Herpes 1 + 2 guide

Definition

What is Herpes?

Herpes is one of the most common and contagious STDs in the United States and is caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). According to the Centers for Disease Control and Prevention (CDC), about 1 in 6 Americans between the ages of 14 and 49 are infected with HSV-2.

HSV-1 usually causes cold sores and blisters on the mouth … in fact, many people are infected during childhood in a social situation, like receiving a kiss from an infected relative. Most HSV-2 infections occur in adulthood and cause sores on the vagina, penis and surrounding skin. Herpes is transmitted through skin-to-skin contact, or unprotected vaginal, anal or oral sex … the virus can enter the body through breaks in the skin or mucous membranes.

While herpes is not curable, it is not life-threatening in adults … it can be treated and managed with antiviral medications that can prevent or shorten the duration of outbreaks, and decrease the risk of spreading the infection to others. Depending on the severity of outbreaks, no treatment may be necessary … but there's a chance that herpes can evolve into serious health problems, from meningitis to encephalitis. It's also possible for an infected mother to transmit herpes to her baby, potentially causing blindness, brain damage … even death.

Additionally, herpes can increase the risk of getting other STDs, like HIV … so the earlier herpes is diagnosed, the more successfully it can be treated.

Reference

Risk

Herpes risk factors

How do people get infected with herpes?

Anyone can get herpes … usually through direct contact with active sores during sexual activity, including kissing or skin-to-skin contact with a person who has sores on the mouth or genital area. The most common risk factors are:

  • A history of STDs
  • A history of unprotected sex
  • A new sexual partner
  • Multiple sexual partners
  • Gay and bisexual men
  • Being HIV-positive
  • Early age for first sexual activity

Due to reporting disparities and a number of other variables, there is a higher prevalence of herpes among sexually active women and African-Americans … for example, women are more likely to get screened, and some ethnic/minority groups are more likely to use public clinics that report STD cases. As well, awareness of STDs and how to prevent them, and access to regular healthcare are inconsistent among populations that are disadvantaged by poverty and other social determinants … these groups may therefore be more likely to engage in risky sexual activity.

If you have herpes, it's best to avoid sex during an active outbreak. And remember, herpes can also be transmitted when no symptoms are present … this is called "viral shedding." Also be aware that oral herpes can be spread to the genitals through oral sex.

What are some ways that herpes cannot be spread?

You cannot get herpes through contact with toilet seats, bath tubs, hot tubs, swimming pools, towels, or the like.

Want to learn more?

Symptoms

Herpes signs and symptoms

Genital herpes is most contagious from the first tell-tale signs of tingling or burning (prodrome), until sores have completely healed.

According to the Centers for Disease Control and Prevention (CDC), however, more than 80% of people infected with HSV-2 (genital herpes) don't know they're infected … they have mild or no symptoms, but they're still contagious to others. That's why getting tested is so important.

Initial HSV-2 symptoms in women (within two weeks after exposure)

Common
  • No obvious symptoms
Uncommon
  • Blisters, sores or red bumps in the vaginal area, anus or cervix
  • Itching or other discomfort in the genital area
  • Painful urination
  • Vaginal discharge
  • Flu-like symptoms (including headache, muscle aches, fatigue or fever)
  • Swollen lymph glands
Rare
  • Blisters or sores in and around the buttocks, inner thighs or fingers (herpes whitlow)
  • Difficulty urinating

Initial HSV-2 symptoms in men (within two weeks after exposure)

Common
  • No obvious symptoms
Uncommon
  • Blisters, sores or red bumps on the penis, scrotum or urethra
  • Itching or other discomfort in the genital area
  • Painful urination
  • Flu-like symptoms (including headaches, muscle aches, fatigue or fever)
  • Swollen lymph glands
Rare
  • Blisters or sores in and around the buttocks, anus, inner thighs or fingers (herpes whitlow)
  • Proctitis (uncomfortable inflammation of the lining of the rectum)

HSV-1 symptoms

Common
  • No symptoms
Uncommon
  • Cold sores on the lips or inside the mouth
  • Flu-like symptoms (including headaches, muscle aches, fatigue or fever)
  • Swollen lymph glands
Rare
  • Blisters or sores on the nose or fingers (herpes whitlow)
  • Eye infection

Recurrences of herpes outbreaks

Recurring signs and symptoms of both genital and oral herpes vary from person to person. Some people experience several outbreaks per year, which can be triggered by stress, fatigue, illness, sun exposure or — in the case of women — menstruation. But for most people, outbreaks are fewer and less intense over time.

Complications

Herpes complications

What if herpes is untreated?

While it's not necessary to treat herpes that is mild or asymptomatic, there's a chance that undiagnosed and untreated herpes can weaken the immune system and increase the risk of suffering from encephalitis (progressive inflammation of the brain). According to a 2010 study published in The Lancet Infectious Diseases Medical Journal, about 19% of percent people with encephalitis were also infected with herpes.

In rare cases, other serious complications from herpes include meningitis (inflammation of the membranes around the brain and spinal cord); eczema herpetiform (widespread herpes across the skin, resembling smallpox); as well as eye infections, pneumonia and other health problems. That's why getting tested is so important.

Herpes and HIV

According to the Centers for Disease Control and Prevention (CDC), people with herpes are two to three times more likely to get HIV if exposed, and vice versa … in particular, genital sores or lesions allow these viruses to more easily enter the body upon contact.

In general, someone who has one STD is at greater risk for infection with other STDs, including HIV. That's because STDs that cause ulcers, sores, or otherwise break the skin or mucous membranes make carriers more susceptible to infection … also, someone with one or more STDs may have a weakened immune system that makes them more vulnerable to other diseases.

