Genital herpes is caused by a virus called herpes simplex. There are two types of this virus: type I and type II. Type I mainly causes cold sores of the lips. It is a very common infection that affects many people in childhood. Sometimes they do not even know they have it.
The second type of herpes virus mainly infects the genital region, but can sometimes spread to the mouth during oral sex with someone who is infectious.
These two herpes viruses belong to a family of viruses called herpes viruses. In the same family of viruses are chicken pox virus ( Varicella-zoster virus) and the virus that causes glandular fever ( Epstein-Barr virus), also known as kissing disease or infectious mononucleosis. Cytomegalovirus, which is the most common viral cause of birth defects in babies also belongs to this family group. A newly discovered member of this family is the human herpes virus 6, and again research is showing it to be quite a common infection, especially in childhood. It is not thought to cause genital infection.
All the viruses in the herpes family have in common that once they infect a person, the infection stays in the cells of that person's body for the rest of their life. The viruses can become active again later in their life, possibly making them sick and infectious again.
Are all types of genital herpes the same?
No. There are different strains. Some apparently never cause repeated outbreaks, others are more severe. In addition each person reacts differently to a herpes infection, some people having many recurrences, others with the same strain having few or no recurrences. If you have genital herpes and you meet someone else with genital herpes you should still make sure that you take steps to avoid catching their type.
How do you catch the herpes virus?
Type I herpes is usually caught in early childhood from other children, but it can be caught at any time in your life from someone who is infectious. This virus is usually caught by kissing or by droplet spread, from sneezing or coughing. It can also be caught by oral sex. Someone with the sores on their mouth or lips can spread it to the genitals of a partner, who can then pass it back to their genitals during sexual intercourse. Type I herpes which is transferred to the genitals does not change into type II herpes. It is usually only a problem for the first outbreak in the genitals.
Type II herpes is usually caught by sexual intercourse with someone else who has it and is infectious. It can also be caught in the mouth via oral sex.
New studies are showing that genital herpes infection is far more common than it was first thought. Many people with the infection do not even know they have had it. Some people who know they have had it cannot tell if they are having a recurrence and therefore are infectious.
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I had sex with someone with herpes, will I get it?
Probably not. It depends how infectious they were and how good your own immunity is. If you were unfortunate enough to catch it, the symptoms will usually appear within two to 14 days, although it has been known to take as little as 24 hours or as long as years. Some people catch it but never develop symptoms. Most often people with herpes cannot be sure who they caught it from.
What is it like to have herpes?
In the first outbreak (primary infection) most people feel generally miserable and unwell. Often they have a temperature and mild headache. There is soreness and itching where the infection is and there may be some discomfort passing urine. The local lymph glands are usually quite swollen and sore. In women there is often a vaginal discharge, and there may be an associated yeast infection. Small blisters may be seen on the skin of the penis and the vulva or sometimes other areas of skin close to the genitals. These are full of infectious herpes simplex virus. Usually they burst after a few days, leaving a small sore that heals over with a scab and falls off leaving no scar. The first infection can last up to three weeks without treatment.
If you think you are having an outbreak of genital herpes infection for the first time, go and see your local doctor or a doctor at an STD clinic. There is very good treatment to make you feel better within 24 hours and stop the infection spreading further than it already has. It is important for the doctor to do tests to find out what sort of infection it is you have, in particular whether it is type I or type II herpes simplex infection. You should also be checked to make sure you do not have any other infection as well.
Another good reason for being checked is that the symptoms or signs you are experiencing may not be herpes. I see many people who think they are having herpes recurrences when in fact it is not that at all.
How is herpes diagnosed?
The usual test for genital herpes is to take some fluid from the blister or ulcer and grow the virus. The virus can grow in 48 hours but sometimes it grows quite slowly, taking up to a week. If the test is negative it does not prove absolutely that you don't have herpes, as there is a chance the virus wasn't picked up in the test. If you're not sure and the symptoms recur, have the test repeated within 24 hours of the recurrence.
Blood tests are not usually accurate enough to diagnose the type of herpes infection which has occurred.
What happens after the first outbreak of herpes?
If you catch type I herpes in the genital area it is probable that you will never again have another outbreak of that infection there. This is why it is a good idea if you think you might have an infection with genital herpes to see your doctor and have tests to find out what sort of infection it is. You will certainly feel much better if you find out that it is only herpes type I.
If you have just had your first infection with type II herpes don't be dismayed, the news is not as bad as it seems. You have a better than 50% chance of never suffering another outbreak! Be optimistic and hope that you will be one of the lucky majority.
Recurrences are milder than the first outbreak, and usually they become less severe and less frequent with time. Recurrences occur because the virus, once it gets into the body, stays in the nerve cells. For various reasons the virus travels down to the skin surface where it may be associated with an outbreak.
