Herpes: your questions answered

What is herpes?

Herpes is a common, life-long infection caused by the herpes simplex virus (HSV) and generally transmitted through skin-to-skin contact. The symptoms of herpes can vary greatly, mainly depending on whether a person is experiencing their first episode or a recurrence. Once infected you may have symptoms returning on and off for years.

A commonly recognised symptom is the appearance of small, painful blisters - also called vesicles - on the skin. Herpes can appear on the lips (oral herpes), genitals (genital herpes) or on other parts of the body (non-genital herpes).

The herpes simplex virus belongs to a larger family of viruses that cause chickenpox, shingles and glandular fever.

There are 2 types of herpes simplex virus — herpes type I (HSV-1) and herpes type 2 (HSV-2). Herpes type 1 is the virus that most commonly causes cold sores on the lips or face. While often transmitted during childhood through close physical contact, this infection can be transmitted at any age. It can also be transmitted to the genitals through direct skin-to-skin contact, often via oral sex. Although HSV-1 infection is common, many people with the infection do not experience symptoms.

HSV-2 is responsible for the majority of genital herpes and is commonly transmitted through sexual contact — anyone who is sexually active can get herpes type 2. Genital herpes is thought to be one of the most common sexually transmitted infections in Australia.

The primary difference between the 2 viral types is preference of location. Herpes type 1 is usually located in the trigeminal ganglion, a collection of nerve cells near the ear. From there, it tends to recur on the lips or face. In contrast, herpes type 2 is usually found in the sacral ganglion at the base of the spine. From there, it recurs in or around the genital area.

The 2 types of herpes simplex virus behave somewhat differently depending on whether or not they are residing in their preferred site.

Either viral type can reside in either or both parts of the body and infect oral and/or genital areas.

How do you know if you have genital herpes?

Many people will have no noticeable symptoms following infection and will not even realise that they have come into contact with the virus. They may notice symptoms only at a later date. People can be infected with genital herpes and pass it on to others even though they have no symptoms themselves.

For others, the first symptoms of genital herpes show up from 2 to 21 days after coming into contact with the herpes virus. This first episode of genital herpes is frequently the most severe. When you first come into contact with the virus, your immune system has not had time to develop protective antibodies, leading to the virus multiplying rapidly and causing significant symptoms.

In a severe first episode of genital herpes, you may notice the following symptoms.

  • Your lymph glands (the glands under your arms, on your neck and in your groin) may be swollen.
  • You may have flu-like symptoms such as sore muscles, tiredness, headaches, fever and chills.
  • You may have swelling, pain or itching around the genitals, possibly followed by painful red spots that can form blisters.
  • Your blisters may burst to form open sores or ulcers, which will later crust over and heal.
  • You may experience pain when urinating due to the tenderness in your genital area.

Herpes of the anus or rectum may also result in rectal and lower back pain, an urgent need to pass faeces, bloody or mucous discharge, constipation and blisters on the skin area around the anus.

How is herpes diagnosed?

Accurate diagnosis of herpes is essential to ensure you receive the correct treatment.

People may mistake their herpes outbreaks for insect bites, yeast infections, jock itch, ingrown hair follicles, haemorrhoids, abrasion or razor burn. Accurate diagnosis is made most easily and correctly at the time of an active herpes infection, preferably the first time the symptoms appear.

There are several diagnostic tests available for herpes, requiring either a swab from a herpes blister or a blood test. The blood test can tell if you have been exposed to the virus in the past, but will not tell you if a particular sore is caused by herpes, or reliably differentiate between HSV-1 and HSV-2. Swabs can tell you if the sore is herpes or not, and what type it is, but can't tell if it is an initial infection or a recurrence. If you think you may have contracted the virus, see your doctor for testing.

How is herpes treated?

There is no cure for herpes - the virus just has periods of activity and inactivity within your body.

