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Herpes

Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Dec 13, 2018
Last Modified Date: Dec 13, 2018
Published Date: Dec 13, 2018

TABLE OF CONTENTS

Chapter 1: Herpes: The Basics
Chapter 2: Genital Herpes Symptoms
Chapter 3: Managing Genital Herpes
Chapter 4: Oral Herpes Symptoms
Chapter 5: Managing Oral Herpes
Chapter 6: Your Herpes tests came positive, now what?
Chapter 7: Diagnosis and Treatment of Herpes


Genital herpes is a viral infection caused by either of two viruses, herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). It is an extremely common infection in the United States, with more than one of every six people between the ages of 14 to 49 infected with genital herpes, according to the Centers for Disease Control and Prevention (CDC). So, what can be done about herpes? How is it treated? Is there a cure for herpes?

Herpes can periodically cause sores

Herpes: The Basics

Genital herpes is a viral STD, or sexually transmitted disease, that can be spread from one person to another during vaginal, anal or oral sex. It can cause pain, itching and sores in and/or around the genital area. However, it is important to note that many people who are infected do not have symptoms, which is why, according to the CDC, most people who have herpes are unaware that they are infected. For people who do have symptoms, the first ones typically appear within 2 to 12 days of catching the virus. Symptoms during this phase of infection, called the primary stage of herpes, may include any of the following:

  • One or more blisters on or around the genitals (vagina, penis, testicles), rectum or mouth. These blisters typically break open to become open sores that take a week or more to heal.
  • Headaches
  • Fever
  • Body aches
  • Swollen glands, particularly in the groin area
  • Vaginal discharge
  • Bleeding between menstrual periods
  • Pain while urinating
  • Fatigue (feeling very tired)

After that initial outbreak, the virus usually becomes inactive, which is called the latent phase of the disease. However, since the virus remains in the body, it can reactivate periodically, causing many people to have recurring herpes outbreaks. Symptoms of repeat outbreaks, which may happen several times a year, are typically less severe than that first one and may include:

  • Itching, tingling or pain in areas where outbreaks happened before
  • Aches and pains in the legs, back or buttocks
  • The appearance of herpes sores in or around the areas of the initial outbreak

Genital Herpes Symptoms

Herpes refers to a group of viral diseases that affect the skin or nervous system. Since herpes is a long-term condition, it's vital for those who have herpes to understand what it is; and, how to manage it. Symptoms can be infrequent, if they occur at all; so, it's best if patients can identify them at the first outbreak and take appropriate action to further manage the disease.

There's no cure for herpes; so, those who are infected will have the disease for life. Herpes is incredibly common. Roughly, one American in six has genital herpes; and, over half of Americans have oral herpes. Herpes is manageable when one knows what to do about the symptoms when they appear.

The Initial Genital Herpes Episode

Genital herpes can occur with both the HSV1 and HSV2 viruses. The HSV2 virus is more commonly associated with genital herpes. Patients with this virus have roughly four or five outbreaks of genital herpes each year. Patients with HSV1 typically experience oral symptoms; but they may exhibit genital herpes as well. Outbreaks with HSV1 tend to occur about once or twice a year; and, are less severe than those associated with HSV2.

After coming into contact with the virus, people typically have their first outbreak within two weeks. Most will experience symptoms within 24 hours. However, not everyone will experience their initial outbreak this quickly. Some patients don't have an outbreak for years, though they're carrying the virus unknowingly.

The initial herpes outbreak is usually the most severe. It can be quite alarming for a newly infected patient to discover the infection through this potentially painful outbreak. Around the affected area, the patient may feel itching, swelling, tingling, and pain. Other symptoms are flu-like and include:

Herpes testing

  • Fever
  • Loss of appetite
  • Headache
  • Fatigue
  • Swollen lymph nodes
  • Generalized aches and pains

These symptoms may last for a few hours or a few days. Once this period has passed, the individual will often see the genital blisters that are characteristic of the disease. These lesions are red and inflamed, often appearing in clusters. After several days, the blisters crust over and heal. They don't leave permanent scars.

Genital herpes lesions typically appear around the vagina in women. They may also occur in the cervix, where they're less noticeable. Men tend to experience lesions on the shaft of the penis. The sores can also appear on the thighs, buttocks, and anus for both men and women.

