t Pass It On

If either you or your partner has herpes, you can lower the odds of transmitting it. If you are infected, discuss the infection with your current partner and with any future partners. Bringing up the subject can be difficult, so think about what to say and how your partner might react. In general, people react best if you share this information before becoming sexually active.

Avoid sexual contact (oral, anal, vaginal) when you or your partner has sores or warning signs of an outbreak (such as itching, tingling, or pain)–not just because you could transmit the infection, but also because open sores give other infection-causing agents, including HIV, easier access to your bloodstream.

Use condoms between outbreaks. Condoms can reduce the risk of transmission by covering the sites most likely to be involved in asymptomatic viral shedding (transmission in the absence of an outbreak). While very effective, condoms do not provide 100% protection.

One study has shown that infected partners who take certain medications for herpes daily are less likely to pass the virus on, so you or your partner might want to discuss this with your clinician. Be aware that even if you follow all of these guidelines, there is no guarantee that you will prevent transmission. Also avoid oral sex, if you or your partner has cold sores, because the disease could be transmitted to the genitals.

If You’re Pregnant or Planning Pregnancy

Most women with genital herpes have healthy babies. Although herpes can infect a baby during pregnancy or delivery, this occurs rarely. During pregnancy, it is very important to tell your clinician that you have herpes. If you have an outbreak at the time of labor, your clinician may recommend a caesarian section to prevent the baby from getting the virus.

If you become newly infected with herpes late in pregnancy, your baby is more likely to get infected. Thus, you should take special precautions during the last 3 months of pregnancy: If you do not have HSV-2 infection but your partner does, or if you do not have HSV-1 and your partner has genital HSV-1, avoid intercourse. If you do not have HSV-1 infection and your partner has cold sores, avoid receiving oral sex.

Things to Remember

Millions of people with genital herpes lead healthy, active, productive lives and have healthy babies. If you or your partner has this infection, seek out the information, treatment, and support you need.

Resources:

  • CDC National Hotline: 1-800-CDC-INFO (1-800-232-4636)
  • American Social Health Association: http://www.ashastd.org
  • National Herpes Hotline: 1-919-361-8488
  • Herpes Resource Center: 1-800-227-8922