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What is herpes?
Herpes is one of the most common sexually transmitted diseases in the U.S. It is an infection caused by two different but closely related viruses, called Herpes Simplex Virus Type 1 (HSV-1) and Herpes Simplex Virus Type 2 (HSV-2). HSV-1 is usually transmitted by touching and kissing not by sexual contact. It most commonly causes “cold sores” or “fever blisters” on the lips but it can also cause sores around the teeth and gums when a child is first exposed or lesions by the eyes or face. However, HSV-1 can also be spread by oral sexual contact and then cause genital herpes. HSV-2 is almost always spread by sexual contact and causes genital herpes with painful lesions around the vulva, cervix, anus, and penis.
How common is herpes?
Almost 90 percent of Americans have the most common form of herpes – Herpes Simplex Virus type 1 (HSV-1) or oral herpes (“cold sores”) at some time in their life. Half a million Americans are diagnosed with genital herpes every year. However, many more do not know they have herpes because they have never had or noticed the symptoms.
How is herpes spread?
Direct skin-to-skin contact can spread herpes. This includes touching, kissing, and sexual contact (vaginal, anal, penile, and oral). Moist areas of the mouth, throat, anus, vulva, vagina, and the eyes are very easily infected. Herpes can be passed from one partner to another, or from one part of your own body to another part. If one partner has oral cold sores, he/she can pass on the virus during oral sex and cause genital herpes. Herpes is most easily spread when there are open sores. It can also be spread before the blisters actually form. It is very unlikely that herpes is spread by toilet seats, swimming pools, bathtubs, whirlpools, or moist towels. An infected mother can pass the virus to her baby during or after childbirth. Women who acquire the infection for the first time close to the time of delivery are particularly likely to pass the virus to their baby. Pregnant women should always let their doctor know if they have had herpes or been exposed to herpes.
What are the symptoms of oral herpes?
The first infection with HSV-1 or oral herpes often causes no symptoms but it may cause sores in the mouth around the teeth and gums (“gingivostomatitis”). Typically the infection shows up as small blisters on the lips (“cold sores” or “fever blisters”), a flare-up of an earlier infection. The flare-ups are more common during colds, fevers, and sun exposure.. Oral herpes can be spread through contact such as kissing, or though oral sex. Direct contact for a short amount of time is enough to spread the virus. Cold sores are annoying, can be dangerous to a newborn, and can cause genital herpes through oral sex.
What are the symptoms of genital herpes?
Genital herpes may be caused by HSV-1 from oral sex or from HSV-2 from genital sexual exposure. Infection with herpes may not cause any symptoms and the person may not know they have the virus until they pass it on to another person or get symptoms when the virus is “reactivated.” If you do have symptoms, they can begin from 2 to 20 days (usually within 2 weeks)after the virus enters the body. The first occurrence of symptoms during the first infection of genital herpes is called "primary herpes." You may have a tingling or itching in the genital area at first. You could have pain or soreness in the buttocks, legs, and groin area. Small, painful red bumps appear on the area near where the virus entered the body- on the labia, clitoris, vagina, vulva, cervix, anus, thighs, or buttocks in girls and penis, scrotum, anus, or buttocks in boys. These bumps turn into blisters or open sores. Between 24-72 hours after the small blisters show up, they can burst and leave painful sores.
Other symptoms of primary herpes infection can include:
Symptoms usually go away within 3 weeks; even faster if you are treated with medication. The sores usually scab over and heal without scars. But after going away, the virus stays in the body. It can "flare up" and cause sores again from a few days to years later. Symptoms are usually worst during primary herpes, and are milder with flares. However, the flares may come frequently enough or be painful enough that you may choose treatment for that too.
How is herpes diagnosed?
Your health care provider can diagnose herpes by looking at the sores during a physical exam and by testing fluid taken from the sores to see if you have HSV-1 or HSV-2. There are also type specific blood tests which can be helpful in some patients to figure out which virus type caused the symptoms or to figure out if one partner has been infected by herpes. If you think you have herpes sores, see your health care provider right away to see if you need testing and treatment.