Herpes lesions can continue to form over a period of roughly 10 days. These lesions last longer during the first outbreak than they will in later outbreaks, and may persist anywhere from two to six weeks. Some patients mistake genital herpes lesions for jock itch, insect bites, an allergic reaction, or a yeast infection. If you suspect that you might have herpes symptoms, you should speak with your doctor as soon as possible for a conclusive diagnosis.

Recurrent Genital Herpes Episodes

Though later outbreaks of genital herpes are usually less severe, they still come with several symptoms. It's important to identify these symptoms and be aware of the possibility of outbreaks at any time. If you did not identify the virus with the first outbreak, these subsequent outbreaks can help you recognize the presence of genital herpes so you can begin getting the care that you need.

Compared to the initial outbreak, subsequent genital herpes outbreaks are usually much less severe. These outbreaks last about half as long as the first outbreak, rarely lasting longer than 10 days. The lesions are often small enough to be mistaken for razor burn, pimples, or ingrown hairs. Patients are unaware that the virus is active in about a third of their outbreaks.

Herpes, along with other STDs, can cause an inflamed cervix in women, known as cervicitis. Patients may notice an unusual discharge, spotting between periods, or discomfort during intercourse. The condition can be quite uncomfortable but will clear when the underlying infection receives treatment.

Genital herpes may also reactivate without any lesions at all. This is known as asymptomatic reactivation.

Symptoms of Prodrome

Prodrome is a warning that can alert you to a pending herpes outbreak. Not all patients experience prodrome, but those that do can prepare for an outbreak appropriately by paying attention to this sensation. Prodrome can occur hours or days before the herpes outbreak. Patients typically notice a peculiar sensation of tingling, itching, or general discomfort in the genital area.

Prodrome symptoms may include:

  • Nerve pain in the legs
  • Tender muscles
  • Shooting pains in the legs, buttocks, or groin
  • A pinching or stinging sensation in the genital area

Prodrome is more common in the first few outbreaks. As the body builds more immunity to the virus, these symptoms are less noticeable. Patients should pay close attention to sensations that may indicate prodrome so they can enjoy the benefits of a little advance warning before a genital herpes outbreak. Prodrome can alert you to an active period in which the virus is shedding, even when lesions never occur.

If you believe that you're experiencing prodrome, you should take precautions to avoid spreading the herpes virus. Avoid sexual intercourse, even if your partner also has herpes. Sexual activity may worsen the symptoms of your outbreak. If you've been provided with antiviral medication, prodrome is a key indicator that it's time to start taking it.

Many people have triggers that will spur on an outbreak of genital herpes. If you're experiencing prodrome, you may want to consider your diet and activities over the last few days to see if you can identify anything that may be causing your herpes outbreaks.

Frequency of Genital Herpes Symptoms

As mentioned previously, genital herpes can occur with both HSV1 and HSV2. As much as 30 percent of genital herpes is caused by HSV1, yet only 2 to 5 percent of these infections result in recurring genital outbreaks. Patients with genital herpes caused by HSV1 may experience few outbreaks if any. On average, these outbreaks occur about once a year. HSV2 outbreaks can occur as much as 10 times more often than HSV1 outbreaks.

Though these averages can give you a general idea of what to expect with genital herpes, there are many variables that will impact how often you have symptoms. You're more likely to experience a genital herpes outbreak if you have a compromised immune system. This may occur as the result of HIV, cancer, or a severe burn. Patients taking immunosuppressant medications are more likely to experience genital herpes outbreaks. The longer you have genital herpes, the less frequent your outbreaks will be.

Genital Herpes Triggers

Certain conditions often trigger genital herpes outbreaks. Understanding these conditions can help patients take steps to avoid any unnecessary outbreaks. Tracking your outbreaks can help you identify common personal triggers. These vary from one person to the next, so it's important to pay attention to what happens to your body.

Some common triggers of genital herpes include:

  • Illness which compromises the immune system
  • Surgery
  • One's menstrual cycle
  • Hormonal changes
  • Periods of stress
  • Sexual intercourse
  • Smoking

Your dietary choices may trigger genital herpes outbreaks as well. Foods high in arginine, such as chocolate and nuts, are common triggers. Beverages high in caffeine can also be problematic. Red wine causes outbreaks in some people, too. While you should strive for a healthy diet to help keep your genital herpes under control, you should not engage in an overly restrictive eating plan.