Sometimes just prior to a recurrence people get a funny feeling or an itch, and then blisters appear. (Putting ice on the spot when it becomes itchy may stop the outbreak, but this does not work for everyone.) Others have slightly stronger feelings and yet others may have no symptoms at all, even if there is a small blister or sore.
People with a recurrence are infectious from the prodrome, which is the first abnormal feeling in the area, until all the scabs have fallen off, or the skin has healed over.
How should I look after myself?
If this is your first outbreak of herpes, you can be reassured it will get better soon. Even if you are one of the unfortunate minority who go on to further infections, you can be confident that future infections will not be as bad as the first time. Recurrences become less frequent and become less severe over time. The first episode is always the worst.
Unfortunately for women, their first infection is often worse than it is for men, because a much larger area of skin is involved. The vagina and cervix are usually infected.
When you are infected, you are sick. You may have a slight headache and feel feverish. You should give yourself as much rest and sleep as you possibly can. You should definitely be resting in bed with someone helping to look after you. Washing the sore area with a salt and water solution is the cheapest and most effective way of relieving pain and keeping the area clean. One quarter of a teaspoon of cooking salt to one cup of water is the recipe. Of course you can use warm water if you like.
Bathe the sore area every three to four hours, or more often if it gives relief. Some people have to bathe themselves every one or two hours for a while. For women who really are having a severe outbreak and are having difficulty urinating, it is sometimes useful to urinate into a tub of water or bath of water. This eases the stinging and burning.
Very occasionally women having their first outbreak find it is so bad that they can't pass water, and they need to be admitted to the hospital. Even if this happens to you, don't be discouraged. How bad the first outbreak is has nothing to do with whether you are going to get any recurrence, and please remember that the majority don't.
If you think you are having your first herpes outbreak, for your own sake see a doctor. If tests confirm a primary herpes infection, you can be prescribed acyclovir tablets. Acyclovir stops the virus from multiplying, so the infection gets better more quickly, the pain goes more quickly and you are not as infectious for as long. Unfortunately the tablets do not eradicate the infection from your body and do not reduce your chances of having a recurrence.
If you are female and having your first outbreak, and you are on the oral contraceptive pill, it is sometimes wise to continue taking the active pill tablets so that you miss having your menstrual period during the time when the infection is bad. To do this you go straight on to the next packet of pill tablets instead of missing tablets for a week or taking a week of sugar tablets. Discuss this with your doctor first.
Don't wear tight clothing.
The lesions or sores which appear with an outbreak of herpes are highly infectious. If you touch the spot where there is a sore and then touch yourself on another part of your body, the infection can be spread there. If you touch someone else, they can be infected.
Always wash tour hands immediately if you touch a herpes sore. Do not share your bath towel with any one else when you have a herpes outbreak. However, herpes cannot be spread on the bathroom soap or toilet seat.
It always surprises me to have to say this but when you are sore below it is best to avoid sex. Definitely sex should be avoided whilst you or your partner has an active herpes infection, to stop the infection spreading to other places, and to allow the infected area time to heal.
You or your partner are infectious until all the lesions have healed over and the scabs have fallen off. People with their first infection are infectious for longer than those who are having a recurrence. Oral sex (placing the mouth to the genitals), manual stimulation (touching the genitals with your hands) and actual sexual intercourse should be avoided until all the area has healed.
Avoiding sex does not mean you can't touch each other or kiss and hug. Only the infected area is infectious.
Taking care of yourself after the first outbreak
If you have herpes recurrences, don't say that you are 'suffering from an attack'. Using words like this puts the virus in control of you. It is much better to use the terms herpes outbreak or herpes recurrence. If you suffer from frequent recurrences this choice of terminology is extremely important in your regaining control over your health. How you think about yourself seems to have a lot to do with how your body reacts to disease.
Some people find that recurrences are triggered by stress, overwork, overuse of alcohol or other drugs, repressed anger, smoking too much, menstruation, other illness, hard physical exertion, and eating poorly.
If you do have recurrences it is important to keep yourself healthy. Lots of rest and relaxation is important, some people find that playing golf, fishing, or doing yoga is helpful. Others find benefit in attending a herpes support group. Your doctor or local clinic should be able to give you information about this. It's wise to check with your doctor to confirm that the symptoms you have really are herpes. Many times people think they are having a herpes recurrence when really it is something else.
Many people find benefit in psychological counseling, and for some only a few visits are all that is needed before they stop having recurrences. For others it may take longer.
Occasionally people suffering repeated recurrences need to take acyclovir tablets. Acyclovir is very useful to give a person a break from frequent recurrences so they can feel what it's like to be well again.
Each person needs their own individual treatment program. It depends on what you and your doctor feel is best for you.
Long term use of acyclovir
So far I've said some good things about the benefits of acyclovir, but as you may have guessed there are cautions about its use.
