What is herpes?

Herpes is a very common infection caused by two different but closely related viruses — herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Both are easy to catch. They remain in the body for life, and can produce symptoms that come and go. Both forms of herpes can infect the oral area, the genital area, or both. When the infection is on or near the mouth, it is called oral herpes. Oral herpes is caused most often by HSV-1. When herpes infection is on or near the sex organs, it is called genital herpes. Genital herpes is caused most often by HSV-2.

How many people have herpes?

Between 50 and 80 percent of American adults have HSV-1. And about 25 percent of American adults have HSV-2. Millions of people do not know they have herpes because they never had, or noticed, the symptoms.

What are the symptoms of oral herpes?

"Cold sores" or "fever blisters" usually show up on the lips or around the mouth. Sores may also show up inside the mouth, but this usually only happens the first time oral herpes symptoms appear. Symptoms may last a few weeks and go away. They may return in weeks, months, or years. They are annoying but usually harmless in children and adults. But cold sores can be very harmful to a newborn.

What are the symptoms of genital herpes?

Most people with genital herpes have no symptoms or have very mild symptoms that go unnoticed or are not recognized as being a sign of infection. The most common symptom is a cluster of blistery sores — usually on the vagina, vulva, cervix, penis, buttocks, or anus. Symptoms may last several weeks and go away. They may return in weeks, months, or years.

The first episode of symptoms of a genital herpes infection is also called "initial herpes." The symptoms of first episodes are usually more severe than later outbreaks.

Symptoms may include

• blisters
• burning feelings if urine flows over sores
• inability to urinate if severe swelling of sores blocks the urethra
• itching
• open sores
• pain in the infected area

Severe first episodes may have symptoms that include

• swollen, tender lymph glands in the groin, throat, and under the arms
• fever
• chills
• headache
• general run-down feelings
• achy, flu-like feelings

How is herpes spread?

Herpes is spread by touching, kissing, and sexual contact, including vaginal, anal, and oral sex. It can be passed from one partner to another and from one part of the body to another. Brief skin-to-skin contact is all that's needed to pass the virus. Because herpes may have no symptoms for years, sometimes it is very difficult to know who passed it to whom.

Herpes is most contagious when sores are open and "weeping" — until the scabs heal and fall off. But herpes can also be spread when no symptoms are present — most people get genital herpes from people with no symptoms. And most people with oral herpes were infected as children.

Mucous membranes of the mouth, vagina, penis, anus, and eyes can become infected with herpes easily. Skin can be infected if it is cut, chafed, or burned, or has a rash or other sores.

How long does it take for sores to appear after a person gets infected?

When there are symptoms, the first episode of herpes usually appears from two to 20 days after infection — but it may be years before the first symptoms appear.

How long do sores last?

The sores usually heal in about two to four weeks with the first episode of herpes symptoms. But the virus stays in the body. It can flare up and cause sores again. Symptoms from flare-ups usually heal in 10-14 days. Symptoms may be more painful and last longer in women or men with illnesses that weaken the immune system — like leukemia and HIV.

What is a recurrence?

When herpes flares up again, it is called a "recurrence" or "outbreak." There may be some early warning signs before an outbreak occurs — tingling, burning, or itching where sores were before. The warning signs may start a few hours or a day before the sores flare up. When symptoms recur, they are usually not as severe.

What causes a recurrence?

Oral herpes recurrences may be caused by sunburn, injury to the lips, or other infections.

No one is sure what causes genital herpes recurrences. Other infections, stress, surgery, menstruation, sexual intercourse, and skin irritations may bring on recurrences.

Does herpes always recur?

Recurrences are individual and vary. Some people rarely have them. Others have them often. Recurrences are most common in the first year after infection. Oral herpes caused by HSV-1 is much more likely to recur than oral herpes caused by HSV-2. Genital herpes caused by HSV-2 is much more likely to recur than genital herpes caused by HSV-1. Recurrences may be more frequent for people with weakened immune systems.

How is herpes diagnosed?

Only a clinician can diagnose herpes by performing a physical exam and tests. A blood test can tell if you are infected with HSV-1 or HSV-2 — even if you don't have symptoms. Clinicians can also confirm herpes infection by testing fluids taken from the sores.

