What is it?

Herpes is a virus, also known as the herpes simplex virus (HSV). There are two types of HSV. There is HSV type I, which is most often associated with cold sores on the mouth (but can also cause genital herpes sores) and there is HSV type II, which is usually associated with genital sores. Once someone has been infected with HSV, the virus remains in their body.

How is it spread?

Herpes is spread through direct contact. You can become infected with herpes by:

In most cases, people with herpes pass on the virus when they have an outbreak of sores or blisters, but sometimes they can pass on the virus when there are no sores. Babies born to mothers with active herpes can become infected during pregnancy and/or childbirth.

What are the symptoms?

Approximately two to 20 days after contact with an infected person a rash or blister may appear where the virus entered the body (i.e. mouth, genitals, groin, buttocks, anus). With the first infection or outbreak there may also be an itching or tingling sensation on the skin, flu-like symptoms, fever, pain with urination and/or enlarged lymph nodes. The sores or blisters are often very painful and will heal within one-two weeks without scarring. The virus remains inactive or dormant in the nerve endings until the next outbreak. When the virus becomes active again, the sores/blisters may return but are usually less painful, less frequent and will heal faster.

Recurrences vary from person to person. Factors which seem to trigger outbreaks in some people include sunlight, stress, injury to the affected area, poor diet, menstruation, and a lowered immune system.

How is it diagnosed?

Herpes can be accurately diagnosed by a physical examination and confirmed by a swab/culture. A swab is taken from the sore(s) or blister soon after they appear (ideally within 48 hours) and is sent to the lab for testing. With this type of testing, positive test results will differentiate between herpes simplex I and herpes simplex II.

The standard, widely available blood test is not a useful test for diagnosing herpes because it will not differentiate between HSV I and HSV II. Most people have been exposed to HSV I (even though they are not actually infected with it) and will therefore test positive for HSV antibodies in their blood. For this reason, this blood test for HSV is not recommended for diagnosis of herpes.

In the absence of a sore, there is now a new blood test that is type-specific. Hassle Free does not offer this test as it is not covered by OHIP. This test is called the herpes western blot, manufactured by the University of Washington (and was approved for use in Canada in 2001). You can go to their website for more details about their test.

Have your family doctor call 206 · 598 · 6066 for more information or call the Phoenix Association at 416 · 449 · 0876 for Toronto-based information. The test is processed in Vancouver and is best performed at least four months after possible exposure or infection. This test will not tell the location of infection on the body.

What are the complications?

Rarely, herpes sores can become infected with bacteria. Women with a severe first outbreak in the genital area may have difficulty urinating. Herpes of the eye can cause blindness. Women with a primary outbreak during the first trimester of a pregnancy can pass it to their child in the womb. On rare occasions, babies born to mothers with an outbreak at the time of delivery, may develop herpes of the central nervous system shortly after birth. To prevent this, a cesarean-section is usually done. If a pregnant woman has a history of herpes but does not have an outbreak at the time of delivery, she will may be able to have a vaginal birth without any risk to the baby. Any pregnant woman with herpes should discuss this with their healthcare worker.

How is it treated?

There is no cure for herpes. There are anti-viral medications that will help reduce the symptoms and speed the healing of the sores or blisters. Some anti-viral medications used for herpes are Famvir, Valtrex and Acyclovir.

Pain medication, salt water baths, cold compresses to the affected area and urinating in water, may relieve the discomfort. Keeping the area clean and dry, wearing cotton underwear and loose clothing may also help reduce the discomfort.

What about sexual Partners?

Your sexual partner(s) need to be informed. The only way to prevent herpes transmission is to avoid direct contact with the sores/blisters. Using latex condoms or a latex barrier during sex may provide some protection from herpes if it covers the areas where the sores are located.

Prevention

Avoid having sex when you have sores or if you think you are about to get an outbreak. A tingling sensation in the area of the outbreak often signals that an outbreak is about to begin. If your partner has active herpes sores, don’t have sex until they are healed. Don’t have oral sex if one of you has a cold sore, as HSV I can be transmitted to the genitals. Even if your partner is symptom-free, use a condom.