Herpes is an infection that can be caused by two viruses: herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). HSV-1 usually infects the mouth, causing cold sores or fever blisters. HSV-2 usually infects the genitals, causing genital herpes. However, both viruses can infect either area. It is believed that up to 80% of adults in the U.S. are infected with HSV-1, and a little over 16% are infected with HSV-2.
Herpes is spread by skin-to-skin contact, including touching, kissing, and vaginal, anal, and oral sex. It can be passed from one partner to another and from one part of the body to another. Herpes is most contagious when sores are visible, but can also be transmitted when a person is asymptomatic.
Most people with herpes do not experience symptoms. If they do, the most common symptom is a cluster of blister-like sores around the mouth or genital area (including the thighs and buttocks). The sores can be painful and/or itchy.
After initial infection (whether or not symptoms were present), the herpes virus goes into latency in the nervous system. This means that it remains in the body forever, but can be inactive or active at different times. When the virus is reactivated, it may cause symptoms (“recurrence”) or not (“asymptomatic shedding”). People with genital herpes usually experience several recurrences a year, which tend to become less frequent and less severe over time. Recurrence may be triggered by stress, illness, or menstruation. Some people might be able to predict a recurrence a day or two in advance by noticing “prodromal” symptoms such as tingling, redness, itching, or pain in the genital area.
Herpes does not usually cause any major complications. If a woman experiences her first herpes outbreak during pregnancy, it can increase the risk of transmission to her baby.
If you are currently experiencing an outbreak of sores, you should visit a clinician as soon as possible so that the sores can be cultured for diagnosis. This test is most accurate during the first outbreak, as later outbreaks are likely to produce false negative results.
The other diagnostic test available is a blood test for HSV antibodies. IgG antibody tests are recommended over IgM antibody tests, because the former can differentiate between HSV-1 and HSV-2. However, it takes a while for the body to produce antibodies, so for accurate results you should wait to be tested until 3-4 months after your last possible exposure. Even then, a blood test may not be useful, as it cannot tell you where on the body (oral area or genital area) you have the virus. For this reason, many medical providers are reluctant to perform blood tests without visible sores.
Although herpes cannot be cured, its symptoms can be treated. Antiviral medications are available to help with herpes outbreaks. These medications are often prescribed during the first outbreak, but can be used later as well. “Episodic therapy,” where a person takes the medication at the first sign of prodromal symptoms of an outbreak, can shorten the length of the outbreak. “Suppressive therapy,” where a person takes the medication every day, can help to reduce the number of outbreaks or prevent them completely. Things you can do at home during an outbreak include taking warm baths, wearing cotton clothing, holding a cold compress on the sores, and taking a painkiller such as ibuprofen, acetaminophen, or aspirin. Over-the-counter creams and lotions should not be used during an outbreak, as they can interfere with the healing process.
The following strategies can help reduce the risk of infection:
• Mutual monogamy
• Condoms, dental dams, or other barrier methods
A person who has genital herpes can reduce the risk of transmission by:
• Avoiding sexual activity during an active outbreak
• Using condoms and other barrier methods during asymptomatic periods
• Suppressive therapy with antiviral medications may reduce the risk of transmission