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Herpes Simplex Virus

Herpes is a sexually transmitted infection (STI) caused by the virus Herpes Simplex Virus (HSV). It can occur on the skin around or sometimes inside the penis or external genitals, vagina or internal genitals, anus, and mouth. For many people, herpes is a skin condition that comes and goes without causing problems.

Herpes can be managed.  It is a very common STI in British Columbia.

There are two types of herpes simplex virus: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2).

HSV-1 is commonly found around the mouth and is often called "cold sores". It can be passed orally by kissing and it can be passed to the genitals through oral sex. HSV-2 is commonly found in the genital area and is passed through vaginal and anal sex, but it can also be passed to the mouth through oral sex. It is uncommon for HSV-2 to be found on the lips, but it is becoming more common to find HSV-1 in the genital area. Both types are sometimes passed to other areas of the body through skin-to-skin contact.

After the first outbreak, herpes stays in the body and becomes inactive. The virus may become active from time-to-time. When this happens, symptoms usually show up in the same general area as the first time. There is no way of knowing if, or how often, a person will have future outbreaks. For most people, outbreaks happen less often over time.

Causes

Herpes is passed through vaginal, oral, and anal sexual contact.  This includes both penetrative sex and sexual activities where there is skin-to-skin contact. The contact needs to be directly with the part of the body where a person has the virus. 

Herpes can be passed to others even if you don’t have symptoms.  The virus can be found on the skin even when there are no symptoms, called "asymptomatic shedding".  However, it’s more likely to be passed when symptoms are present. 

Once you have one type of HSV, it is unusual to get the same type on another area of your body. The exception is within the first few months after you are exposed to HSV, while your body is building up antibodies to the virus. HSV can be passed to other parts of the body during this time. Try not to touch the sores and wash your hands often, to lower the chances of passing it to another part of your body.

If you have one type of herpes, then it is not possible to get that same type again.

Symptoms

If you have herpes, it is common to not notice any symptoms. If you do get symptoms, they will most likely show up between 2 to 21 days after sexual contact. 

The first time you come in contact with the virus and get symptoms is called a primary outbreak. The first outbreak can last longer and be more severe than future outbreaks. Early symptoms include itching, burning, or tingling at the site where blisters or sores may appear, followed by painful red sores or tiny blisters and sometimes swollen glands, fever and body aches. You may have severe flu-like symptoms, such as fever, headache and muscle aches. Over time, outbreaks usually happen less often and the symptoms are milder.

Herpes outbreaks may be triggered by different things.  These can include sun exposure, lack of sleep, alcohol use, skin irritation, and stressful events. Symptoms may be reduced by using sunscreen, getting enough sleep, drinking water, using lube, eating well and using coping strategies for stress.

Tests and Diagnosis

Most testing for herpes is done by an exam and a swab taken from a blister. Results are the most accurate if you see a health care provider as soon as a sore develops.  They will look at the sore to determine what it is.  If possible, they will take a swab. 

There is a blood test for herpes but it is not routinely done.  The patient guide at the bottom of this page has more information on blood testing for herpes.

It is best to get tested for herpes when you have symptoms.

Window Period (how long you should wait to get tested): Most swab tests are accurate once you have symptoms.  Most blood test results are accurate 12 to 16 weeks after you come in contact with herpes.  In British Columbia, most test results should be ready in 10 days.

Treatment

You can choose if you want to treat herpes.  Symptoms will go away without treatment, though they may go away sooner with treatment.  Herpes is treated with prescription antiviral medications.  These medications can lessen the severity of an outbreak and lower the chances of passing it to sexual partners. Medication works best if it is started as soon as possible after an outbreak begins. 

To help with the symptoms of a genital outbreak, you can try the following:

  • wear loose-fitting clothing and cotton underwear
  • bathe in warm water to soothe sores
  • keep the area dry
  • apply an ice pack, wrapped in a clean covering, to sores
  • take acetaminophen or ibuprofen (over-the-counter pain medication) if needed
  • drink plenty of fluids to keep urine diluted (to lower pain when urinating)
  • if urinating is painful, try urinating in a warm shower or bath, or try pouring warm water over the genitals when urinating
  • only use medications, ointments or creams as directed by your health care provider

Sexual Partners

It is your choice if you talk to your current sexual partners about herpes.  Telling your partners lets them make informed choices, but you may not want to or you may not feel safe telling your partners.  You need to make the decision that is best for you.

Current partners can check themselves regularly for herpes.  If they notice any symptoms, they can see their health care provider for testing.  Once your outbreak is over, it is less likely that you can pass herpes to sexual partners.

Complications

Herpes does not usually cause any other health problems.   Serious complications, although extremely rare, may include:

  • higher chance of getting and passing HIV
  • ongoing, frequent and painful outbreaks
  • eye herpes
  • brain infection and inflammation (encephalitis or meningitis)

Pregnancy:  Tell your health care provider if you are pregnant and have herpes.  You can pass herpes to your child during birth.

Prevention

To lower the chances of passing or getting herpes:

  • you can still be sexual when you have an outbreak, but take care to avoid skin-to-skin contact in the area where you have sores (for example, do not give oral sex when you have a sore on your mouth)
  • consider antiviral medication if you have frequent outbreaks

It is a good idea to be tested regularly for STIs, especially if you have new sexual partners or open relationships.  Talking with partners about safer sex makes sure everyone knows what to expect.  Condoms are great if they work for you – the correct use of condoms might reduce your chance of getting and passing herpes (depending where outbreaks are located).

Resources

These two resources - a detailed 25-page patient's guide and a 4-page handout - have been produced by the BC Centre for Disease Control. You can download or print these booklets for more information on herpes, including testing, treatment, and talking to your partners about herpes.

HealthLink BC – Information about herpes in multiple languages
SmartSexResource – If you are worried or have anxiety about herpes
Trans Care BC – Gender-affirming sexual and reproductive health information


Download and print this page (below).

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herpes, HSV, STI, STD, HSV-1, HSV-2, cold sores
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