If you're struggling with frequent genital herpes outbreaks, try keeping a journal of your diet and activities. Examining this information over a period of time, you might notice commonalities such as a higher number of outbreaks at a certain point in your menstrual cycle, after high-stress work presentations, or when you're drinking more often. Herpes is different for everyone, so you should take the time to examine what the virus looks like for you.

Genital Herpes Infection and Risk Factors

Getting tested for herpes

Patients with genital herpes don't always experience a noticeable outbreak. Many infected individuals carry the virus for a long time before realizing that they have it. Understanding the risk factors for genital herpes will help you avoid the disease, when possible; and, take the appropriate actions if you've been in a situation in which you might have been exposed to the virus.

Genital herpes caused by HSV1 is spread through oral sex. HSV2 is typically spread through sexual intercourse. The herpes virus doesn't survive long on non-living surfaces; so, you can't get it from somewhere like a toilet seat.

If you have unprotected sex, you're at a higher risk for contracting genital herpes. You should speak with your partner about his or her sexual history, but do keep in mind that many people with herpes are unaware of it. If your partner has engaged in high-risk sexual behavior, you may discuss getting tested for herpes and other STDs.

Condoms can help prevent the spread of genital herpes, though they're not 100 percent effective since herpes can exist on other parts of the body beyond the genitals. Avoid having physical contact when a genital herpes outbreak is active. If you have been diagnosed with genital herpes, speak with your doctor about herpes medications that can reduce your risk of spreading the virus.

Managing Genital Herpes

Genital herpes outbreaks can be uncomfortable, but there are several things that you can do to minimize your symptoms and get through an outbreak with little disruption to your daily life.

Taking an antiviral medication such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) can reduce the severity of an outbreak if taken at the first sign of symptoms. You can also reduce the frequency of your outbreaks by taking these medications daily. Speak with your doctor to determine which schedule is best for your case.

During a herpes outbreak, you should keep the infected area clean using soap and water. Use a separate towel to clean the area and launder this immediately after use. Avoid antibiotic ointments, which ultimately hinder airflow to the sores. Avoid restrictive clothing, which may cause chafing. Choose breathable, loose-fitting cotton.

A warm bath, cool compress, or cool air from a blow dryer can ease some of the discomfort of herpes sores if they're particularly severe. Ibuprofen, acetaminophen, and aspirin can help relieve pain.

When to Get Tested for Genital Herpes

Testing for genital herpes isn't recommended for individuals who do not have symptoms. False positive results could then be possible. So, this STD isn't screened for as regularly as others. However, there are some specific cases in which herpes testing is recommended.

Pain or Burning During Urination is a Symptom of Herpes

If you or your partner has had any symptoms that may be associated with genital herpes, you should speak to your doctor about getting tested. Individuals who have had multiple sexual partners may also request a test.

If you have active lesions that you believe may be from genital herpes, your health care provider can take a sample of the cells from these sores to determine whether they are from genital herpes. A PCR blood test can also determine if you have genital herpes. You may get a false negative if you were infected too recently to form antibodies in the blood, or if your provider swabs sores that have already begun to heal.

Oral Herpes Symptoms

Oral herpes is most commonly caused by the HSV1 virus. The lesions associated with oral herpes are often referred to as fever blisters or cold sores. Some people may refer to herpes blisters as canker sores; but, this is inaccurate. Canker sores are not contagious. They are caused by an irritation of the mouth.

Herpes sores typically appear on the lips or around the mouth. In some cases, patients might experience sores on the chin, on the cheek, at the back of the throat, or inside the nose.

The first outbreak of oral herpes is the worst. This usually occurs two to 12 days after the initial contact with the virus. The outbreak may begin with itching, burning, or tingling before the sores erupt. Individuals typically experience fluid-filled blisters that may appear singly or in clusters. These lesions have a red base around small gray ulcers. If you're not familiar with the symptoms of oral herpes, you might mistake these sores for insect bites, pimples, or even chapped lips.

As the lesions heal, they will crust or scab over. At this point, the sores take on a dry, yellowish appearance. During this outbreak, you may experience flu-like symptoms such as fatigue, fever, enlarged lymph nodes, and muscle aches.

