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| STD ->Genital Herpes: Answers to common questions about Herpes |
Why get tested?
To screen for or diagnose infection with the herpes simplex virus
When to get tested?
If you have symptoms of an infection with the herpes simplex virus, such as blisters or sores around your mouth or in the genital area
Sample required?
A swab or scraping from a blister or sore in the infected area or a blood sample drawn from a vein in your arm; for meningitis (inflammation of the spinal cord) or encephalitis (inflammation of the brain), a sample of cerebrospinal fluid (CSF)
What is herpes?
- Herpes is caused by a virus: the herpes simplex virus (HSV).
- HSV is in a family of viruses called herpesviruses. This family includes Epstein-Barr virus, the cause of mono, and varicella zoster, the cause of chicken pox and shingles.
- Although there are several viruses in the herpesvirus family, each are separate viruses and different from one another.
- There are two types of herpes simplex; herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2).
- HSV is a common and usually mild recurrent skin condition.
- HSV can cause oral herpes (cold sores or fever blisters on the mouth or facial area) as well as genital herpes (similar symptoms in the genital region).
- The majority of oral herpes cases are caused by HSV-1 and the majority of genital herpes cases are caused by HSV-2; however, both type-1 and type-2 can occur in the genitals, oral area or both.
- About 50 percent to 80 percent of the adult population in the United States has oral herpes.
- Most people contract oral herpes when they are children by receiving a kiss from a friend or relative.
- About one in five adults in the United States has genital herpes, however as many as 90 percent are unaware that they have the virus.
- Anyone who is sexually active can contract genital herpes.
How can a person get genital herpes?
- Any person who is sexually active can get genital herpes.
- Herpes is transmitted through direct skin-to-skin contact. This occurs when a contagious area comes into contact with a mucous membrane, primarily the mouth and genitals.
- Most skin on the body is too thick for the virus to go through.
- If a person with oral herpes performs oral sex, it is possible for the partner to get genital herpes.
- If a person with genital herpes has sex, it is possible for his or her partner to get genital herpes.
- Herpes can be transmitted when there are no symptoms present.
- There are several days throughout the year (called asymptomatic reactivation, asymptomatic shedding or subclinical shedding) when a person can be contagious without having a symptom.
- There are no documented cases of a person getting genital herpes from an inanimate object such as a toilet seat, bathtub or towel. Herpes is a very fragile virus and does not live long on surfaces.
Genital Herpes Symptoms - When, What, Where and How OftenWhile some people realize that they have genital herpes, many do not. It is estimated that one in five adults in the United States has genital herpes, however, as many as 90 percent are unaware that they have the virus. This is because many people have very mild symptoms or no symptoms at all. Because symptoms can vary a great deal, we recommend that an individual see a health care provider to obtain a culture of the symptom.
When do symptoms appear?
- A person may show symptoms within days after contracting genital herpes, or it may take weeks, months or years.
- Some people may have a severe outbreak within days after contracting the virus.
- Some people may have a first outbreak so mild that they do not notice it.
- It can be difficult for people to know when and from whom they may have contracted the virus.
What are the signs or symptoms of genital herpes?
Outbreaks of genital herpes can vary greatly from person to person. They can be mild for one individual and severe for another. Symptoms may last for up to 3 to 4 weeks, but they usually heal within 2 to 12 days. Symptoms may include the following:
- One or more sores, blisters, cuts, pimples, bumps or a rash
- Itching, burning or tingling in the genital area
- Aches or pains in the genital area
- Flu-like symptoms (headache, fever, swollen glands in lymph nodes near groin)
- Painful urination and a discharge (vaginal or penile) are possible, but uncommon, symptoms for genital herpes
- Many people have outbreaks that heal quickly, cause no pain or occur in an unnoticeable spot. People sometimes mistake herpes outbreaks for:
| - Insect bites | - Jock itch | | - Yeast infections | - Ingrown hair follicles | | - Abrasions or razor burn | - Hemorrhoids |
Where do symptoms of genital herpes appear?
