Worried about Herpes?

There are 2 types of herpes infection. Herpes type 1 (HSV 1) typically, occurs around the mouth and HSV 2 typically occurs in the genital areas. However it is important to note that you can get HSV 1 infection of the genitals, and this happens commonly in adults.

Herpes has many different clinical presentations. It is possible to have no symptoms despite having been infected with the virus (asymptomatic infection) and it is estimated that this happens in as much as 80% of infections. This is a major reason why it is possible to catch herpes from a partner, who might not even aware that they have the virus. I want to point this important fact out as there is a lot of anxiety and blame involved when it comes to herpes and it can cause unnecessary difficulties in a relationship.

Once a person has been infected with either HSV 1 or 2, they will usually develop antibodies against the type they have been infected with. However this process can take several months, which is why a blood test is not always the best test to establish if a recent infection has occurred.  If you are concerned that you have been infected recently we can offer serial blood tests over a few months, to see if you develop the antibodies. If the blood test comes back positive for HSV 2, it is almost always genital herpes, whether you develop the actual lesions or not. If the test comes back as positive for HSV 1, this is more complicated, as it could be either oral (coldsores) or genital herpes. A lot of people already have antibodies to HSV 1, and this is usually just due to exposure to the virus from family members as a child. If you test positive for HSV 1, we would then go more on whether you develop lesions and if so where they develop.

Lesions usually appear within 2 days to 2 weeks after exposure to the virus. As mentioned HSV 2 is primarily passed on through sexual contact. The risk of infection is higher if someone has the active lesions present, but again, it is possible to catch the infection from someone who doesn’t have the lesions. The typical herpes lesions are blisters or erosions and they are usually quite painful, although this is dependent on how severe and aggressive the infection is, and also on the site of infection. A large proportion of people will not develop these classic symptoms, and will instead have minor symptoms such as a bit of skin irritation or even just an  abrasion in the genital area. If the skin is broken then it is possible to get a bacterial infection on top of the herpes infection.

The first attack is usually the worst and can last for several weeks. Some people will develop sensory changes in the area before the blisters appear and others might feel systemically unwell with fever , muscle pains or have enlarged lymph nodes in the groin. Lesions usually clear up eventually on their own, but if you suspect you have been infected it is best to see a doctor as soon as possible, as there are treatments that can help reduce the length and the severity of the attack, as long as the treatment is started as soon as possible after the lesions appear.

If you develop suspicious lesions or a rash in the genital area, then often we would perform a swab test from the site. This PCR test is very accurate at detecting HSV and will also distinguish between HSV 1 or 2. Results take between 3-5 working days.

The nature of herpes infection is that is is recurrent. Some people get very frequent attacks others might get one per year. It is impossible to predict the course. Most people find though that the frequency and severity of attacks subside after the first few years. However, if you have an HSV infection, you are infectious most of the time, whether you have the lesions or not. Studies show that viral shedding still occurs from the site to varying degrees even in the absence of lesions. This is probably one of the reasons why herpes infection is so common in adults, as people might not be aware that they are infectious in between outbreaks as well.

Unfortunately at the moment there is no cure for herpes. However it is possible to manage the symptoms by taking antiviral medication, either when you get an outbreak, or as suppressive therapy, over a few months, to try and keep it at bay. Herpes is not life threatening in any way. There are ways to try and reduce the likelihood of infecting sexual partners. Condoms help reduce the risk by about 50% but only if the infected area is in the area protected by the condom. It helps to notify partners so you can both be alert to signs of an outbreak and abstain during that period and as mentioned antivirals can cut transmission rates too.

Many of my female patients are worried about the effect of herpes on fertility and pregnancy. The only real issue is that if you have been infected with herpes in the vagina, then if you are pregnant the doctors need to be informed to decide if a vaginal delivery would still be ok, as there might be a risk of passing the infection on to the baby during vaginal delivery. It is also important to note that if you have been infected with Herpes , we would always advise screening for other STI’s including HIV, as we know that HSV infection makes HIV transmission a bit easier.