Recurrent oral herpes outbreaks are less severe than the initial outbreak. Patients will notice similar symptoms, but the sores will typically clear faster, and the outbreak may be smaller and less noticeable.

Frequency of Oral Herpes Outbreaks

The frequency of oral herpes outbreaks varies from one person to another. The longer you've had the virus, the less frequent your outbreaks will typically be. Since many people contract HSV1 as children, they may have few to no outbreaks as adults. Individuals who contract an oral case of HSV2 usually see no outbreaks at all. HSV2 is more commonly associated with genital herpes, but you can get it orally through oral sex.

Those with a strong immune system will have fewer outbreaks, while individuals with a compromised immune system will typically see oral herpes appear more frequently. There are many other triggers that can increase the frequency of oral herpes outbreaks, as discussed in the next section.

Oral herpes outbreaks usually last anywhere between eight to 10 days. If your symptoms last two weeks or longer, you should see your health care provider. There may be an underlying infection that's preventing your herpes outbreak from clearing as it should.

Oral Herpes Triggers

Understanding the triggers that might cause your oral herpes to flare up can help you avoid outbreaks, as much as possible. Individual triggers vary from one person to another; so, you may want to track your diet and other activities to determine what is truly causing your outbreaks, particularly if you have oral herpes outbreaks often.

Sunlight, is a common trigger for oral herpes outbreaks, that patients might easily overlook. Pay attention to your outbreaks; and, note whether they happen after prolonged exposures to the sun. Avoiding these UV rays can help limit herpes outbreaks, particularly in the summer months when you're likely to have more exposure.

Illnesses, such as colds, weaken the immune system and may trigger an outbreak. If you have a fever, immune depression, or experience trauma to a nerve region where you've had a previous outbreak from; then, you're at a higher risk for getting fever blisters.

Stress and fatigue may trigger herpes outbreaks. Though these aren't always easy to control, taking measures to keep stress levels under control and getting adequate sleep at night will help protect you from getting fever blisters.

Women may notice that herpes outbreaks occur at a particular time in their menstrual cycles. Hormonal changes can trigger these sores. Tracking your cycle might help you better predict when an outbreak is likely to occur.

Oral Herpes Infection and Risk Factors

Oral herpes is easy to transmit via contact with the skin or saliva. It's not an uncommon virus, and the infection rate is much higher than many people realize.

Oral herpes is transmitted through contact with the herpes simplex virus, when the contagious area comes in contact with broken skin or mucous membrane tissues around the mouth and genitals. Oral herpes is often passed through something as simple as a kiss on the face. Many patients contract herpes this way when they're children. An individual can transmit oral herpes even when sores are not present.

You can minimize your risk of contracting oral herpes by avoiding contact with those who have an active outbreak. However, it's important to understand that oral herpes is incredibly prevalent. In the Americas, nearly half of all women and almost 40 percent of men carry HSV1. Contracting oral herpes is not always as disruptive to one's life as you might imagine.

Managing Oral Herpes

No cure exists for oral herpes yet; so, it may be valuable for patients to know how to handle outbreaks when they occur. You can take several steps to ease the discomfort of oral herpes and aid the healing process. Antiviral pills can speed the healing process when taken at the start of a herpes outbreak. Prescription medications can decrease pain at the lesion site and reduce the length of a herpes outbreak by roughly half a day.

If you're dealing with a significant amount of pain, you can use a topical anesthetic to speed healing and reduce discomfort. Something as simple as a cold, moist compress can help with pain as well. Aloe Vera gel offers a similar effect by cooling the area.

You can limit the spread of a herpes outbreak by boosting your vitamin C intake so your body is more able to fight the infection. Applying a warm tea bag to the sores for about 15 minutes, three to four times a day, may minimize the spread of the outbreak as well.

When to Get Tested for Oral Herpes

Many doctors can diagnose oral herpes with a visual examination during an active outbreak. To confirm the diagnosis, your physician might perform a viral cultural analysis, PCR test, or staining test.

If you believe that you may have oral herpes, speak with your doctor as soon as possible, whether you have an active outbreak or not. Your physician can speak with you about prescription medications that may help you better control outbreaks so you'll suffer less from the uncomfortable sores associated with this virus.

