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Herpes Simplex Virus

Herpes is one of the most common sexually transmitted infections. It is caused by the herpes simplex virus (HSV). Most Canadians will have at least one type of HSV in their lifetime. Many of those people have never had symptoms and are not aware that they have HSV.

There are two types of herpes simplex virus: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). For many people, herpes is a minor skin condition that comes and goes without causing problems.

HSV-1 is commonly found around the mouth, and is often called "cold sores". It can be passed to the genitals through oral sex. HSV-2 is commonly found in the genital area, but it can 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, HSV 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

HSV is spread by direct skin-to-skin contact. HSV can be passed even when sores are not visible, although it is less likely to happen during these times.Sometimes the virus can be found on the skin even when there are no symptoms. This is called "asymptomatic shedding".

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 a person first gets HSV. 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 HSV, then it is not possible to get that same type again from a new partner.

Symptoms

A person can have HSV and not know it. Symptoms may not appear for months or years. Many people who do get symptoms do not realize that they are caused by HSV.

The first time a person comes in the contact with the virus and gets symptoms is called a primary outbreak. Usually symptoms begin 2 to 21 days after contact. 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. Sometimes people 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 sores may be triggered by different things. Some triggers that people describe include sun exposure, lack of sleep, alcohol use, stressful events and skin irritation. Symptoms may be reduced by getting enough sleep, eating well and minimizing stress.

Complications

Complications are rare and most often occur with the first herpes outbreak. During this time, it is possible to spread HSV to other areas of your body, such as the hands and fingers, anus and eyes. To lower the chances of this, try not to touch the sores and wash your hands often.

A pregnant person can pass genital herpes to the baby during childbirth. This is most likely to happen if the person has their first outbreak near the time of delivery. Talk to your doctor if you have any questions about herpes and your pregnancy.

Severe complications, although extremely rare include:

  • Ongoing, frequent and painful outbreaks
  • Ocular (eye) herpes
  • Brain infection and inflammation (encephalitis or meningitis)

See your health care provider if you are concerned about symptoms or complications.

Tests and Diagnosis

The best test for herpes involves taking a swab from the sore as soon as possible after it develops. Results will usually come back within 7 to 10 days, but some clinics may take longer.

Blood tests are not routinely done, but in some cases (e.g. pregnancy), blood tests may be helpful. Most blood tests are accurate 12 to 16 weeks after possible exposure to HSV.

A positive herpes test does not tell you how long you have had the virus or where it will show up on the body.

Treatment

Antiviral medication can lessen the severity of an outbreak, lower the chances of passing the virus to a partner and shorten the time it takes for a sore to heal. Medication works best if it is started as soon as possible after an outbreak begins.

It is not necessary to treat herpes, but you can talk to your doctor or health care provider if you want more information about this medication.

To help with the symptoms of a primary 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
  • Only use medications, ointments or creams as directed by your health care provider
  • Take acetaminophen or ibuprofen (over-the-counter pain medication) if needed
  • Drink plenty of fluids to keep urine diluted (to lower pain when urinating or peeing)
  • If urinating (peeing) is painful, try urinating in a warm shower or bath, or try pouring warm water over the genitals when urinating

Prevention

To lower the chances of passing or getting HSV:

  • Condoms and dental dams may help to prevent HSV
  • You can still be sexual when you have an outbreak, but take care to avoid skin-to-skin contact in the area of the sore (this would mean not having oral sex when you have a sore on the mouth, but genital contact is fine)
  •  Consider antiviral medication if you have frequent outbreaks

If you have herpes

HSV is very common, but many people worry about how it will affect their lives. Sometimes they feel bad about themselves and worry about how to talk to partners. Most people who have HSV have few or no symptoms. It does not need to get in the way of your sexual enjoyment and relationships.

Helpful herpes resources

These two resources - a detailed 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.

Other resources

Herpes Handbook – Information on herpes (USA)
BC Centre for Disease Control – Genital Herpes / Herpes Simplex virus
Metro Vancouver Herpes Support Group
CATIE.ca – Genital herpes factsheet

Download and print this page (below).

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herpes, HSV, STI, STD
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