Frequently-Asked Questions

 

 

(The following Q&A was adapted from information developed by the U.S. Centers for Disease Control)

 

What is genital herpes?

 

The STD (sexually transmitted disease) called genital herpes is caused by two forms of the herpes simplex viruses: type 1 (HSV-1) or type 2 (HSV-2). Most oral herpes is caused by HSV-1, and most genital herpes is caused by HSV-2. Most people have do not show signs or symptoms from HSV-1 or HSV-2 infection – or they may show minimal symptoms. When signs of genital herpes do occur, they typically appear as”outbreaks”  of blisters on or around the genitals or rectal area. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Another outbreak can appear weeks or months after the first, but it is usually less severe and shorter than the first outbreak.  Though the herpes infection usually remains in the body indefinitely, the number of outbreaks tends to decrease over time.

 

How common is genital herpes?

 

Genital herpes infection is quite common in the U.S; at least 45 million people ages 12 and older, or 20% of U.S. adolescents and adults, have had genital HSV infection.

 

Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of eight). This may be due to male-to-female transmission being more likely than female-to-male transmission.

 

How do people get genital herpes?

 

Both Herpes Type 1 and 2 can be transmitted by contact with the sores that the herpes viruses cause, but they can also be released between outbreaks via “shedding” from skin that does not have a sore on it. In most cases, a person gets HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission frequently occurs from an infected partner who does not have a visible sore, and may not even know that he or she is infected with the virus.

 

It is possible for HSV-1 to cause genital herpes, but it is more common for it to cause infections of the mouth and lips, so-called “fever blisters” or “cold sores.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital outbreaks of HSV-1 recur less frequently than genital outbreaks caused by HSV-2.

 

What are the signs and symptoms of genital herpes?

 

Many people who are infected with HSV-2 are not even aware that they are infected. However, if symptoms do appear during the first outbreak, they can be quite dramatic. The initial outbreak usually occurs within two weeks after the virus is transmitted from one person to another, and the sores usually heal within two to four weeks after virus transmission. Other signs during the primary episode may include a second group of blisters, and flu-like symptoms, including fever and swollen glands. Most people with HSV-2 infection, however, never have sores, or they have very mild signs that they don’t even notice, or that they mistake for some other skin condition.

 

Individuals who are diagnosed with a first outbreak of genital herpes usually have several (typically four or five) recurrent outbreaks within a year. Over the years, these recurrences usually decrease in frequency.  Sometimes, a person does not become aware of the infection until years after it is acquired.

 

What complications are associated with genital herpes?

 

Genital herpes can cause recurring bouts of painful genital blisters, and herpes infection can be more severe in people with immune systems depressed due to other causes. Regardless of how severe the symptoms are, genital herpes frequently causes psychological distress in people who know they are infected, due particularly to the attached social stigma.

 

Genital herpes can lead to potentially fatal infections in babies. It is important for women to avoid contracting herpes during pregnancy, because a new infection during late pregnancy poses a greater risk of transmission to the baby than a long-standing infection. If a woman has an active outbreak of genital herpes at delivery, a cesarean section delivery is usually performed. Due to these precautions, and the use of herpes-suppressing drugs, infection of babies by mothers with herpes is uncommon.

 

The herpes virus may play a role in the spread of the HIV virus, which causes AIDS. The herpes virus can make people more susceptible to contracting an HIV infection, and it can make HIV-infected people more likely to infect others.

 

How does one diagnose genital herpes?

 

There is a variety of signs and symptoms associated with herpes Type 2. Certain health care providers can diagnose genital herpes by visually inspecting the outbreak if the outbreak is a typical one, or by taking an actual sample from a sore and testing it in a laboratory. Herpes infections can be diagnosed between outbreaks by the use of an antibody blood test. These blood tests, which detect  antibodies the body produces to fight HSV-1 or HSV-2 infection, can be useful, although the results are not always absolutely clear.

 

How can you prevent getting herpes?

 

The one sure way to avoid transmission of herpes and other sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term,m mutually monogamous relationship with someone who has been tested and is known not to be infected.

 

Sores can occur in areas that are not covered by a latex condom, so condoms are not fool-proof. Hoever, proper and consistent use of latex condoms can reduce the risk of contracting the herpes virus.