Herpes and pregnancy

Pregnant women with herpes may transmit the virus to their baby, particularly if their initial herpes outbreak occurs near delivery … in these cases, it's best to perform a cesarean delivery.

While herpes in newborns is rare, the disease can have devastating effects in infants. If a pregnant woman is infected with genital herpes before the third trimester, or pre-pregnancy, and there are no outbreak symptoms, vaginal delivery is generally safe … according to the CDC, the risk of your baby is less than 1%. But if you're newly infected with herpes, or if symptoms are present when your water breaks or during labor, you'll definitely need a cesarean delivery.

Note: The American College of Obstetricians and Gynecologists recommends that pregnant women with recurrent genital herpes take oral antiviral medication from about 36 weeks until delivery … this reduces the possibility of a herpes outbreak during labor.

If you're pregnant and concerned about herpes, be sure to consult your regular doctor.

Testing

Herpes testing

How do I get tested for herpes?

We make getting tested for herpes simple. The most common methods to diagnose herpes are a blood test or a viral culture test (swabbing or scraping a sample of a herpes sore or lesion). Both of these tests — known as serology or virus detection, respectively — can confirm a doctor's preliminary visual diagnosis of whether or not a person has herpes, based on a physical exam and an understanding of that person's sexual health history.

The Herpes Simplex Virus Type-Specific HSV-1/2 IgG blood test (or HSV 1/2 IgG) screens for both HSV-1 and HSV-2 antibodies. Recommended by the Centers for Disease Control and Prevention (CDC), this test is easy and safe (no undressing or swabbing required!) … and it's the most accurate and reliable herpes test available today. However, if you opt for a viral culture test, see your regular doctor in person since a swab test cannot be done at a standard testing facility.

What herpes test results mean

  • HSV-2 antibodies present (positive): This means you may have genital herpes.
  • HSV-2 antibodies not present (negative): This means you probably don't have genital herpes, unless you were recently infected and your body has not yet produced detectable antibodies … in which case, you may want to get tested again in three months to confirm that you're negative.
  • HSV-1 antibodies present (positive): This means you may have oral herpes.
  • Neither HSV-1 or HSV-2 antibodies present (negative): This means you probably don't have genital or oral herpes, unless you were recently infected and your body has not yet produced detectable antibodies … in which case, you may want to get tested again in three months to confirm that you're negative.

If you test positive for HSV-2, we're here to help. You'll have the opportunity to consult with a doctor on the phone right away. We'll answer your questions, prescribe treatment, and help you determine the next steps based on your specific circumstances.

Note: We do not provide a medical consult for HSV-1 positive test results because this type of herpes is usually a benign infection that is most often asymptomatic, or only results in cold sores on the lip. Please see your regular doctor for HSV-1 oral or topical treatment options.

Understanding false-positive or false-negative test results

As with most medical tests, there's a slight chance (1-4%) that a positive test result indicates an infection when there isn't one (false-positive); or a test comes back negative, despite the presence of infection (false-negative). For example, a false-negative test result can happen if an infected person tests too early for an infection to be detected … that means it's possible to get a negative test result but still have an STD.

Get tested 2 weeks after you believe you were first exposed; and then again 3 months later.

Learn more about "testing windows" — the recommended amount of time between potential exposure to an STD infection, and when screening is expected to identify the infection (or re-infection); for example, if you had unprotected sex last night and became infected with herpes, the virus wouldn't necessarily show up right away … it could take up to three months to test positive.

Treatment

Herpes treatment

Is there a cure or treatment for herpes?

Yes. Once you've been tested and diagnosed with oral or genital herpes, it can be treated … but not cured.

Remember, herpes is not life-threatening in adults … and depending on the severity of herpes outbreaks, no treatment may be necessary. Oral antiviral medications — most commonly, acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex) — are safe and effective, and can prevent or shorten the duration of outbreaks, reduce the frequency and severity of recurrent outbreaks, and decrease the risk of spreading the infection to others.

Herpes can recur

Even if you're being treated for herpes, outbreaks may continue … the frequency of recurring outbreaks depends on the duration and severity of the first herpes episode. An initial infection that lasts five weeks or more correlates with almost twice the number of recurrences, compared to an initial infection that doesn't last as long.

Additionally, there's a 60% likelihood of recurring outbreaks with HSV-2, compared to a 14% likelihood of recurrences with HSV-1. The good news is that people with recurrent outbreaks usually have milder symptoms, or no symptoms at all. Be sure to continue to use latex condoms or a dental dam to minimize the risk of spreading herpes to your sexual partner, even if you don't notice any outbreak symptoms … this is especially important if you are pregnant.

Episodic vs. suppressive therapy

With episodic therapy, you only take the prescribed medication when you're experiencing herpes symptoms; however, to minimize the aggravation of symptomatic herpes (more than five outbreaks per year), daily suppressive therapy may be your best option … this also reduces the risk of transmitting herpes to an uninfected partner. We're happy to help you determine the best treatment for you, including FDA-approved use of Valtrex to treat recurrent genital herpes.

Note: The Clinic does not provide medical consultation for HSV-1 positive test results because this type of herpes is usually a benign infection that is most often asymptomatic, or only results in cold sores on the lip. Please see your regular doctor for HSV-1 oral or topical treatment options.

Pregnancy and treatment

Ideally, to protect the health of your baby, avoid genital exposure to HSV-1 or HSV-2 during pregnancy.

In general, herpes can also be treated during pregnancy with prescription medication. Consult your regular doctor about the risks involved, and to identify a treatment that's best for you and your baby.

Concerned about Herpes?

Find out if you should get tested today; peace of mind has never been easier. Questions about our process? See how our STD testing works.