What is it?
Herpes is the common name for two viruses - Herpes Simplex Type 1 and Herpes Simplex Type 2. Herpes can affect mouth/face, genital and/or rectal area.
It used to be thought that Herpes Simplex Type 1 caused sores and blisters on the mouth or face whereas Herpes Simplex Type 2 caused these same symptoms in the genital and/or rectal area. It's now known that Herpes Simplex Type 1 can spread to the genital and rectal area and Herpes Simplex Type 2 to the face and mouth.
Herpes is incurable and once a person is infected with the virus they will have it for life and may or may not periodically experience symptoms associated with it.
How do you get it?
The herpes virus is spread by skin-to-skin contact either genital to genital or face/mouth to genital (oral sex). Symptoms do not need to be present for the virus to be passed from one person to another. In fact, the herpes virus can be inactive or latent for long periods of time.
It's for this reason that many people who have Herpes never realize it, and most people who pass it on to someone else are unaware of their infection at the time. This is called asymptomatic shedding.
The good news is that over 95% of the time herpes can be detected when the virus is active allowing the person to avoid exposing a partner.
It's also important to note that people who have oral herpes may have partial resistance to being infected with genital herpes. Once you have herpes, you cannot be infected again with the same virus.
What are the symptoms?
The symptoms of genital herpes vary widely and are often not easy to recognize. Some people don't experience any symptoms at all; some have outbreaks that heal quickly, cause no pain or occur in a place where they're unnoticeable. Others mistake herpes outbreaks for bug bites, ingrown hairs, pimples, hemorrhoids, etc.
The virus has several stages of infection. These are:
Initial Infection
When someone has symptoms in their genital area for the first time, it's called an initial infection. Symptoms can range from mild irritation to severe pain with sores and flu-like illness.
Non-Primary Initial Infection:
If someone has been exposed to the virus before, but feels symptoms in the genital area for the first time it's called a non-primary initial infection. Previous exposure to the virus has enabled the body to develop partial immunity so symptoms may take longer to develop or be less severe.
True Primary Infection:
If someone has never been exposed to the virus before and they become infected it's called a true primary infection. With no previous exposure to the virus and no partial immunity, symptoms can be quite severe. For most people though, symptoms are mild and usually go completely unnoticed. Many people become aware of their herpes only when they develop recurrent infections.
Recurrences:
Soon after being infected, some of the virus goes into nerves in the skin and sits dormant there for months or years. A recurrence takes place when the virus replicates itself and travels down the nerve to the site of the initial infection. Symptoms for recurrent episodes are often less severe than primary episodes because antibodies were made during the initial infection.
Symptoms
Each person's experience of herpes is different and your own experiences may be different from one outbreak to the next. Generally, the symptoms for herpes include:
For Women:
- Change in vaginal discharge
For Men and Women:
- Sores
- Small blisters filled with clear, whitish fluid
- Skin ulcers
- Genital and/or rectal irritation
- Raw, itchy skin
- Flu-like illness
- Swollen lymph nodes
- Painful urination
- Difficulty starting urination
With genital herpes the virus reactivates an average of 4 times a year after the initial infection causing another episode. It's not known exactly why the virus reactivates, however the following physical and psychological factors are thought to be triggers for some people: illness; injury; physical trauma and chronic stress.
Healing after a recurrent episode takes about 4 - 10 days and is complete when the skin is smooth and feels normal to touch, with no tenderness or raw feeling in the area. After healing, a white or red mark may appear for days or weeks.
It's also important to note that although it's not common (), the virus can still be passed from one person to another even after the skin appears completely healed (asymptomatic shedding).
What's the test like?
There are several testing options for Herpes, the most common being to test for herpes by viral culture of a lesion. This test, however, relies on a lesion being present when a person is at the clinic. Also, the test must pick up enough virus to detect. A negative result does not rule out herpes infection.
A standard blood test can only tell you if you've been infected with the Herpes virus, but it can take up to 3 months for antibodies to appear after exposure to the virus. The test looks for any antibodies to Herpes, either Type 1 or Type 2. This means that people with Herpes cold sores will test positive, but the test cannot determine if these people have genital herpes.
A Western Blot is another form of blood test, but one that can differentiate between Type 1 and Type 2 herpes. The cost for this test, however, is not included under BC medical insurance.
Talk to your health care provider about which test is best for you.
What is the treatment?
Antiviral medications are prescribed for all phases of herpes, from initial infection through to recurring episodes. They can shorten the duration of the infection and may also diminish complications or symptoms.
