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How can I tell if I have genital herpes? What are the symptoms?

How can I catch it?

Can it be passed on through oral sex and what is the difference between HSV-1 and HSV-2?

Is there or will there be a cure?

Will I have more outbreaks?

What can I do to prevent outbreaks?

What are the best treatments?

Does it mean my sex life is over?

Can I pass it on even when I have no outbreaks?

How do I tell my partner I have herpes?

Can I have a baby?

Can I purchase herpes medications via the internet?

Are people with genital herpes at greater risk of acquiring HIV?

How can I tell if I have genital herpes? What are the symptoms?

Symptoms of genital herpes can vary widely from person to person. For some individuals symptoms can appear as a small area of redness, sometimes with raised bumps (papules) or fluid-filled blisters, ulcers (sores) or a small cut or abraded area. For many, these signs may go unnoticed or are mistaken for another infection such as thrush (or yeast infection), or they may be confused with mild abrasions in the genital area which could have been caused by sporting activity or vigorous sexual intercourse.

Other people experience more obvious symptoms which may include the following:

If you think you have genital herpes, go to a doctor or sexual health clinic as soon as possible. The doctor will need to examine the genital area to make a diagnosis. Sometimes the symptoms of genital herpes are so typical that the doctor can make an accurate diagnosis straight away, however this should always be confirmed by a swab test to detect the virus.

Remember, people who present with so-called typical lesions are the minority. 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. When the herpes outbreak is mild, the swab may not pick up the virus, and some people have repeated swabs with recurrent outbreaks before the diagnosis is confirmed.
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How can I catch it?

Genital herpes is passed from person to person through direct skin-to-skin, genital-to-genital or mouth-to-genital contact. Therefore, it is most commonly transmitted during intimate sexual contact. Many people first discover they have the infection at some time during the course of a long-term, monogamous relationship. Evidence of infection in a long-term relationship does not necessarily indicate that there have been other, recent sexual partners.

Many people try to find out which sexual partner passed on the virus; clinics in some countries still advocate ‘contact tracing’. This may be difficult or even impossible because symptoms of infection can be so mild in some people that it goes unrecognised; there may even be no symptoms. Approximately 80% of people with the genital herpes virus are unaware they are infected, either because they have no symptoms or symptoms are unrecognisable and the individual remains undiagnosed.

Genital herpes is not caught from toilet seats, towels, sharing baths, showers and soap. Neither is it caught through trying on clothes, nor by sleeping in the same bed as someone who has herpes.
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Yes, herpes can be passed on through oral sex. Many people do not realise that 'cold sores' on the mouth and facial area are caused by herpes simplex virus (HSV). HSV-1 is most often the cause of facial herpes and HSV-2 is more frequently the cause of herpes in the genital area. 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.

Herpes in the facial area is most infectious when there is an active outbreak, with blistering or cracks causing a 'cold sore.' This is a time to avoid oral sex as there is a high likelihood of passing the virus to the genital area of a partner. However, the virus may be passed even at times when there is no evidence of an outbreak.
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Is there or will there be a cure?

Although there is research being conducted to find a cure, there is no absolute cure for herpes infection at the present time. Research is being carried out with HSV vaccines, which may be effective both at treating herpes outbreaks and preventing acquisition of infection, but these are still in the development stage.

The body's immune system effectively deals with this viral infection in the majority of people, meaning that for many people, the infection is mild or unrecognised.

Effective oral antiviral medication can be prescribed for people who experience physical and/or psychological distress from genital herpes.
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If you have an initial genital herpes outbreak caused by HSV-2 there is an 80-90% chance that you will experience recurrences. If you have genital HSV-1 infection, there is a 50% chance that you will have recurrences. For those who have HSV-2 the number of outbreaks varies from person to person. The average number tends to be 4-5 per year, but outbreaks 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 experience ongoing confusion over symptoms and whether or not they are having another herpes outbreak or whether they have a yeast infection or some other skin condition. It is therefore helpful to find a doctor with whom you have a good rapport and can go and discuss these concerns and have a check-up to clarify issues. Alternatively, a visit to a specialist STD clinic may be preferred, where staff are experienced in talking to patients who may have herpes.

Remember - effective oral anti-viral treatments are available for problematic herpes.
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What can I do to prevent outbreaks?

Although there is not usually an obvious reason for a herpes recurrence, there are certain trigger factors that some people identify as causing an outbreak.

This may be anything that reduces your general well-being, including, illness, poor diet, being run-down, emotional or physical stress, lack of sleep, excess alcohol and surgical trauma. A healthy lifestyle which includes good nutrition, stress management, adequate rest and exercise can, therefore, help reduce outbreaks.

Some people find that excessive friction during intercourse may trigger an outbreak. This is most likely to occur if intercourse is prolonged and vigorous and there is insufficient lubrication. A personal lubricant may be helpful in these circumstances.
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What are the best treatments?