Doctors are concerned over-use of acyclovir will encourage the emergence of new and resistant strains of herpes, just as past over-use of antibiotics has been associated with the development of bugs that are not killed by the antibiotic. There are already reports that some types of herpes may be resistant or partially resistant to the action of acyclovir.
The long term side-effects of acyclovir are not known. Acyclovir has not been available for very long. Studies of people taking it for up to four or five years are available and so far so good, but that is all that can be said.
Generally I am reluctant to encourage young, fit, otherwise healthy people of childbearing age, to go onto tablets without some effort on their part to change their lifestyle or other factors that can be causing the recurrences.
There is an exception however. Anyone who is infected with HIV (the human immunodeficiency virus which causes AIDS) should have treatment with acyclovir if they have recurrent herpes. This is because frequent herpes outbreaks have been associated with a speeding up of the progression of the HIV infection to AIDS.
People who are given long term acyclovir should make sure they avoid becoming pregnant and should also have their liver and kidney function tested regularly to make sure the drugs are not causing harm.
Herpes, pregnancy, and babies
Contrary to popular myth, people with genital herpes find it as easy to get pregnant as other people, so be careful!
Will herpes affect my baby?
People with genital herpes infection should tell their obstetrician (doctor who looks after pregnant women and delivers babies). Pregnant women who have had the infection should tell their obstetrician, no matter how long ago the infection was, and even if they have never had a recurrence. Male parents-to-be who have genital herpes infection should let their partner's obstetrician know, even if their partner hasn't had any signs of the infection.
The obstetrician is then warned to look out for signs of the infection in the last month or so of pregnancy. Most women with herpes infection do not have an outbreak at this time, but if they do, the obstetrician is likely to perform a c'sarean delivery (operation to deliver the baby out of the abdomen) to avoid the possibility of the baby becoming infected when passing through the birth canal.
The problem these days seems not to be the people who know they have herpes but the people who don't know, especially if it's their first infection.
How can I avoid passing on herpes to my partner?
It is important to talk to your partner and let them know that you have the infection. If you are having an outbreak you are infectious from the time you first develop symptoms until the last scab has fallen off. You must avoid sexual intercourse including foreplay and touching the infected area during all this time. Having sex using condoms during this time is not advised as there is a risk of contact with infectious secretions.
When the infection is not active the risk of it being passed on is low. In long term relationships where condoms are not being used it is probable that at some stage the partner will also catch the herpes infection, even when all precautions are taken. Luckily though for most couples the infection in the partner is not too troublesome except for the first outbreak. Infection can sometimes occur in the partner without them even knowing about it.
Acyclovir will not stop the virus being passed on although there is some evidence that it may reduce the risk. Talk to your doctor about this.
Sometimes in long term relationships herpes can appear seemingly out of the blue, even though neither partner has been unfaithful. This can happen because the original infection may not have been noticed and so no precautions have been taken.
How can I avoid catching herpes?
Talk to your partner and ask them whether they or their previous partners have had herpes. If you are entering a new sexual relationship it is a good idea to both go and have a general STD (sexually transmittable disease) checkup prior to starting to have sex.
Even if you are both cleared, it is a good idea to use condoms until you both know the relationship is a good one and that you are going to be with each other for a long time (many years).
Condoms are not a 100% safeguard against catching genital herpes. Condoms only protect the area of skin they cover. For example if there is a herpes outbreak on the scrotum or vulva, condoms will not stop the infection from being passed on. Condoms do however greatly reduce the risk, so they are a good common sense thing to use in early relationships until you can be certain your partner has nothing to hide from you.
Relationships often take up to six to nine months before uncomfortable aspects about yourself and your partner are discussed. When people fall in love it is like a fairy tale they have dreamed about and they do not want to do or say anything which may possibly destroy the relationship by frightening the other person away. Later they may feel more secure and able to risk revealing hidden truths. Remember the Bill of Rights and your right to protect yourself.
Finally, don't forget, people can be infected with herpes without even knowing it. Some people can pass herpes on without themselves having any signs or symptoms. People who have herpes and are on acyclovir can still be infectious. It's your right and your responsibility to protect yourself.
Your Sexual Health
by Jenny McCloskey.
Reprinted with permission (©) of the publisher, Halo Books.
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About The Author
Dr. Jenny McCloskey completed her medical degree at the University of Melbourne in 1976, where she shared the Australian Medical Association Prize in Public Health. As a medical registrar at the Sir Charles Gairdner Hospital in Western Australia she gained extensive experience in various medical specialties including hematology and oncology. She has a Diploma of Venereology (London) and is a elected fellow of the Australasian College of Venereologists. She travels throughout Western Australia, lecturing and teaching health professionals, community groups, and aboriginal communities. She practices in Perth as a Venereologist.