 

People with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.

 

 

 (The following Q&A is adapted from information developed by MetroKC.gov (King County)

 

 

Exactly what is genital herpes?

 

There are two types of herpes, caused by two different herpes simplex viruses: HSV-1 and HSV-2. Both types of herpes can infect either the oral or genital area, or sometimes, both. The infection causes signs and symptoms that may come and go. There is no cure for herpes, but the symptoms can be treated and relieved with certain medications and treatments.

 

When the herpes infection is on or around the mouth, it is called oral herpes. Oral herpes causes sores on the mouth or lips called “fever blisters” or “cold sores.” Oral herpes is usually caused by the HSV-1 variety of the virus.

 

However, when a herpes infection is on or near the genitals, it is called genital herpes. Genital herpes is usually caused by the HSV-2 variety of the herpes virus.

 

In the U.S., how many people have herpes?

 

About 25% of adults in the U.S. has Type-2 genital herpes. About half a million to a million new infections occur each year. A lot of people with genital herpes are not even aware that they have I, because they have never had or noticed symptoms such as outbreaks of sores.

 

How do you get herpes?

 

You get genital herpes via direct skin-to-skin contact, usually during vaginal or anal sex. The herpes virus is most contagious when herpes sores are open and have not yet healed, but herpes can be spread even when there are no sores present and no signs of an infection. If someone with oral herpes gives oral sex to his or her partner, the partner can develop genital herpes. In this way, some cases of genital herpes are caused by HSV-1, instead of the usual transmission via genital-to-genital contact of HSV-2.

 

Contrary to some myths, the only way to spread herpes is through skin contact. You can’t get herpes from swimming pools, towels or toilet seats.

 

What are the symptoms of a herpes infection?

 

Many people with who have genital herpes either have no symptoms or have such mild symptoms that they don’t notice. Sometimes people mistake the symptoms for something else.. When symptoms do occur, they may last several weeks, then go away and return later. Both the frequency and severity of herpes symptoms vary between individuals.

 

The initial herpes outbreak:

 

In cases where symptoms do appear, the first outbreak of genital herpes usually appears within two to twenty days after transmission. The most common symptom is one or more sores or blisters that appear on the genitals, anus, buttocks or (rarely) elsewhere on the body. These blisters soon break open to become painful sores. The sores usually heal in about two to three weeks, although the virus remains in the body after the sores are gone.

 

During outbreaks, people may also experience the following:

 

    * discomfort or pain around the genitals, legs or buttocks

    * swollen lymph nodes in the groin area

    * burning or itching while urinating

    * difficulty urinating or constipation

    * fever, chills, headaches, body aches or other flu-like symptoms

 

The first outbreak’s symptoms are usually more severe than subsequent outbreaks of herpes.

 

“Hidden” or latent infection:

 

When the initial outbreak is over, the herpes virus becomes inactive and does not cause symptoms. This period is called latent infection. At any time after this, the virus can reactivate and cause sores again. No one is sure what causes the virus to “wake up”. It is thought that stress, other illnesses, sex or menstruation can cause outbreaks, but research is not conclusive.

 

Repeated herpes outbreaks:

 

Repeated flare-ups of genital herpes are called a “recurrences” or “outbreaks.” Sores usually heal sooner and are not as painful as the during the initial outbreak. Recurrences are most common in the first year after infection with herpes. Each person has his or her own unique pattern of recurrences. Genital herpes caused by HSV-2 is much more likely to recur than genital herpes caused by HSV-1. Recurring outbreaks may be more frequent for people whose immune systems are suppressed.

 

Even though a person may not know the exact cause of an outbreak, he or she may sense that an outbreak is coming. These signs can include tingling, itching, numbness or tenderness where the sores will appear. There can be pain near the buttocks, back of legs or lower back. These and other warning signs may start a few hours to a day before the sores actually appear on the skin.

 

Sores can re-appear anywhere on or near the genitals, often at the same place as they initially appeared.

 

Recurrences with no symptoms

 

The herpes virus can become active again without causing usual symptoms like blisters, pain or itching. Called “asymptomatic shedding” or “subclinical shedding”, this is most frequent in the first year of infection, but it can continue on and off for several years. The herpes virus is often spread during these times, since people may not know their virus is active again, and that they are able to infect others.