Is there treatment for herpes?
Yes. Your health care provider can prescribe medications that quicken healing, make symptoms less painful, and lower the risk of getting outbreaks while you are taking the medications. These medications don't kill the virus and don't prevent you from getting outbreaks in the future. Once you catch the herpes virus, you always have it. Even when you don't have any symptoms, the virus is in the body and can "flare up." However, outbreaks usually become fewer and less severe as time goes on. Outbreaks can be prevented or treated early with anti-viral medication to lessen symptoms.
Does treatment cure herpes?
No. Although herpes cannot be cured, it can be treated! For oral herpes, using a sunblock around the borders of the lips and a hat can lessen the chance of cold sores from sun exposure. Medications can be used to treat herpes infections and to prevent genital herpes recurrences.
Is there anything I can do to relieve my symptoms for genital herpes?
Your health care provider will likely prescribe an anti-herpes medication to help your sores heal faster. If you are having frequent outbreaks, your health care provider may also suggest medication to lessen the number of episodes of herpes or to start treatment as soon as tingling or other symptoms start.
You can do several things to help relieve your discomfort or pain:
What is an outbreak or “flare-up” of herpes?
After you have primary herpes (first occurrence of herpes symptoms), symptoms go away but the virus stays in your body. The virus can "flare-up" at anytime and cause an outbreak of new symptoms. During an outbreak, new sores break out in the same places. Symptoms are less severe and last for less time (a few days to a week) than those that occurred during the first occurrence of symptoms. Symptoms that occur during outbreaks can include: blisters, sores, itching and pain.
You may have some early warning signs that an outbreak is going to occur. These include tingling, burning, and itching where you had sores before. These signs could start a few hours or days before the outbreak.
How often do outbreaks occur?
Half of the people who have herpes don't have any more outbreaks or flare-ups after the first occurrence of symptoms. This is especially true if the infecting herpes was HSV-1. Some people only get a few outbreaks, while others get many. People can have many outbreaks in a row and then go months or years without one. People with illnesses that weaken the immune system, such as leukemia and HIV, are more likely to get more outbreaks and have symptoms that are more painful and last longer.
What causes an outbreak?
It is not clear what causes outbreaks. Some ideas are:
Is there anything I can do to prevent outbreaks?
Make sure that are you are eating a healthy diet, getting enough rest, exercising, and finding ways to relieve stress. If you have frequent or severe outbreaks, talk to your health care provider about taking a medication to prevent outbreaks or to treat them early.
How can I prevent spreading herpes?
If you are having a herpes outbreak, you should not have any sexual contact until all sores have healed, the scabs have fallen off, and the skin is normal again. Using condoms lessens the chance of getting herpes but does not completely protect against spreading the disease because the condom does not cover sores on the body. Touching sores can also spread herpes to other parts of the body or to your partner. If your skin has become normal again and you have no symptoms of herpes, you can have sexual contact again but herpes can still be spread when there are no symptoms (although the risk is low). You should always use condoms whenever you have oral, vaginal, or anal sex.
If you get any of the typical warning signs that an outbreak may occur—tingling, burning, and itching where sores were before—you should stop having sexual contact until the “flare-up” is over. These signs can start a few hours or a day before the sores flare up. Talk to your health care provider about whether you should take medication to lessen your chance of transmitting herpes to your partner. Pregnant women should particularly avoid getting a herpes infection and let their doctor know if they have ever had symptoms of genital herpes.
The general rules to follow if you are having a herpes outbreak are:
Does herpes cause cervical cancer?
No! Cervical cancer is caused by infection with certain human papilloma viruses, not by herpes. However, you talk to your health care provider about when to start getting annual Pap tests.
Is there a connection between herpes and HIV infection?
People with herpes or other sexually transmitted diseases that cause genital sores are more likely to get HIV. The sores provide a place for the HIV virus to enter and start spreading. If a person with HIV also gets genital herpes, the herpes infection is likely to be more severe.
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Updated: 11/2/2009
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