While no cure for herpes exists, patients can manage it and live comfortably. Knowing that you have herpes is the first step in taking better control of the disease. It's important to speak with your doctor if you've had symptoms of either genital or oral herpes so you can get tested and take the proper steps going forward. A few smart precautions can minimize your outbreaks and help prevent the spread of the virus to others.

Symptoms of Herpes: Men vs. Women

What are the Common Symptoms of Herpes in Men?

Symptoms of genital herpes in men are often very mild, if any symptoms occur at all. According to the CDC, approximately one of every five men has genital herpes, and about four of every five who do, or 81.1 percent, have not been diagnosed and are likely unaware of the disease. In men that do experience symptoms, the most common include:

  • Irritation, itching, burning or tingling on or around the mouth, face, penis, scrotum, thighs or buttocks
  • Development of herpes lesions in the areas cited above
  • Burning or pain with urination
  • Fatigue
  • Swollen lymph nodes, which can occur in the neck or groin
  • Headaches
  • Chills
  • Fever
  • Muscle aches, especially in the lower back or groin area

Perianal mucocutaneous lesion caused by Herpes Simplex

What are the Common Symptoms of Herpes in Women?

Women are more likely than men to show severe symptoms of herpes infection. Common herpes symptoms in women include:

Herpes lesions, typically developing in clusters, on the vulva, labia, clitoris, inside the vagina, anus, buttocks or thighs, often proceeded by itching, tingling or pain in the infected area

  • Fever
  • Muscle aches
  • Headache
  • Swollen lymph nodes in the neck or groin
  • Nausea and/or decreased appetite
  • Pain or burning during urination
  • Vaginal discharge
  • Menstrual cycle changes

How to Find Out if You Have Herpes

If you have noticed symptoms that cause you concern or suspect that you may have been exposed to the virus by a past or current sexual partner, finding out whether you have been infected as soon as possible, is important. Firstly, it is essential to your own sexual health to be aware of a herpes infection. Secondly, it is important to ensuring that you are not spreading the virus to others. So how can you find out?

By getting tested for herpes. This is something every sexually active person should be doing regularly. According to CDC screening guidelines, most sexually active people should be tested for common STDs once a year, since anyone who has vaginal, oral or anal sex is at risk for these infections.

Getting tested is a quick and simple process. Tests that are commonly used to detect herpes virus in the body include:

Herpes blood tests – These tests look for antibodies to herpes simplex virus (HSV) types 1 and 2 in a blood sample. Antibodies are made by the immune system, resulting from exposure to these viruses, so a positive result can indicate herpes infection. However, it is important to note that antibodies can take a few weeks to build up to detectable levels after a person has been infected with herpes. For that reason, people who think they may have been exposed to the virus should have testing done 3 to 4 weeks after that suspected exposure, and if results are negative, get tested again after another 12 weeks has passed to ensure accurate results.

Viral culture tests – This test can only be done if you have active symptoms, since it involves using a swab to take a sample of the fluids inside a sore, which is then processed by a lab to look for the viruses that can cause herpes.

Polymerase chain reaction (PCR) tests – These are blood tests that look for the DNA of the herpes viruses in a blood sample to detect infection and/or determine whether a herpes infection is caused by HSV type 1 or type 2.

If you think you have herpes, there are things you can do

Your Herpes tests came positive, now what?

Have you had a Herpes test that came back positive? According to the Centers for Disease Control and Prevention (CDC), more than one out of every six people between the ages of 14 and 49 years old have genital herpes. After your diagnosis, you may be under the impression, as are many newly-diagnosed individuals, that your sex life is over and you are doomed to be alone. However, as common as that impression is, it is a false one. It is very possible to have a healthy and fulfilling sex life while living with herpes. Here are some pointers on how to have safe sex with herpes.

Communicating with Your Partner is Vital

This is most likely a very important step you can take in terms of having safe sex with herpes. As difficult as it can be, it is essential to be very upfront with current or new sexual partners about your diagnosis. Fact is, taking the right precautions can make transmitting the disease to your partner very unlikely; but, cannot totally eliminate his or her risk of infection. Your partner deserves the opportunity to make an informed decision about his or her own health, since he or she will be assuming some level of risk of contracting the disease. Additionally, if this is or may become a longer-term relationship, being honest right from the start establishes a solid foundation of trust for a healthy relationship. It is also important to note that in some states, there are legal penalties that can become an issue for people who know they are infected with herpes; and, fail to disclose that information to their partner especially if that partner develops the disease.

