What Are The Differential Diagnoses
Other medical conditions could be confused with genital herpes or cold sores. The conditions are severe, and it is wise to consult with a medical expert. Herpes could be distinguished from these conditions with a lab test or medical exam.
- Medical reactions: Medication might lead to sensitive reactions and allergies that could appear as rashes. Although medication-induced rashes do not appear in the genital area, they are common around the patients mouth and lips.
- Concurrent HSV-2 or HSV-1: If the patient has either type of herpes, they could also be infected with the other. The viruses are different, and having one does not prevent or cause the other.
- Pre-cancer or Cancer: Lesions around and in your genital area could be symptoms of cancer. The appearance of precancerous or cancerous shouldnt have blisters that come with HSV lesions. However, your doctor should be able to tell the difference.
- Syphilis: Syphilis is an STD that manifests in genital sores that could be confused with herpes. Your OBGYN should be capable of telling the difference through visual lesions inspection.
- Canker sores: Usually, canker sores are red, raw, painful, and whitish in the middle. They are due to oral trauma and can appear in the mouth. While the painful sensation of cold sores and canker sores is alike, a lesion looks different.
How Is Genital Herpes Managed Or Treated
If you have mild symptoms or infrequent outbreaks, you might not need or want treatment. During an outbreak, these steps can ease symptoms:
- Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
- Keep genitals dry. Wear cotton or other nonsynthetic underpants and avoid tight-fitting clothes. Moist sores take longer to heal.
- Soak in a warm bath.
- Take nonsteroidal anti-inflammatory drugs to relieve pain.
- Wear loose-fitting clothing.
Antiviral medications can prevent outbreaks. They can also lessen symptoms and help symptoms go away faster. You take this medicine as a pill, intravenous injection or skin cream. When taken daily, antivirals can prevent an outbreak. They lower the chances of spreading the virus to other people.
Risk For Genital Herpes
According to the US Centers for Disease Control and Prevention , about 1 in 6 Americans ages 14 to 49 years have genital herpes. While HSV-2 remains the main cause of genital herpes, HSV-1 has significantly increased as a cause, most likely because of oral-genital sex. Except for people in monogamous relationships with uninfected partners, everyone who is sexually active is at risk for genital herpes.
Risk factors for genital herpes include:
- History of an STD
- First sexual intercourse at an early age
- High number of sexual partners
- Low socioeconomic status
Women are more susceptible to HSV-2 infection because herpes is more easily transmitted from men to women than from women to men. About 1 in 5 women, compared to 1 in 9 men, have genital herpes. African-American women are at particularly high risk.
People with compromised immune systems, such as those who have HIV, are at very high risk for genital herpes. These people are also at risk for more severe complications from herpes. Drugs that suppress the immune system, and organ transplantation, can also weaken the immune system and increase the risk for contracting genital herpes.
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How Is Genital Herpes Spread
- Saliva from a partner with an oral herpes infection
- Genital fluids from a partner with a genital herpes infection
- Skin in the oral area of a partner with oral herpes or
- Skin in the genital area of a partner with genital herpes.
You also can get genital herpes from a sex partner who does not have a visible sore or is unaware of their infection. It is also possible to get genital herpes if you receive oral sex from a partner with oral herpes.
You will not get herpes from toilet seats, bedding, or swimming pools. You also will not get it from touching objects, such as silverware, soap, or towels.
If you have more questions about herpes, consider discussing your concerns with a healthcare provider.
What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What is the best treatment for me?
- What are the side effects of antiviral medications?
- How can I reduce the risk of future outbreaks?
- Whats the best way to prevent getting another STI?
- How can I protect my partner from getting genital herpes?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Millions of people are living with the herpes virus that causes genital herpes. Its a common STI. You shouldnt be embarrassed or put off seeking medical care if you develop symptoms. Treatments can ease symptoms, reduce outbreaks and protect sexual partners from infection. Having the virus shouldnt affect your relationships or sexual health. However, you do need to tell your sexual partners that you have the virus. Your healthcare provider can discuss ways to prevent spreading this STI.
Last reviewed by a Cleveland Clinic medical professional on 11/23/2020.
References
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Recurrence Course Triggers And Timing
Course of Recurrence
Most cases of herpes simplex recur. The site on the body and the type of virus influence how often it comes back. Recurrences of genital herpes are more likely with HSV-2 infection than with HSV-1 infection.
The virus usually takes the following course:
- Prodrome. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itchy skin, pain, or an abnormal tingling sensation at the site of infection. Headache, enlarged lymph glands, and flu-like symptoms may occur. The prodrome, which may last from 2 hours to 2 days, stops when the blisters develop. About 25% of the time, recurrence does not go beyond the prodrome stage.
- Outbreak. Recurrent outbreaks feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer. After blisters erupt, they typically heal in 6 to 10 days. Occasionally, the symptoms may not resemble those of the primary episode, but appear as fissures and scrapes in the skin or as general inflammation around the affected area.