 

What are the consequences of having genital herpes?

 

For most people, outbreaks are mild, and many people don’t have symptoms frequently. Sometimes, outbreaks can be more severe. Usually, genital herpes can be well managed with medication, stress management and healthy eating. Fortunately, genital herpes infections almost never cause long-term damage in healthy adults. Those with suppressed immune systems can have longer and more severe outbreaks of herpes. But, even these outbreaks can still be reduced with treatment. Research has shown that genital herpes does not cause cervical or any other types of cancers.

 

For many, the emotional impact of the disease can be the worst part. Some people feel depressed or worried about giving herpes to other, repeated outbreaks, or developing intimate relationships with new people. However, with proper treatment and open communication, most people with herpes find they can have normal, healthy, enjoyable relationships.

 

How do you know if you have herpes?

 

Symptoms of the herpes virus can be similar to symptoms of other diseases, so the only way to be sure whether you have it or not is testing. Even if you don’t have symptoms, a blood test can tell if you have HSV-1 or HSV-2 virus infection. Tests can usually detect herpes antibodies anytime after  4 – 6 weeks following infection. Testing before this time may not give an accurate result. Over 90% of people who become infected test positive within 3 - 4 months. A positive herpes test means that you are infected with HSV and can spread the virus to other people.

 

You can be tested when you have sores. Your provider can swab the sores and perform a viral culture test for the herpes virus. However, this method is not always reliable. If the sores are starting to heal, the test might be negative even if you do have herpes infection. Blood tests provide the most reliable diagnosis.

 

Should you test positive for herpes, it is very important to tell each of your sex partners so they can also be tested for the virus also.

 

 

Relieving pain.

 

If you experience pain during an outbreak, there are various ways to relieve it:

 

    * You can take warm baths or hold ice packs on the sores for several minutes.

    * You can wear loose cotton clothes to prevent chafing.

    * Try to keep the area dry with baby powder or cornstarch.

    * You can take aspirin, acetaminophen, or ibuprofen to relieve pain and fever.

 

What about herpes and pregnancy?

 

Those women who get herpes before becoming pregnant have a low risk of passing the virus to the baby. There is a higher risk if the mother gets herpes during her final trimester of pregnancy. Women should be very careful not to contract herpes during pregnancy, taking extra precautions about partners and protection.

 

The majority of mothers with genital herpes have normal vaginal deliveries and give birth to healthy babies. However, If a mother delivers during her first herpes outbreak, contact with the mother’s herpes sores can cause the infant to develop serious infections. The baby can be treated to prevent or reduce long-term damage. In cases where a woman has symptoms at the time of delivery, a Caesarean section delivery can be performed.

 

Information and resources.

 

HIV/STD Hotline: 206-205-7837

 

HIV/AIDS Program: hivstd.info@kingcounty.gov

 

CDC national STD/HIV hotline numbers:

800-227-8922 or 800-342-2437;

en español: 800-344-7432; TTY 800-243-7889

 

    * Planned Parenthood: Herpes

    * CDC Herpes Fact Sheet

 

 

 

 

The following Q&A is from the American Social Health Association (ASHA), the New Zealand Herpes Foundation and the International Herpes Management Forum (IHMF):

 

 

 

 

What are the symptoms of genital herpes?

 

Individuals who suffer from genital herpes can have a wide range of symptoms. For some, genital herpes appears as a small area of redness, sometimes with raised bumps (called papules) or fluid-filled blisters, ulcers (sores) or a small cut or abraded area. For many, these signs may go unnoticed or may be mistaken for another infection known as thrush (or yeast infection). Symptoms also may be mistaken for genital abrasions that could have been caused by vigorous activities like playing sports or sexual intercourse.

 

Some people may also experience more distinctive signs of genital herpes, which may include:

 

    * Itching, burning or tingling in the genital area

    * Flu-like symptoms (headache, swollen glands, fever)

    * Painful urination and/or discharge

 

If there are no visible symptoms, a doctor cannot identify an HSV infection with a physical examination. Blood tests are available, but blood test must be type-specific to be useful. Oftentimes, the virus that causes genital herpes may live in the facial area, where it causes 'cold sores.' 'Cold sores' are most commonly caused by HSV type 1 and genital herpes is most commonly caused by HSV type 2. Because 70% of people have been infected with HSV-1 by the time they reach adulthood (usually kissing someone with 'cold sores' during childhood) a positive HSV blood test result is common, but does not denote whether there is a genital HSV infection. If the blood test indicates HSV-2 infection, this generally indicates that the infection is in the genital region.