If you think you have herpes sores, see a clinician as soon as possible. It's important to be sure that the sores are herpes. Other serious sexually transmitted infections, like syphilis, may look like herpes but need different treatment.

How can symptoms be relieved?

Ongoing use of anti-herpes drugs is usually very effective in speeding up the healing of sores and in preventing recurrent outbreaks. Anti-herpes drugs are less effective when used to treat individual recurrent outbreaks, but they may be helpful to some people. Using these medicines only during outbreaks is called episodic therapy.

Warm baths may give some relief of pain. Cotton clothes will help prevent chafing. Keep the sores dry — moisture can slow healing. Holding cool compresses or ice packs to the sores may be soothing. Aspirin, acetaminophen, or ibuprofen may help relieve pain and fever.

Is there a way to prevent recurrences?

People who have herpes may consider taking anti-herpes drugs to help reduce the frequency and duration of recurrences. They are most effective in people with frequent outbreaks. Daily use of these medicines is called suppressive therapy.

A good diet, enough rest and sleep, and effective stress management may help prevent herpes recurrences.

Is there a cure for herpes?

No. However, in most cases outbreaks become fewer and weaker over the course of a few years.

How can people prevent spreading herpes to others?

There are three main ways to prevent spreading genital herpes.

• Stop having sexual contact as soon as you feel warning signs of an outbreak. Do not have vaginal, anal, or oral sex — even with a condom. Wait until seven days after the sore heals. The virus can spread from sores not covered by the condom. It can also spread in sweat or vaginal fluids to places the condom doesn't cover.
• Use condoms between outbreaks to reduce the risk of transmission.
• Take anti-herpes drugs. The risk of transmission can be greatly reduced if the partner with herpes takes a small daily dose of anti-herpes medication.

Touching any type of herpes sore may spread the virus from one partner to another or from part of the body to another, especially during initial herpes. If you have herpes sores

• Don't touch the sores. If you do, wash your hands with soap and water — this kills the virus. Wash your hands
  • after going to the bathroom
  • before rubbing your eyes
  • before touching a contact lens
• Don't wet contact lenses with saliva — especially if you have oral herpes.

If you have a cold sore on your mouth, don't kiss anyone — especially infants, children, or pregnant women.

What happens if a woman is pregnant and has herpes?

Most women who have herpes don't need to worry. Rarely does a woman with recurrent herpes pass the infection on to her newborn. The greatest danger for the fetus is during delivery if a woman is having her first episode of genital herpes. In some of these rare cases, contact with herpes sores can lead to a severe, life-threatening infection for the baby. If herpes sores are present when a woman begins labor, a cesarean section can be done to avoid infecting the newborn. Very rarely is a fetus infected earlier in pregnancy.

What can a woman do to prevent her newborn from getting herpes?

The most important thing a woman can do is to avoid becoming infected with herpes during pregnancy. A woman and her partner may want to consider herpes testing if the woman has never had genital herpes symptoms and if her partner has a history of genital herpes or if she has any concerns about being exposed. If a pregnant woman does not have genital herpes but her partner is infected, they should avoid unprotected oral, vaginal, and anal sex. An infected partner may also want to consider suppressive therapy throughout the woman's pregnancy to reduce the risk of passing the infection.

A pregnant woman should work with her clinician to plan the best care for herself and her baby. Discuss any concerns you may have about herpes and pregnancy with your clinician.

Is there any connection between herpes and AIDS?

Yes. Studies show that all sexually transmitted infections can increase the risk of getting HIV. People with genital herpes have at least twice the risk of becoming infected with HIV if exposed to it than people without infection. And people with HIV and genital herpes are more likely to pass HIV to their partners than people without genital herpes.

Where can I get more information about herpes?

Many Planned Parenthood^® health centers have support groups for people living with herpes. Call toll-free 1-800-230-PLAN to reach the nearest Planned Parenthood health center.

The American Social Health Association sponsors a program that assists people with herpes — the Herpes Resource Center. It publishes a quarterly newsletter, operates a telephone hotline, and organizes help groups.

For more information:
Herpes Resource Center
American Social Health Association Resource Center
P.O. Box 13827
Research Triangle Park, North Carolina 27709
Herpes Hotline 1-919-361-8488
www.ashastd.org/hrc/

More resources:
International Herpes Resource Center
www.herpesresourcecenter.com