Herpes

How is it spread?

Genital herpes is spread through direct contact and you can become infected by:

• Having vaginal or anal sex with someone with genital herpes

• Receiving oral sex from someone who has oral herpes (cold sores)

• Touching herpes sores/blisters and then touching your eyes, mouth and/or genitals

In most cases, infections occur when a partner has an outbreak. Sometimes people can be infected even when there are no sores – this is called asymptomatic shedding.

What are the symptoms?

Approximately 2 – 20 days after contact with an infected person a rash or blisters may appear.  During the primary (first) outbreak, there may also be an itching or tingling sensation on the skin, flu-like symptoms, fever, painful urination and/or enlarged nodes.   The sores or blisters during the primary outbreak are often very painful but will heal within 1-2 weeks without scarring.

Recurrences can vary from person to person. Recurrent outbreaks are usually less painful, less frequent and the sores will heal faster.  In some cases, some people never experience any outbreaks after their primary outbreak.  Factors that may trigger outbreaks include stress, illness, injury to the infected area, hormonal changes or a compromised immune system.

How is it diagnosed?

Herpes can be diagnosed by a physical examination. If there are sores present, a swab is taken and sent to a lab for testing. If you do not have a sore then there is no way to definitively test for HSV. Blood tests currently available are not useful because they cannot tell you where on your body you have HSV. Blood tests are not covered by OHIP.

How is it treated?

There is no cure for herpes although there are anti-viral medications that help reduce the symptoms and speed the healing of the sores or blisters. You can take these medications when you feel an outbreak starting. If you have frequent outbreaks, you can consider taking these medications on an ongoing basis, although they are expensive. Please follow-up with your doctor or a walk-in clinic regarding repeat prescriptions for antiviral medications. Supplementing the diet with foods rich in the amino-acid lysine have also been shown to reduce outbreaks. Pain medication, witch hazel, salt water baths, cold compresses to the affected area and urinating in water, may relieve the discomfort.

What are the complications?

Herpes is a very common virus and complications are rare. While uncommon, a sore can become infected with bacteria.  Individuals with a severe outbreak may have difficulty urinating.  Herpes of the eye can cause blindness. There are some considerations with HSV and pregnancy. Individuals with a true primary outbreak during the first trimester of a pregnancy can pass it to their child in the womb.  On rare occasions, babies born to people with an outbreak at the time of delivery may develop herpes of the central nervous system after birth.  To prevent this, a caesarean section may be done.  If you have a history of herpes but do not have an outbreak at the time of delivery, you may be able to have a vaginal birth without risk to the baby.  Any pregnant individual should discuss HSV with their doctor or midwife.

What about sexual partners?

Although it can be difficult, talking about having HSV to your sexual partners is important. It’s not uncommon to worry about how people are going to react. Despite being a common virus, there is still a lot of stigma and fear that surrounds HSV. If you talk about HSV with your friends or partner, their reaction can vary. While they may initially be surprised or upset, you could also find out they may already have HSV or that HSV is not something they’re worried about once they have the correct information.

Prevention

To reduce the risk of transmitting HSV avoid sexual contact when you have an active outbreak, or just before an outbreak starts. A tingling sensation often signals that an outbreak is about to begin. HSV-1 can be transmitted to the genitals, so do not give oral sex when you have cold sores. Using latex condoms, gloves, dams and other barriers during sex also provides some, but not total, protection. Anti-viral medications can also reduce the risk of transmission however the cost is significant.