Avoid Sexual Activity When Symptoms Are Present

You have a higher risk of transmitting the virus to others when herpes sores are present; so, be sure to avoid all sexual contact when you have an outbreak or when you feel one is coming up. Recurring outbreaks may be very mild; so, if you are sexually active, examine yourself carefully and regularly. While some outbreaks may exacerbate as painful blisters or sores, others may be less obvious. These latter can be in the form of small red bumps, resembling pimples, a simple rash, or even ingrown hairs on the genitals, buttocks or thighs that may or may not produce an itching, tingling or burning feeling. Even during mild outbreaks, the herpes virus is active, which means that it can easily be transmitted to your partner.

Seek Treatment

Herpes has no cure, but it can be treated. Seeking treatment can not only make outbreaks less frequent and severe making the disease easier to live with; but, it can also greatly reduce the risk of transmitting the virus to others. The most common and effective treatment options for herpes sufferers are antiviral medications. These can reduce your risk of transmitting herpes to a sexual partner by 50 percent, as long as you are careful and take your medications daily as prescribed by your doctor.

Learn About Effective Protection

Herpes is spread via skin to skin contact, and there is some level of risk even when no obvious herpes symptoms are present. For this reason, use barrier methods to reduce your risk of transmitting the virus to others. Condoms should be part of every sexual encounter, including sexual intercourse, oral sex and anal sex, and dental dams are an important precaution to take when performing or receiving vaginal, anal or oral sex.

Be Vigilant About Taking Precautions during Sex

Condom usage can prevent genital herpes

The combination of taking antiviral suppression therapy and the effective use of condoms and/or dental dams during sex, can make the risk of transmitting herpes to your partner very small. However, getting that type of prevention means that you will need to be very consistent while taking these measures. This implies that you will need to take your antiviral medications regularly as instructed by your doctor; and, be vigilant about using protection in every sexual encounter. The only potential exception to that rule is if you are having sex with a partner who already has herpes, since being exposed to the herpes virus again presents no added risk. However, using condoms and/or dental dams is still important to reducing risk of other STDs – which can be easier to catch when you have herpes. So, unless you are in a long-term monogamous relationship with this partner and you have both been tested for STDs, it is still wise to take precautions.

Regular STD Testing Is Important

Even with all those precautions, you should get screened regularly for STDs, since the only 100 percent certain way to protect against all STDs is to avoid sex entirely. Both you and your partner should be tested for common STDs about once a year, and that screening should include herpes testing for your partner. Other important times to get tested are when you have a new partner, are having sex with more than one partner; or, have had any type of unprotected sex, whether it is sexual intercourse or just oral sex.

Be Well Informed About Herpes and Well Equipped to Explain It

As mentioned above, effective communication with a current or potential partner is the key to a safe and fulfilling sex life. That means being very sure of the facts surrounding your condition, able to explain the precautions you and you partner need to take to be safer during sex and how they help to reduce risk of herpes transmission. Being well-informed about these matters will give you the opportunity to explain them thoroughly to your partner, helping you reassure him or her about your concern for his or her sexual health. Of course, it will also help you protect your own sexual health, which is just as important to enjoying a happy, healthy and safe sex life after a herpes diagnosis.

Is There a Cure for Herpes? Treatment for Genital Herpes

The short answer to that question is no, herpes cannot be cured yet. However, it can be controlled very successfully in most cases. That means that a positive screening test, or a herpes diagnosis, is not the end of the world, and it does not ignal the end of your sex life.

The primary method of treatment used to manage genital herpes is antiviral drugs, which can offer relief in many ways. Among the potential benefits of these drugs are:

  • Faster healing rate for sores during the initial herpes outbreak
  • Aid in reducing the severity of symptoms during repeat outbreaks and shorten the time it takes for those symptoms to clear
  • Less frequent outbreaks
  • Greatly reducing the risk of passing the herpes virus along to sexual partners

According to Medical News Today, antivirals may be prescribed in a couple of different ways to help control herpes. In some cases, they are used only when outbreaks happen. This is called episodic treatment and is generally used to treat patients who have fewer than six outbreaks over a period of one year. Typically, a 5-day course of antiviral medication is prescribed each time herpes symptoms appear.