Triggers of Recurrence
Herpes outbreaks can be triggered by different factors. They include sunlight, wind, fever, physical injury, surgery, menstruation, suppression of the immune system, and emotional stress. Oral herpes can be triggered within about 3 days of intense dental work, particularly root canal or tooth extraction.
Timing of Recurrences
Is There Any Resistance To Genital Herpes Medication
Resistance to drugs that treat genital herpes even after 20 years of use is very rare. Herpes medications may not work as well in patients who are very immunosuppressed and have been treated with these drugs for a long time. Each individuals response to treatment may vary. In some cases, patients may need more drugs to suppress their viral outbreaks than others.
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Can I Pass Herpes On To My Baby During Pregnancy
During pregnancy, it is possible for the herpes virus to be passed on to the baby. However, the vast majority of women with genital herpes have normal pregnancies and deliver healthy babies.
The virus can be transmitted via:
- the placenta, when the baby is still in the womb
- during delivery or
- after the birth .
Fortunately, women who have genital herpes before falling pregnant and those infected early in pregnancy have a low risk of passing the virus on to their babies, because their body has built up antibodies to the virus. These antibodies cross the placenta to protect the baby.
Is There A Cure Or Treatment For Herpes
There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication.11 In addition, daily suppressive therapy for herpes can reduce the likelihood of transmission to partners.11
There is currently no commercially available vaccine that is protective against genital herpes infection. Candidate vaccines are in clinical trials.
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Can Genital Herpes Cause Other Problems
For most women, genital herpes does not usually cause serious health problems.
Women with HIV can have severe herpes outbreaks that are long-lasting. Herpes also may play a role in the spread of HIV. Herpes sores can make it easier for HIV to get into your body. Also, herpes can make people who are HIV-positive more likely to spread the infection to someone else.
Why You Should Go To A Sexual Health Clinic
You can see a GP, but they’ll probably refer you to a sexual health clinic if they think you might have genital herpes.
Sexual health clinics treat problems with the genitals and urine system.
Many sexual health clinics offer a walk-in service, where you do not need an appointment.
They’ll often get test results quicker than GP practices and you do not have to pay a prescription fee for treatment.
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How Do You Know If Someone Has Genital Herpes
Some people with genital herpes have outbreaks of genital sores, while other people have no symptoms at all and dont even know they have the virus in their body. So its possible to transmit the virus to sexual partners even if you dont have symptoms .
Mostly, you wont know whether or not your sexual partner is infected with one of the viruses that cause genital herpes. In fact, many people dont know themselves whether or not they are infected. So, when having sex with a new partner, its always best to follow safe sex tips .
Genital Herpes Treatment In Pregnancy
You may be offered antiviral treatment:
- to treat outbreaks in pregnancy
- from 36 weeks to reduce the chance of an outbreak during birth
- from diagnosis until the birth if you first get herpes after 28 weeks of pregnancy
Many women with genital herpes have a vaginal delivery. You may be offered a caesarean, depending on your circumstances.
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Can Genital Herpes Come Back
Yes. Genital herpes symptoms can come and go, but the virus stays inside your body even after all signs of the infection have gone away. The virus becomes “active” from time to time, leading to an outbreak. Some people have outbreaks only once or twice. Other people may have four or five outbreaks within a year. Over time, the outbreaks usually happen less often and are less severe.
Experts do not know what causes the virus to become active. Some women say the virus comes back when they are sick, under stress, out in the sun, or during their period.
Herpes Myths Vs Facts
Herpes Myth: Only certain sorts of people get herpes.
Fact about herpes: No, it is very common and anyone who has ever had sex can get genital herpes. It’s not about being clean, dirty, good or bad it’s about being normal and sexually active.
Herpes Myth: Herpes isn’t that common, and I am unlikely to get it.
Fact about herpes: Herpes is very common and may be caused by both herpes simplex type 1 and herpes simplex type 2 . HSV-1 causes “cold sores” on the mouth, and up to 80% of the population has this virus. However, it may also be transmitted to the genitals through oral-genital sex and about 40% of genital herpes is caused by HSV-1. Up to 22% of sexually active adults have genital herpes caused by HSV-2. Most people with herpes will not have symptoms and therefore will not be aware they have it. 75% of people who have genital herpes get it from partners who are entirely unaware that they have it themselves.
Herpes Myth: Herpes “cold sores” on the mouth are not the same as genital herpes.
Fact about herpes: Cold sores on the mouth or face are caused by HSV-1 and are commonly transmitted to the genitals through oral-to-genital sex. Up to 40% of genital herpes is caused by HSV-1.
Herpes Myth: Herpes can only affect the genital area.
Herpes Myth: People always know if they have genital herpes.
Fact about herpes: No, 80% of those with genital herpes do not know they have it, as they may have no or very mild symptoms.