Antiviral medications like Acyclovir (Zovirax, Avirax), Valacyclovir (Valtrex), Famcyclovir (Famvir), are best if used within the first few days of the infection. They are usually prescribed for a 3 - 10 day period. All first episodes of genital herpes should be treated as soon as possible with antiviral medications for 7 days.
If someone experiences recurrences frequently or if they are problematic, an antiviral medication may be prescribed for daily use. Treatment is usually done for a year, stopped for a few months and then started again if recurrences are still a problem.
Daily use of an antiviral medication may also decrease the risk of asymptomatic shedding. It should be avoided while breast-feeding.
Is there anything else I should do?
Treatment for Herpes also include general comfort measures, such as wearing loose fitting clothing. Discuss these with your health care provider.
How common is it?
Herpes is a very common STD. In BC, 17% of adult women have Type 2 Herpes and 60% have Type 1. Studies have shown that men are at a lower risk of getting genital herpes, which is probably due to their anatomy. Women are four times more likely than men to acquire genital herpes.
Studies in Vancouver, BC, have shown that 20% of women who have had sex have genital herpes Type 2. If that woman has had six or more partners, that number would increase to 40%. And with more than 10 sexual partners, almost 60% of women would have the virus.
Of particular concern to women
There is no reason to avoid becoming pregnant because of Herpes. Delivery can usually be vaginal if an active infection is not present. A cesarean section is advised if an active infection is present.
Transmitting Herpes to a newborn is uncommon because mothers with recurrent genital herpes protect their newborn through transfer of antibodies.
The pregnancies at greatest risk are those where the male partner has Herpes and the expectant mother has never had it. If she is infected for the first time during pregnancy, special treatment and follow up may be required to prevent infecting the baby (Neonatal Herpes).
Babies who get Neonatal Herpes are usually born to mothers with a true primary infection during late pregnancy and childbirth. The risk of a mother with recurrent herpes giving birth to a baby with neonatal herpes is quite low. (2-5% if delivered at time of lesions).
If the pregnant woman has no history of Herpes but her partner does, it is recommended that all sex (penis to vagina, penis to mouth, penis to rectum) be avoided during the last 12 weeks of pregnancy.
Use of antiviral medications in pregnancy may be considered. They have been used to reduce asymptomatic shedding during labor and for recurrences of Genital Herpes near the expected due date.
Prevention
Latex or polyurethane condoms (male and/or female), may offer some protection against passing the virus from one person to another. However, the herpes virus can live on skin that is not covered by the condom, so there are no guarantees.
Since most virus transmission happens during the asymptomatic shedding stage, a person with herpes needs to take safety precautions all the time.
Many people avoid relationships or limit contacts to casual partners in order to keep their Herpes a secret or avoid talking about it with a partner. When this happens, the secret itself has become the problem. There are resources to help people learn to deal with and talk about Herpes infection.
Emotionally Surviving Herpes
For most people, the emotional and social impact of Herpes is greater than the physical impact, at least at the beginning.
There is a stigma attached to having an STD and many people can be very judgmental, especially when it comes to Herpes. This is in part because it's an incurable viral infection that stays with you for life.
When people are first diagnosed with Herpes they tend to feel a multitude of emotions from shock, anger, or embarrassment to fear, helplessness, guilt, shame or change in self-image. Many people worry about how herpes will affect their current or future relationships.
They usually need time to adjust to the idea that they have the infection and accept that they will have it for the rest of their life. Once there, they can begin to learn more about the virus including how to manage it.
How do I tell a partner I have Herpes?
How, what, when and if you tell a partner is an individual decision. Honesty in a relationship is important and will build trust and respect. Your partner can make an informed choice if you tell them. Telling a partner may not only prevent transmitting herpes, but may also open up a larger discussion around sexual health, safer sex and other STDs. A good time to tell partner would be once you have established trust in the relationship but have not yet become sexually intimate.
Resources for those with Herpes
A health care provider such as a family physician or a nurse at an STD clinic, can provide useful information and some support.
Books:
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"The Truth About Herpes", by Dr. Stephen Sacks.
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"Managing Herpes: How to Live and Love with a Chronic STD", by Charles Ebel.
Websites:
- National Herpes Resource Center - Information on Herpes. The United States National Herpes Resource Center (HRC) focuses on increasing education, public awareness, and support to anyone concerned about herpes. This site has information for support in the Vancouver area.
- Herpes.org - Comprehensive information on Herpes. The content on www.herpes.org is overseen by a Medical Director, Dr. H., with input from the members of the Medical Advisory Board.
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