Suppressive antiviral therapy is the other common way antiviral medications are used to treat herpes. For this type of treatment, patients are asked to take antiviral drugs every day. The goal is to prevent future outbreaks as well as minimize the risk of spreading the disease to a partner. Generally, this form of treatment is most likely to be recommended to herpes sufferers who have frequent outbreaks and/or severe ones that significantly impact their quality of life.

Diagnosis and Treatment of Herpes

Individuals experiencing any of the symptoms associated with herpes should avoid getting tested immediately, one has to wait a given amount of time. Several diagnostic tests can be used to detect the presence of herpes infection. If herpes lesions are present, fluid from those lesions will typically be swabbed and tested for the presence of HSV 1 or 2. DNA testing of either blood or tissue samples can be done to detect the virus or determine the specific types present. Blood tests can also be performed to detect antibodies to HSV in the bloodstream.

While herpes is an incurable disease, it can be treated with antiviral medications. Antiviral creams or ointments can be used to alleviate the pain, itching and discomfort of herpes lesions. Oral antiviral medications can be used to shorten or even suppress recurrent herpes outbreaks; and, can decrease the risk of the virus being transmitted to others.

Herpes: some questions answered

How Common is herpes?

A virus infection that affects the sex organs, genital herpes is transmitted through sexual intercourse or oral sex. Both sexes and all ages can be affected. It is caused by the Herpes type 2 virus (HSV-2) and is often confused with the Herpes type 1 virus (HSV-1) which causes common cold sores around the mouth. The two are distinctly different viruses but can cause similar symptoms.

Up to 70 percent of adults report having common oral herpes (HSV-1) by the time they are 40. This type of virus is typically transmitted through nonsexual means, often from an adult who carries the HSV-1 virus, or from other children. (HSV-2 infections can also occur around the mouth but they are uncommon).

Genital herpes, or HSV-2, is one of the most frequently reported sexually transmitted diseases, with about 50 million adults over the age of 15 believed to have genital herpes. Generally transmitted by a sexual partner who has active herpes lesions, there is a relatively high risk of the disease among teens and young adults who are newly sexually active. The lesions can be on the genitals, hands, lips or mouth and can include the Herpes type 1 virus.

The risk for genital herpes is generally higher if you have an illness that has lowered your immune system. Some people report emotional or physical stress as a “trigger,” as well as genital trauma, sunbathing, menstruation or certain types of infections. There is no cure at present but antiviral drugs are effective in treating symptoms and reducing the severity of outbreaks. It has been reported that first outbreaks are the worst in severity, with recurring outbreaks milder. Men tend to experience recurrence of herpes more frequently than women.

What are the main signs of herpes that I need to notice to get tested?

Though you can have a sexually transmitted disease without any symptoms, the following 10 signs and symptoms may indicate that you have genital herpes. The only way to have the proper diagnosis is through a lab test for herpes. These are the general signs.

Herpes sores on male back

  • Severe itching or irritation of the vaginal lips or penis.
  • Development of painful blisters within 2 to 20 days of the first infection, on the vaginal lips or on the penis. These blisters may extend from the vagina to the cervix and the urethra.
  • Painful and/or difficult urination.
  • On occasion, enlarged lymph glands.
  • Fever and a generalized feeling of illness that is often mistaken for the flu or another type of virus. In rare cases, there may be headache, back pain, leg pain, stiff neck, sore throat and heightened sensitivity to light, along with fatigue. These symptoms can easily mimic the flu.
  • Episodic outbreaks - symptoms that last for just a few days and then disappear for long periods of time. The period of infection in which symptoms are present is called an “outbreak.”
  • Itching, tingling or pain in the area where the outbreak takes place – a warning that the virus is reactivating.
  • In women, vaginal discharge or pain during urination. In men, there could be burning urination without lesions or discharge. While symptoms can vary from person to person, they are often mistaken for a yeast or bladder infection in both men and women.
  • If anal sex is involved, a herpes infection can occur in the anal and rectal areas. Symptoms in these areas can include rectal pain and discharge. Fever, muscle aches and changes in bowel movements may also occur.