When a person has genital herpes, the virus lies dormant (sleeps) in the bundle of nerves at the base of the spine. When the virus reactivates (wakes up), it travels nerve paths to the surface of the skin, sometimes causing an outbreak. The nerves in the genitals, upper thighs and buttocks are connected; therefore, a person can experience outbreaks in any of these areas. Such areas include:
| - Vagina | - Vulva | | - Penis | - Scrotum or testicles | | - Anus | - Buttocks | | - Thigh | |
How often do outbreaks of genital herpes occur?
- The amount of outbreaks someone has varies from person to person.
- The average number of outbreaks per year is four to five.
- The first outbreak may be the most extreme outbreak a person will have.
- Usually, there are more outbreaks during the first year.
- Many people find that recurrences tend to lessen in severity and frequency with time.
- Illness, poor diet, emotional or physical stress, friction, surgical trauma and steroidal medication (such as asthma treatment) may trigger a herpes outbreak.
- The frequency of outbreaks can often be managed through effective stress management, and getting adequate rest, nutrition and exercise.
How can people find out if they have genital herpes?
If symptoms of genital herpes appear, they can vary widely from person to person. If a person does experience visible symptoms, we recommend obtaining a culture test within the first 48 hours after symptoms appear. Beyond 48 hours, there is a risk of receiving a false negative test result because symptoms may have begun to heal and there is not enough virus left on the skin to culture.
Blood tests can be used when a person has no visible symptoms but has concerns about having herpes. Blood tests do not actually detect the virus; instead, they look for antibodies (the body’s immune response) in the blood.
There are many older blood tests commercially available, but most are not accurate because they cannot accurately distinguish between antibodies for type-1 and type-2 herpes. This makes it possible to get a false positive result, especially for HSV-2.
There are currently four blood tests available that can give accurate results for herpes. Like any blood test, these tests cannot determine whether the site of infection is oral or genital. However, since most cases of genital herpes are caused by HSV-2, a positive result for type-2 antibodies most likely indicates genital herpes. For the most accurate result, it is recommended to wait at least 12 - 16 weeks from the last possible exposure to herpes before getting an accurate blood test in order to allow enough time for antibodies to develop.
These accurate tests are:
- biokit HSV-2 Rapid Test
- HerpeSelect HSV-1 and HSV-2 tests from Focus Diagnostics, Inc.
- Herpes Western blot
- CAPTIA HSV IgG Type Specific ELISAs
The biokit HSV-2 Rapid Test (manufactured by biokit USA) is a blood test that can be done in a doctor's office and provides results for type-2 in less than 10 minutes. For more information on the biokit HSV-2 Rapid Test, please call 1-800-926-3353 or log on to www.biokit.com. This test is also available under the name Sure-Vue HSV-2 Rapid Test from Fisher HealthCare. For more information on the Sure-Vue HSV-2 Rapid Test, please call 1-800-766-7000 or log on to www.fishersci.com.
There are two blood tests manufactured by Focus Diagnostics, Inc.
under the name HerpeSelect. Both of these tests require blood to be drawn by your health care provider and sent off to a lab that carries HerpeSelect for results. The accuracy of these tests is very good. If you are interested in HerpeSelect you can log on to www.herpeselect.com or call 1-800-505-0536.
The Herpes Western blot can also accurately distinguish between type-1 and type-2. However, this test is primarily only used for research purposes and is not readily available. If you are interested in the Herpes Western blot, your doctor will need to call the University of Washington in Seattle, WA at 1-206-598-6066 to order the test.
The CAPTIA HSV IgG Type Specific ELISAs can detect type-1 and/or type-2 antibodies. Blood drawn by your health care provider will be sent to a lab for results. For more information, contact the manufacturer, Trinity Biotech, at 1-800-325-3424 or log on to www.trinitybiotech.com.
How can someone reduce the risk of contracting genital herpes?
Any sexually active person may contract genital herpes. Ways to reduce risk include:
- If someone has a symptom around the mouth (oral herpes), she or he should not perform oral sex until all signs have healed.