The most effective treatments are oral anti-viral therapies, which work by preventing the herpes virus from multiplying. They can be used in two different ways:

To treat the symptoms of a herpes outbreak as they appear – this is called 'episodic' treatment. If started promptly, the treatment may shorten the duration of the outbreak and speed up the healing process. It may also help to reduce the pain and severity of the outbreak.

To prevent recurrent outbreaks – this is known as 'suppressive' therapy. This approach is normally used for people who are particularly affected by their symptoms or for people who experience frequent or severe outbreaks. The treatment is taken on a continuous daily basis to prevent or reduce the frequency of outbreaks.

These medications can only be prescribed by a doctor.

Topical anti-viral products such as creams or gels are available over the counter in some countries. However they are not recommended as a treatment for first episode or recurrent genital herpes, as they have only marginal benefit.

Many people make enquiries about 'natural' remedies and their place in the treatment of herpes simplex virus. Caution is recommended when considering alternative medicines. People living with herpes are often a vulnerable target group for those touting miracle cures, which never come cheaply. The natural course of HSV infection, in most people, is such that the number of episodes reduces over time and some people never have recurrences. Therefore 'cure' claims are often linked to outcomes that were inevitable even without the 'natural' remedy. Some people apply 'natural' remedies directly to the genital area. Just because a product is 'natural' it does not mean it is necessarily suitable for the delicate skin and mucous membrane of the genital area, and it may possibly delay healing, rather than help the process.

For further information see our 'Treatment Options for Genital Herpes' leaflet.
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When first diagnosed with genital herpes, many people are anxious about what the infection will mean in a current sexual relationship or when searching for a new sexual partner. No – genital herpes does not mean that your sex life is over.

Some people experience a burden of responsibility when they know that they have an incurable infection, It is important to remember that your partner may already be infected. If they are, they may experience mild or unrecognised symptoms like many people who are infected.

For casual or short-term sexual relationships, protection in the form of condoms is recommended to help to reduce acquiring 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.

In an on-going relationship where both partners fully understand the implications of genital HSV infection and the risk of transmission, the decision not to use condoms may be agreed.
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Yes. You are more likely to infect your partner if you have sexual contact during an active episode of herpes, ie when symptoms such as sores or blisters are present, since that is when the highest levels of the virus are present on the skin. However, the virus can still be present and passed onto others even when no signs or symptoms are apparent - this is known as 'asymptomatic shedding'. Most people avoid sexual contact when they know they are having an active episode of herpes. As a result, approximately 70% of cases of transmission of genital herpes result from asymptomatic shedding, ie when no signs or symptoms are present and people are not aware that they are experiencing an outbreak.

Using latex condoms at all times can help to reduce the risk of transmission. However, it does not provide 100% protection since the virus can still be passed on by contact with areas of the skin not covered by the condom.

A recent major study has shown that once daily suppressive therapy with valaciclovir, one of the commonly prescribed antivirals, reduces transmission of symptomatic genital herpes (signs and symptoms of infection) by 75% when combined with safer sex practices such as regular use of latex condoms.
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Many people do not feel comfortable talking about sexuality and sexual heath issues. It is important to know and understand what and how you are going to tell a partner.

Most people find their partners are both supportive and understanding. It is a common assumption to initially think a person may base their judgement of you on the fact that you have genital herpes. People fear the possibility of rejection but the reality of this is that it rarely happens.

Being prepared is important and it may help you to feel more confident in discussing herpes with your partner, by reading our 'Herpes and Relationships: How to Tell' leaflet.
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Herpes should not affect your fertility or ability to have a baby.

Women with genital herpes can experience a safe pregnancy and vaginal childbirth. This is especially so when a women has a diagnosis of genital herpes prior to becoming pregnant. If you already have genital herpes you will have anti-bodies circulating in your blood which will protect the baby from the impact of infection during pregnancy and delivery.

Although it is rare, a woman can pass herpes to her new baby, which can 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. If you or your partner is infected with HSV and you are considering getting pregnant or are already pregnant it is, therefore, important to discuss genital herpes with your doctor.

For further information see our 'Genital Herpes: The Facts' and 'Herpes Simplex and Pregnancy' leaflets.
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Can I purchase herpes medications via the internet?

The IHA cannot endorse the purchase of prescription medicines via the internet. Prescription only medications should always be prescribed by a healthcare professional who is aware of the medical history of the patient and therefore able to recommend drugs appropriate for the individual.
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Are people with genital herpes at greater risk of acquiring HIV?

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

In addition, further research has suggested that when someone is infected with both HIV and HSV, the HIV virus can potentially be increased in genital secretions which could increase the risk of transmitting HIV to others.

For more detailed information about HIV and herpes visit www.herpes-foundation.org
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