Herpes Myth: People with herpes are always infectious.
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What Is Herpes Simplex
Herpes simplex is a virus that causes skin infections. The infection lasts your lifetime, and it causes painful or itchy sores and blisters that come and go. Herpes simplex virus typically doesnt cause severe problems. But it can be dangerous in infants and people with weakened immune systems. There are two types of herpes simplex:
- Herpes simplex 1 tends to affect your mouth or face. It causes cold sores. HSV-1 spreads through contact with saliva .
- Herpes simplex 2 is a sexually transmitted disease . It causes sores on skin that comes in contact with the genitals of an infected person.
Sometimes a herpes infection can affect other parts of your body, such as your eyes or other parts of your skin.
Herpes Pregnancy And Newborn Infants
Herpes can pose serious risks for a pregnant woman and her baby. The risk is greatest for mothers with a first-time infection because the virus can be transmitted to the infant during childbirth. Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus.
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Support And Advice For Genital Herpes
If you have just found out you have genital herpes, you may feel shocked and may have a lot of questions. It may help you to gather as much information as you can about herpes. This can help you to make fully informed decisions about your treatment, safe sex and preventing further recurrences. Talking to a counsellor about your concerns may also help.
Is There Anything I Can Do To Prevent Recurrent Outbreaks
It is not well understood what reactivates the herpes virus symptoms to recur. The triggers may include:
- Friction or trauma in the genital area
- Exposure to ultraviolet light
- Drinking excessive amounts of alcohol
- Having a weakened immune system
A healthy lifestyle, such as a good diet, getting enough sleep and rest, exercise, and reducing stress may help limit the number of outbreaks. Using a water based lubricant during sexual intercourse can help to reduce friction and skin irriation that may trigger an outbreak in some people.
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How Can You Stop Cold Sores From Spreading
Follow a few simple steps to help stop cold sores from spreading.
1. Dont Touch
Touching is how cold sores are spread. The only time you should touch a cold sore is when youre applying cream. The less you touch it, the less likely it is that youll spread it elsewhere around your body or to someone else. This applies from the first tingle to when its totally disappeared. If youre applying make-up around the area, use a disposable applicator such as a cotton swab rather than your fingers.
2. Wash Your Hands
You should do this after touching your cold sore and before touching your eyes, contact lenses, genitals or any area of broken skin.
3. Dont Kiss
This means any sort of kiss, even on the cheek. Its important to be extra careful around babies, children, pregnant women or people with lowered immunity. Most people get HSV-1 as a child through an affectionate kiss from an infected adult.
4. Avoid Oral Sex
Abstain from engaging in oral sex when you have symptoms of a cold sore, as you can pass on the HSV-1 virus, giving your partner an infection in their genital area.
5. Dont Share Personal Items
This covers food, eating utensils, straws, cups, glasses, lipsticks, lip balm, cold sore cream and anything else that has come into contact with your saliva or cold sore.
6. Change Your Toothbrush
The virus can lurk in the bristles of your toothbrush so treat yourself to a new one after the blister has formed and again after the attack has cleared up.
7. Avoid Your Triggers
Can Cold Sores Be Serious
In most cases, cold sores are just unsightly and painful but clear up within 15 days. However, cold sores can be serious when they affect:vii
- Your eyes If the infection reaches the inner layers of your cornea the transparent layer at the front of your eye and remains untreated, it can be sight-threatening.
- Babies Because their immune systems havent yet developed properly, babies cant fight the virus easily and if the infection spreads to their vital organs, it can be fatal.
- People with weakened immunity As with babies, the infection may spread to vital organs. People at risk include those undergoing chemotherapy for cancer or anyone with a condition affecting their immunity such as diabetes or HIV.
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Can I Catch Herpes Again On Another Part Of My Body Can My Partner Catch Herpes Back Off Me On Another Place
It is rare for people to re-catch a virus that they already have for a second time even on a different part of the body. Their immune system defends them against this. The virus does not travel through the body. So a person with a genital infection can kiss or perform oral sex there is no risk of infecting a partner by doing this the virus will not travel inside the body from the genitals to the mouth.
How can I protect my new partner? What about my new partner? How likely am I to infect my new partner?
Already, you are a safer partner than many others because you have been diagnosed so you will avoid sex from the moment you notice the start of an outbreak, until the time when it has totally cleared up. A man with genital herpes can protect a partner easily if his outbreaks appear in the area covered by a condom.
A woman with genital herpes can tell a man that he is half as likely to catch genital herpes from a woman, compared to the chance of a woman catching it from a man. This information can be useful for diagnosed women when talking to a new partner.
Herpes simplex infections are common. Many new partners will have one or both types already but not know. See the governments statistics for new genital herpes infections diagnosed in clinics in 2019 and add a further 53,000 cases which how many are probably diagnosed by GPs.