- When there are no symptoms present around the mouth, using a barrier or condom when performing oral sex can reduce the risk of contracting genital herpes.
- If someone has signs or symptoms around the genital region (genital herpes), he or she should not have sexual activity until all signs have healed.
- When there are no symptoms present, using latex condoms for genital-to-genital contact reduces the risk of transmission.
- One antiviral medication for herpes, valacyclovir (Valtrex®), has recently been shown to reduce the risk of herpes transmission. When taken daily by a person with a history of recurrent genital herpes, valacyclovir can reduce the risk of transmission to a partner who does not have the virus by 50%. It’s likely that a combination of suppressive valacyclovir and condoms provides greater protection than either method alone.
- Microbicides/Spermicides have not been proven to reduce the risk of transmission. If used, they should be used with a condom, not in place of one.
- Partner communication. It is important for both partners to become educated about herpes and to make decisions together about which precautions are best.
What is the treatment for herpes?
- Currently, there is no treatment to cure herpes; however, there is no cure for any virus at this point.
- There are three antiviral medications (in pill form) approved by the Food and Drug Administration (FDA) that are available for the treatment of herpes: Zovirax® (acyclovir), Famvir® (famciclovir) and Valtrex® (valacyclovir).
- Each of these medications can be used during a recurrence to help speed the healing process of an outbreak.
- All three drugs are FDA approved for daily, suppressive therapy to help reduce the frequency of outbreaks.
- Zovirax is also available in the form of an ointment, but the medication has been proven to be much more effective when taken orally.
- Valtrex, when taken daily (suppressive therapy) by a person with recurrent genital herpes, can reduce the risk of transmission to a partner.
- According to the manufacturers, the most common short-term side effects reported were nausea and headaches. These medications have never been noted to cause any long-term side effects.
- Using medication to treat genital herpes is not required. However, if a person would like to use antivirals, speaking with a health care provider can help determine which treatment may be right for them.
- You can speak to your doctor about the proper medications for you.
- Over-the-counter creams and/or ointments are not recommended for genital herpes.
Herpes and Pregnancy Did you know:
- It is rare for infants to contract herpes.
- Twenty percent to 25 percent of pregnant women have genital herpes.
- Less than 0.1 percent of babies contract genital herpes.
- A mother helps the baby by passing her antibodies to the infant during pregnancy.
- Women who acquire genital herpes before becoming pregnant have a low risk of passing the virus to their baby.
- A woman who contracts genital herpes during the third trimester of pregnancy is at a higher risk of passing herpes to the baby because she has not had time to build up antibodies to the virus.
- Most mothers with genital herpes have normal vaginal deliveries.
- The doctor should do a thorough visual exam at the onset of labor.
- If a woman has symptoms at the time of delivery, a Caesarean section is recommended.
- If an infant does contract herpes during delivery, the symptoms tend to show within two to three weeks after birth.
- Herpes can be life threatening to an infant.
- Medication may help prevent or reduce the lasting damage to an infant if treated early.
- After birth, herpes can be passed to a baby by receiving a kiss from someone with a cold sore on the mouth(oral herpes).
If You're Pregnant and You Have Herpes:
- Talk with your doctor or health care provider.
- Be examined at labor to see if there are any symptoms.
- Notify the doctor if you think you have symptoms during labor.
If You're Pregnant and Your Partner Has Herpes:
- It is important to avoid contracting herpes during pregnancy.
- Using condoms for sexual activity and not having sex while symptoms are present will reduce the risk of transmission.
- Taking valacyclovir daily has been shown to significantly reduce the risk of HSV transmission. Your partner may want to discuss this viable option with a health care provider.
FIND OUT MORE: Call the National Herpes Hotline. Order Managing Herpes, an award winning and informative, comprehensive 288-page book. Subscribe to the helper, a quarterly newsletter of medical facts, updates and reassurance. Talk with your doctor or nurse. Contact the STD clinic in your local health department.
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