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Everything you need to know about herpes

It’s natural to have a lot of questions about herpes. Talking with your health care provider or a sexual health educator in Community Wellness at MIT Medical can help you decide whether to be tested for herpes, how to treat it, and how to discuss it with your sexual partners.

What is herpes?

Herpes is a very common infection that is caused by one of two different types of viruses:

  • Herpes simplex virus type 1 (HSV-1) or
  • herpes simplex virus type 2 (HSV-2).

Both of these viruses can affect the mouth or genitals. HSV-1 has traditionally been associated with an infection in the mouth, while HSV-2 typically infects the genitals. However, recent research shows that HSV-1 is becoming a more common cause of genital herpes infections as well.

HSV-1 is widespread—an estimated 80 percent of adults are infected with it, as are half children under age six. HSV-2 is also quite common and affects about 20 percent of young adults.

Once someone has been infected, both HSV-1 and HSV-2 remain in the body for life. Most of the time, the immune system suppresses the virus so it’s dormant, but it still exists in the nerves deep within the skin. Even if your immune system is strong, however, the virus may start reproducing again, and you may experience an outbreak. Although there is no cure for herpes, certain medications can help prevent and shorten outbreaks. Herpes is not life-threatening and does not affect fertility in women or men.

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What are the symptoms of herpes?

The symptoms of herpes depend on what type of herpes virus you have and which part of the body it affects. Many people with HSV-1 or HSV-2 don’t experience any symptoms during an outbreak. This is called asymptomatic infection, and this makes it easier to unknowingly spread the virus to others. When HSV-1 and HSV-2 do cause symptoms, the two types of illness often look and feel the same. The main difference is that HSV-2 in the genital area is more likely to relapse, or cause outbreaks, than HSV-1.

Symptoms of oral herpes can include:

  • Pain, burning, tingling, or itching on the lips or mouth
  • Cold sores on the lips or around or inside the mouth, which may initially look like shallow ulcers and then crust over. Without treatment, these sores last several days to a few weeks before clearing up on their own.

Symptoms of genital herpes can include:

  • Pain, burning, tingling, or itching on or around the genitals, buttocks, or inner thighs
  • Small blisters on or around the penis, vagina, or anus that usually break and form small scabs before healing within a few days
  • A burning sensation while urinating if the sores are near the urethra (the opening through which urine exits the body)

Studies suggest that having genital herpes may also increase your risk of contracting HIV (the virus that causes AIDS). This is because open herpes sores on the genitals make it easier for the HIV virus to enter the body.

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How does herpes spread?

HSV-1 is spread through contact with saliva, including kissing and mouth-to-genital contact (oral sex). HSV-2 is usually transmitted by direct genital-to-genital or genital-to-anal contact. In the past, HSV-2 was responsible for most cases of genital herpes. However, recent research suggests that almost 80 percent of college students with genital herpes have HSV-1, likely due to the fact that rates of oral sex are high in this group. Remember, a person with herpes doesn’t have to have symptoms to spread the virus to someone else.

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How do I know if I have herpes?

The best way for clinicians to determine if someone has HSV-1 or HSV-2 is to perform a laboratory analysis on a sample from a fresh herpes sore. But because not everyone with herpes has symptoms, your clinician may use a blood test to detect antibodies to the herpes viruses. A blood test can reveal if you have herpes and specify whether you are infected with HSV-1 or HSV-2. However, the test cannot tell you what part of your body the virus will affect.

Talk with your clinician if you wish to be tested for herpes. Even if you have a standard screening for sexually transmitted diseases, it may not include herpes unless you specifically ask.

Remember, however, that HSV-1 is a very common virus and there is an 80 percent probability that you will test positive for it. If you are a sexually active adult who has had multiple partners, there is a 20 percent probability that you will test positive for HSV-2.

Here are some other things to consider before you get tested:

  • If you test negative for one or both of these viruses, what will you do to prevent them?
  • If you test positive for one or both of these viruses, will you tell potential partners before you engage in sexual activity or, in the case of HSV-1, before you kiss them or engage in oral sex?

Learning that you have herpes can be confusing and scary. We encourage you to have an in-depth conversation with your health care provider before you decide to get tested.

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How is herpes treated?

There is no cure for herpes, but antiviral drugs can help you manage outbreaks and relieve symptoms. There are currently three types of antiviral herpes medications:

  • Acyclovir (Zovirax)
  • Famcyclovir (Famvir)
  • Valacyclovir (Valtrex)

All three of these drugs are available in pill form. Acyclovir is the oldest of the three and is less expensive because it is available as a generic drug.

Antiviral medications can be taken two ways to treat herpes:

  1. Treatment for outbreaks. Although herpes sores eventually clear up on their own, antiviral drugs can shorten the duration and severity of symptoms. If your health care provider prescribes antiviral drugs to treat the symptoms of a herpes outbreak, you will need to take the medication multiple times a day for five days (your clinician will recommend an exact dosage).
  2. Suppressive therapy. Some people choose to take antiviral drugs every day. This is called “suppressive therapy,” and it can decrease the likelihood of herpes outbreaks. Suppressive therapy may have other benefits as well. It may:
    • Reduce the likelihood of developing asymptomatic outbreaks
    • Reduce the risk of transmitting HSV to your sexual partner
    • Reduce the risk of contracting HIV because active HSV can also make you more susceptible to the HIV virus
    If you have herpes, speak with your health care provider to determine if suppressive antiviral therapy is right for you.

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What about other approaches?

Despite claims that certain supplements or other alternative approaches can successfully treat or prevent herpes, there is no good evidence that these approaches are effective. Stress and illness can weaken your immune system, making you more susceptible to herpes, but it remains unclear whether maintaining a healthy lifestyle can protect against outbreaks.

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How can I prevent transmission of herpes?

The best way to prevent transmitting or contracting genital herpes is to avoid sexual contact or to be in a monogamous relationship with someone who has tested negative for the virus. That may not be realistic for many people, however. Although the following tips cannot completely prevent the spread of genital herpes, they can help lower your risk of transmission:

  • Don’t engage in sexual activity with an uninfected partner when you have an outbreak, and vice versa.
  • Use a condom for sexual intercourse and foreplay. HSV-2 is transmitted through skin-to-skin contact, not through bodily fluids, so you shouldn’t wait for intercourse to use condoms. When used properly, condoms reduce the risk of herpes transmission by about 50 percent.
  • Use a barrier such as a condom (for fellatio) or dental dam (for oral-vaginal or oral-anal sex) to prevent HSV-1 from being transmitted from the mouth to the genitals or anus.
  • Wash after sex. The herpes virus is surrounded by a lipid (fatty) coating, which causes it to be inactivated by soap. More research needs to be done, but it’s possible that washing with regular soap and water after sex might reduce the risk of contracting HSV.
  • Take antiviral drugs every day (suppressive therapy), which can decrease the risk of transmission by 50 percent.

Because oral herpes is so common, it can be difficult to prevent transmission. If you are concerned about contracting or transmitting oral herpes, avoid kissing people or sharing items like utensils, washcloths, and lip balm when cold sores are present.

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© MIT Medical, 2011

Community Wellness at MIT Medical

Kate McCarthy
Sexual health specialist
617-253-4420
kmcc@med.mit.edu

Multimedia library
E23-205

Medical Services

Primary Care
617-253-4481

Obstetrics & Gynecology
617-253-1315

Mental Health and Counseling
617-253-2916

Other resources

“Dr. Ruth’s Guide to Talking About Herpes” by Dr. Ruth Westheimer and Pierre Lehu. Available in the Community Wellness library, E23-205 (second floor of MIT Medical).

American Social Health Association