In rare, but potentially serious cases, herpes outbreak infections can cause inflammation of the spinal cord (viral meningitis), stiff neck as well as eye pain. Fortunately, this type of secondary complication rarely happens.

Can genital herpes be transmitted from mother to child?

Though the risk of transmitting herpes from mother to fetus is small, if the woman acquired the infection prior to pregnancy, it’s a good idea for both partners to be tested for herpes. They may also want to discuss any possible existing risks on the infant with a healthcare provider, once a pregnancy is confirmed. Using condoms helps decrease the risk of transmitting herpes. If your symptoms differ from those described above, please see other common STD symptoms.

Do I have Herpes? What do I do next?

Whether you're experiencing symptoms that make you suspect you've contracted genital herpes; or, have been told that a partner has been diagnosed with the disease, asking the question “I think I have herpes – what do I do now?” is a very common and understandable reaction.

In many cases, symptoms can be an indication that you have contracted herpes. In patients who experience herpes symptoms, the first outbreak generally occurs within 1 to 2 weeks of a person's exposure to the virus. Among the most recognizable symptoms of herpes are sores on the skin or mucus membranes, typically on or near the genitals, that first appear as small red bumps; then, develop into blisters that pop and become open sores before fading away. This is a process that generally takes place over a period of 2 to 3 weeks. Other common effects include flu-like symptoms, such as fever, swollen glands, headache and muscle aches. However, the absence of symptoms does not necessarily mean that you have not been infected. A large proportion of people who have herpes do not present symptoms at all. Some may present very mild ones that are often mistaken for other skin conditions.

So how can you tell if you have herpes? Even if you have suspicious symptoms, herpes testing is the only way to know for sure, since many other skin conditions can cause herpes-like sores. If you have sores, your doctor can take a swab of fluid from those sores, which will be cultured in a lab to determine whether the herpes virus is present. If so, further testing can be done on that sample to determine whether you've been infected with herpes simplex type one or herpes simplex type 2. If you suspect you've been exposed but haven't developed any symptoms, or perhaps had sores that have already healed, blood testing can be done to detect herpes infection. These tests look for antibodies to the herpes virus; and, if they are present, can determine whether you’re infected with herpes type 1 or herpes type 2.

Once the diagnosis is positive. Here is what comes next! Firstly, seek treatment. Antiviral medications can help suppress outbreaks and reduce your risk of infecting others with herpes. Using condoms when you have sex can reduce – but not eliminate – transmission risk as well. It is important to abstain from sex during outbreaks, and to be aware that is possible to transmit herpes even when you have no symptoms. For that reason, it is important to inform partners that you have herpes and explain the risks.

Your doctor may also recommend dietary changes as part of your herpes treatment, since keeping your immune system strong can minimize outbreaks. Additionally, you may be asked to reduce your intake of certain foods to help prevent flare-ups, such as sugary foods and foods that are high in arginine – an amino acid that can help viruses grow and multiply. Foods high in arginine include nuts and seeds, coconut, chocolate, orange juice, wheat products, lentils, oats, gelatin and protein supplements. Balancing arginine intake with increased amounts of lysine, another amino acid that inhibits viral activity, can also help. Foods rich in lysine include vegetables, chicken, fish, beans and eggs. Your doctor may also suggest a lysine supplement to aid in suppressing the herpes virus.

Does Herpes last forever?

Once you've been infected with genital herpes, the virus will remain in your body forever. However, the good news is that herpes does not cause any serious health issues and, in most cases, it will remain dormant most of the time. The first outbreak is typically the worst, and outbreaks generally become less frequent and severe over time. Last, but not least, herpes is not the end of the world. While getting diagnosed with the disease can certainly be traumatic, most people who have herpes go on to live full, happy lives that are complete with long-term relationships and even have children.

References:

Centers for Disease Control and Prevention. (2017). Genital herpes — CDC fact sheet (detailed) [Fact sheet]. Retrieved from: www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

Herpes signs and symptoms. (n.d.). Retrieved from: www.ashasexualhealth.org/stdsstis/herpes/signs-symptoms

Medicine Net. Genital Herpes in Women Symptoms, Signs, Transmission, and Treatment. Retrieved from: www.medicinenet.com/genital_herpes_in_women_overview/article.htm