Genital Herpes: Common Questions

What is herpes?

The herpes simplex virus (HSV) is a common infection which can infect the mouth (usually HSV-1) or the genitalia (usually HSV-2). Genital herpes is transmitted by direct skin-to-skin contact with an infected partner. When symptoms are present (and actually, this is the minority of cases), genital herpes is hallmarked by small, ulcerated, and often painful lesions in the genital area. It is also common to have pain or swelling in the groin, pain with urination, and/or flu-like symptoms such as headache, fever, or muscle aches. However, most people are unaware if they have or have had herpes, as symptoms may be very minimal or absent. This is called “subclinical infection.”

I have a lesion on my genitals that seems new – how do I know if this is herpes?

The best way to determine whether or not a new change on the genitals is herpes is to be examined by a clinician who has experience in diagnosing different skin/genital infections. At that time, your provider may obtain a “culture” which is a specific test for herpes. Though this is not 100% sensitive in picking up a herpes lesion, the combination of a visual exam and a culture and sometimes serologic (blood) testing can usually correctly diagnose a herpes lesion.

I don’t have any suspicious lesions now, but how do I know if I have had herpes in the past?

It is possible to perform serologic testing which is designed to see if your body has made antibodies to either HSV-1 or HSV-2 in the past. Usually, these tests are able to distinguish between a past and current infection as well. However, these tests are not perfect and can miss infection. Therefore, it is important to first talk with your provider about your history, and whether or not any further testing is necessary.

My partner occasionally gets cold sores on his lip. He has been told that this is herpes. Can I contract herpes from him on my mouth or genitals?

Yes, if your partner has a sore around the mouth, it very well could be related to the herpes virus – most likely HSV-1. If you engage in any mouth-to-mouth or mouth-to-genital contact, it is possible to transmit the virus this way. However, it is uncommon that this type of viral transmission (HSV-1) will progress to become a chronic issue in terms of future genital outbreaks.

I was told that I was having a herpes outbreak many years ago while I was in college. I have never had another outbreak since and feel no symptoms of herpes. I am just beginning a new relationship – what should I tell my partner?

Though it is always very difficult to discuss herpes or any history of a sexually transmitted infection, it is important to find a way to have this conversation. Keep in mind that your partner has a 25% chance of already being infected with the virus, even if he or she has never had a known outbreak. You could suggest that your partner be screened with a blood test before assuming that you are infected and your partner is not. If you confirm that you have been infected and your partner has not, efforts should be made to prevent transmission. If you do have signs or symptoms of an active outbreak, then intercourse should be avoided. If there are no signs or symptoms of an active outbreak, it is still possible (though less likely) to infect a partner. This is because of “asymptomatic shedding,” which means that your genitals are shedding the virus but you have no symptoms. Because of this possibility the best form of protection is the use of condoms, as it creates a barrier between the genital tissues. Though condoms do not prevent transmission 100% of the time, it is the most helpful way to prevent transmission.

I had a primary herpes outbreak about a year ago. Since then, I have an outbreak almost every month, usually around the time of my period. What can I do about these outbreaks?

For women infected with HSV-2 (the most common cause for genital herpes), it is not uncommon to experience recurrent outbreaks. Often, women have outbreaks around their menses as a result of hormonal changes. The other very important factor which has a great bearing on how frequently or severely a woman experiences outbreaks is her overall wellness and immune system. When a person’s immune system is impaired for any reason, the body has a harder time managing any virus, and therefore someone infected with herpes can have more frequent or extreme outbreaks. Things that can weaken your immune system include smoking, inadequate rest, stress, malnutrition, or chronic illness such as HIV, diabetes, or cancer. If you know that you have herpes, it is important to try to eliminate stressors to the body so as to keep your immune system strong. Additionally, there are medications called “antivirals” available, which can significantly improve the frequency and intensity of herpes outbreaks. For a person who has an occasional outbreak the use of medication can shorten the length and intensity of the outbreak, especially when taken at the first signs of an outbreak. For a person who has chronic monthly outbreaks, it is sometimes recommended that medication be taken on a daily basis to “suppress” the outbreaks.

Please feel free to talk with your healthcare provider about the possible use of medication if you have herpes outbreaks.

In the future we will discuss herpes in pregnancy.