 

If you think you may have genital herpes, go to a physician or clinic as soon as possible. The doctor will examine the genital area to make a diagnosis. Sometimes genital herpes symptoms are so distinctive that the doctor can make an accurate diagnosis upon examination. However, a swab test should always be done to confirm the diagnosis.

 

Remember, the telltale signs of genital herpes are not very common. If you notice any blistering, swelling or cracks in the skin, do not squeeze these areas, as it will not help the healing, and it may cause further infection. Do not apply any medications or 'natural remedies' to the area prior to medical consultation as these may make diagnosis more difficult. Many topical agents e.g. antiseptics, can burn the genital area and disrupt the healing. Even if the doctor thinks that the infection is definitely herpes, a swab should be taken to confirm the diagnosis. In some instances where the herpes outbreak is mild, the swab test may not detect the virus. It is common to undergo repeated swab tests with recurring outbreaks before the diagnosis can be confirmed.

 

How is genital herpes transmitted?

 

Genital herpes is passed through direct skin-to-skin, genital-to-genital or mouth-to-genital contact. Therefore, it is most commonly transmitted during intimate sexual contact. Often, one may discover the genital herpes outbreak during the course of a long-term, monogamous relationship; however, this is not necessarily a sign of infidelity.

 

In some cases, people who have contracted genital herpes will attempt to contact recent sexual partners to find out who transmitted the virus. In fact, some countries still advocate ‘contact tracing’. This proves to be difficult or even impossible because symptoms of infection can go unrecognized or there may be no symptoms at all. As a result, approximately 80% of people with the genital herpes virus are unaware they are infected.

 

 

Myths

 

Genital herpes is not contracted through sharing toilet seats, towels, baths, showers or soap. Nor is it contracted through trying on clothes, or sharing the same bed as someone who is infected.

 

How do I distinguish between HSV-1 and HSV-2? Can it be contracted through oral sex?

 

HSV-1 is often the cause of facial herpes and HSV-2 is generally the cause of genital herpes. Essentially, they are different strains of the same virus and both types can live in either area. If you have genital HSV-1 you are likely to have less frequent recurrences than if you have genital HSV-2. It is more common for oral HSV-1 to be transmitted to the genitals through oral sex, than it is for HSV-2 to be transmitted to the mouth.

 

Yes, herpes can be transmitted through oral sex. Many people are unaware that 'cold sores' on the mouth and facial area are caused by the herpes simplex virus (HSV).

 

There are times where transmitting HSV-1 is more likely and one should avoid oral sex to prevent passing the virus to the genital area of a partner. Herpes in the facial area is most infectious when there is an active outbreak, with blistering or cracks causing a 'cold sore.' However, the virus may be still be transmitted even when an outbreak or “flare up” is not visible.

 

 

Is there a cure for herpes?

 

There is no absolute cure for the herpes infection at this time. Research is being carried out with HSV vaccines, which may be effective both at treating herpes outbreaks and preventing the infection, but these are still in the development stage.

 

In most instances of herpes, the body's immune system effectively deals with the viral infection, so for many people, herpes is mild or is not recognized.

 

 

How often will I have outbreaks?

 

Genital herpes caused by HSV-2 carries an 80-90% chance of recurrences. Genital HSV-1 infection carries a 50% chance that of recurrences. For HSV-2 sufferers, the number of outbreaks varies. On average, outbreaks occur 4-5 times per year, but are more frequent during the first 2 years following initial infection.

 

The first genital herpes outbreak is likely to be the most severe. Most people find that recurrences become less frequent and less severe with time.

 

Some people are unclear as to whether or not they are having another herpes outbreak or a yeast infection or other skin condition. Therefore, it’s advisable to discuss this with a doctor with whom you have a good rapport and have a check-up for clarification. Also, visiting a specialist at an STD clinic may be preferred, because the staff is more experienced in treating herpes patients.

 

 

How can I prevent herpes recurrences?