Usually symptoms will heal within 2 to 4 weeks and cause no long-term damage. However, if you experience significant pain with any outbreak you should ask your doctor about antiviral medicines. These can greatly reduce the length and severity of outbreaks and may reduce the risk of you transmitting the infection to a partner. Adverse side-effects from these medicines are rare, although you may get headaches and nausea.

There are other things you can do to relieve symptoms including taking painkillers such as paracetamol, bathing the blisters with warm salty water and dabbing a local anaesthetic ointment on the affected area.

What are some of the common emotions people with herpes experience?

Fear, shock, worry and guilt are common reactions of people who discover they have herpes. This shock sometimes makes it hard to recall any advice given by a doctor or others when first learning about the infection. Doctors understand this, so it may be worthwhile revisiting your doctor to further discuss measures for managing your herpes. Your local sexual health clinic can also provide you with information about support groups and counsellors in your local area.

Do I need to tell my partner I have herpes?

Yes. It is important to discuss your genital herpes with a current or potential partner before having sex. That way, you can work together to reduce the chance of transmission, such as through use of condoms. It may be difficult for you to broach the issue at first, but once the topic is out in the open it will be easier to deal with situations that arise, e.g. you need to let your partner know that there may be times when you cannot have sex.

Sometimes a prospective partner may withdraw from a person with herpes because of their own concerns. However, most people respond well and appreciate the respect that you have shown them, although this may take time. Some partners may already have experienced herpes — it may be worth your partner having a blood test to see if they have already contracted the herpes virus, in which case they are at no further risk — you cannot catch it twice.

Will I get genital herpes again?

Some people have no further episodes or symptoms of herpes. This is called inactive infection, when the virus is hidden in the body and is not infectious.

The symptoms of genital herpes do recur in some people, although a second or third episode is not usually as severe as the first. This is called an active infection and can occur when the immune system is at a low, for example, during times of stress, illness or menstruation, from anything that causes skin irritation, such as friction from prolonged sexual intercourse, but often for no obvious reason.

When a person has genital herpes, the virus ‘sleeps’ in the bundle of nerves at the base of the spine. When the virus reactivates, it travels down nerve paths to the surface of the skin, sometimes causing an outbreak.

The nerves in the genitals, upper thighs and buttocks are connected. So a person can also experience outbreaks in any of the following areas:

  • vagina;
  • vulva;
  • thighs;
  • penis;
  • scrotum;
  • testicles;
  • anus; or
  • buttocks.

What other help is available?

Counselling

You may experience mixed emotions and confusion after discovering you have genital herpes. A counsellor may prove helpful. Counsellors experienced in genital herpes can often be contacted through sexual health clinics. They have an understanding of both the medical and emotional issues associated with genital herpes.

Support groups

Herpes support groups offer a confidential environment for discussing issues and information with others in a similar position. While some groups are facilitated by a counsellor, others have a more social focus. Contact your local sexual health clinic for information about support groups in your area.

Internet

Apart from general healthcare websites such as myDr, there are many sites on the Internet offering information, news, chatgroups and meeting services specifically for people with genital herpes. Please note that the information may not necessarily be accurate so you should verify the information you download from the Internet with your doctor.

Last Reviewed: 26 November 2012
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References

1. Genital herpes simplex virus infection. [Revised Feb 2009]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited: 2012; Nov. http://online.tg.org.au/complete/ (accessed Dec 2012).
2. Lab Tests Online [website]. http://labtestsonline.org.au/ (Accessed Dec 2012).
3. Family Planning NSW. Genital herpes [Factsheet]. Updated Aug 2011. [Internet]. http://www.fpnsw.org.au/189826_8.html (Accessed Dec 2012).
4. BMJ Group Clinical Evidence. Genital herpes. [Fact sheet]. Reviewed Oct 2012. [Internet]. http://clinicalevidence.bmj.com/x/pdf/clinical-evidence/en-gb/summary/532420.pdf (accessed Dec 2012).
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