 

While there is not generally an obvious reason for a herpes recurrence, there are certain triggers that may signify an outbreak.

 

Activities that reduce one’s general well being, including: illness, poor diet, overexertion, emotional or physical stress, lack of sleep, excess alcohol and surgical trauma. Therefore, to reduce outbreaks, a healthy lifestyle, which includes good nutrition, stress management, adequate rest and exercise, is necessary.

 

Excessive friction during intercourse has also been linked to outbreaks—usually, if intercourse is prolonged and vigorous and there is insufficient lubrication. In these instances, it is advisable to employ the use of personal lubricants.

 

 

Can I have a normal sex life after a herpes diagnosis?

 

Upon diagnosis, many people wonder what the infection will mean to their current sexual relationship or when searching for a new sexual partner. But, genital herpes does not mean that your sex life is over.

 

There may be a burden of responsibility to know that you have an incurable infection, but it is important to remember that your partner may already be infected. If they are, they may experience mild or unrecognized symptoms like many people who are infected.

 

For casual or short-term sexual relationships, use of condoms is recommended to aid in reducing the likelihood  of contracting a wide range of sexually transmitted infections. Avoid direct genital skin-to-skin contact during a herpes outbreak, as this is the time the virus is most likely to be passed on. Wearing a condom will not completely prevent transmission during an outbreak, as the virus may be present on the surrounding genital area.

 

It is possible in long-term relationships where both partners are knowledgeable of the genital HSV infection and the risk of transmission, for the couple to decide not to use a condom.

 

 

Is it possible to give herpes to a partner even when I have no outbreaks?

 

Yes. While infecting your partner is more likely during an active episode of herpes, i.e. when symptoms such as sores or blisters are present, the virus can still be present and transmitted even when no signs or symptoms are apparent - this is called 'asymptomatic shedding'. Approximately 70% of the cases of transmission of genital herpes result from asymptomatic shedding, because there are no signs or symptoms present and outbreaks are unknown.

 

Using latex condoms helps reduce the risk of transmission, but it’s not 100% effective since the virus can still be contracted through contact with other areas of the skin in the genital area not protected by the condom.

 

 

How can I inform my partner of my herpes diagnosis?

 

Many people find it difficult to discuss sexual heath issues. It is important to know and understand what and how you are going to tell a partner.

 

Generally, most people find their partners are both supportive and understanding. It is a common to assume a person may pass judgment on the fact that you have genital herpes. However, people who tell their partners of their diagnosis are rarely rejected.

 

 

Does herpes affect my ability to have children?

 

No, herpes has not been found to affect fertility or ability to have children.

 

Women with genital herpes may experience a safe pregnancy and vaginal childbirth—especially when her diagnosis of genital herpes occurred prior to pregnancy. To fight genital herpes, the body produces anti-bodies circulating in your blood, which protects the baby from the impact of infection during pregnancy and delivery.

 

In rare occasions, a woman may pass herpes to her new baby, which could lead to serious illness for the baby. This is most likely to happen if you acquire herpes for the first time in the last 12 weeks of pregnancy. It is important to discuss genital herpes with your doctor if you or your partner is infected and you are considering getting pregnant or are already pregnant.

 

 

Does having genital herpes put me at greater risk of contracting HIV?

 

Some evidence suggests that people with genital herpes are more likely to acquire HIV from an HIV-infected person during intimate contact, than those who don't have genital herpes. This is most likely to happen during sexual intercourse with an HIV-infected partner while experiencing an outbreak of herpes because the HIV infection has easier access into the body via open skin.

 

Also, further research suggests that when someone is infected with both HIV and HSV, the HIV virus may be increased in genital secretions which may increase the risk of transmitting HIV to others through sexual contact.

 

 

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Wald A, Langenberg AGM, Link K, et al.  Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women.  JAMA 2001;285: 3100-3106.

 

Wald A, Link K. Risk of human immunodeficiency virus infection in herpes simplex virus infection in herpes simplex virus type 2 – seropositive persons: A meta-analysis.  J Infect Dis 2002; 185: 45-52.

 

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Page last modified: January 4, 2008

Page last reviewed: January 4, 2008

Content Source: Division of STD Prevention, National Center for HIVion/AIDS, Viral Hepatitis, STD, and TB Prevention.

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