Suppressive Therapy For Recurrences
To suppress outbreaks, treatment requires taking pills daily on a long-term basis. Acyclovir and famciclovir are taken twice a day for suppression. Valacyclovir is taken once a day. The doses for these antiviral drugs are reduced in people with impaired renal function.
Suppressive treatment can reduce the frequency of outbreak recurrences by 70% to 80%. It is generally recommended for people who have frequent recurrences . Because herpes recurrences often diminish over time, you should discuss annually with your provider whether you should stay with drug therapy or discontinue it.
There is some evidence that valacyclovir may help prevent herpes transmission, particularly in situations where one heterosexual partner has HSV-2 and the other partner does not. However, this drug does not completely prevent transmission. While taking any suppressive therapy for genital herpes, it is still important to regularly use latex condoms and to avoid any sexual activity during recurrences.
Understanding Herpes With H Hunter Handsfield Md
Herpes expert H. Hunter Handsfield, MD, explains the basics about genital herpes, including the difference between genital HSV-1 and HSV-2 infection, testing options and the importance of knowing virus type, and the three-prong strategy for prevention. See more herpes videos at sexualhealthTV.com.
Have a question about herpes youd like Dr. Handsfield or our other experts to answer? Visit our Ask the Experts page to learn how.
Symptoms Of Oral Herpes
Oral herpes is most often caused by HSV-1, but can also be caused by HSV-2. It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.
Primary Oral Herpes Infection
If the primary oral infection causes symptoms, they can be very painful, particularly in children. Symptoms include:
- Tingling, burning, or itching around the mouth are the first signs.
- Red, fluid-filled blisters that may form on the lips, gums, mouth, and throat.
- Blisters that break open and leak. As they heal, they turn yellow and crusty, eventually turning into pink skin. The sores last 10 to 14 days and can be very uncomfortable.
- Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.
Recurrent Oral Herpes Infection
A recurrent oral herpes infection is much milder than the primary outbreak. It usually manifests as a single sore, commonly called a cold sore or fever blister . The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat.
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Why You Should Go To A Sexual Health Clinic
You can see a GP, but theyâll 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.
Theyâll often get test results quicker than GP practices and you do not have to pay a prescription fee for treatment.
How Is Genital Herpes Diagnosed
HSV nucleic acid amplification tests are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. 11
Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. 11
Given performance limitations with commercially available type-specific serologic tests , a confirmatory test with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. 11
Providers are strongly encouraged to look at CDCs STI Treatment Guidelines for further diagnostic considerations.
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What Does Herpes Look Like
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Herpes sores can affect many areas of the body, including the mouth, genitals, and eyes. Knowing what herpes looks like across the body can help people diagnose the condition.
Herpes is a skin condition caused by the herpes simplex virus. The symptoms include sores that come and go over time. Different types of herpes affect different body parts.
This article will explain what herpes is, how people get it, and what herpes looks like with pictures.
Most people with HSV are asymptomatic, meaning they will not experience any symptoms. Others will notice sores or lesions. These sores look like blisters filled with fluid. Over a few days, the sores break open, ooze, and form a crust before healing.
People may also notice a tingling, itching, or burning feeling a few days before the sores appear. Some people may also experience flu-like symptoms, such as:
Someone who has contracted the virus will usually have their first sores, or an outbreak, between 2 and 20 days later. The sores may last up to a week or 10 days.
An outbreak may involve a single sore or a cluster of sores. They often affect the skin around the mouth, the genitals, or the rectum. The blisters can take between 2 and 4 weeks to heal.
The symptoms will usually reappear from time to time, though they do not tend to be as severe as the first time.
How Soon Can You Be Tested
The incubation period for herpes is 2 to 12 days, which means that the best time to get tested for the herpes virus if you havent had an initial outbreak is after 12 days. If youre worried that youve been exposed to herpes but have not yet been diagnosed, here are some steps you can take:
- If youre currently sexually active, stop all sexual activity until you can receive a formal diagnosis.
- Reach out to your doctor and schedule an appointment for once the incubation period is up.
- If youre having an outbreak, you dont have to wait to get tested. Its possible to receive a diagnosis based on the lesions.
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What Can I Do If I Have Herpes Simplex 2
Many people who find out they have herpes feel depressed knowing they’ll always have the virus and can give it to others. But you arent alone. Herpes is one of the most common STIs, both in the U.S. and worldwide. If you have herpes, you should:
- Learn all you can about it. Information will help you to manage your disease and feel better about yourself.
- Talk about your illness with your doctor.
If you have herpes, you can still:
- Have sex if you use a condom or dental dam , and you tell your partner about your illness. Some couples, who have sexual relations only with each other, may choose not to use condoms even though one partner has herpes. Because each situation is different, you should ask your doctor if this is the right choice for you in your relationship.
- Have children. People with herpes can still give birth to healthy babies. If you have herpes and plan to have children, discuss your illness with your healthcare provider.
If you have herpes, you should also get checked for HIV and other STIs .
Type Of Tests Used To Diagnose Herpes
There are four main types of diagnostic tests that can be used to diagnose herpes. Your doctor will determine which type of test to use based on whether an outbreak is present or not.
If youre experiencing what you believe to be a herpes outbreak, your doctor can use a viral culture test or virus antigen detection test. If youre not experiencing symptoms, you can have an antibody test.
- Viral culture test.This test is used to determine if a sore contains the herpes virus. This test can sometimes produce a false-negative, meaning that it may not detect the virus even though its present.
- Virus antigen detection test. This test is used to determine if antigens to the herpes virus are present in a sore or lesion.
- Antibody test. If youre not experiencing an outbreak yet but still believe you may have been exposed, you can opt to have an antibody test performed. This test will only show a positive result if the antibodies to the virus have been developed. Therefore, this test isnt necessarily recommended for recent exposure.
- Polymerase chain reaction test. With this test, a healthcare provider can screen a sample of your blood or tissue from a sore. They can use this to determine if HSV is present and which type you have.
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How Do I Talk To My Sex Partners
Telling them about your condition can be hard. Take some time to learn what you can and understand your own feelings first. You may be more at ease to talk openly.
Some people you tell might not think its such a big deal. Others will have strong feelings about it.
You cant control how anyone else reacts. All you can do is share what you know, answer questions, and give them time to think about it.
Initial Outbreak Of Genital Herpes
A person’s first outbreak of HSV-2 tends to last longer than subsequent outbreaks. Some people develop an outbreak quickly after contracting the herpes virus, while others don’t have symptoms that appear for several months or even years. Some lucky people never develop symptoms at all.
The initial episode of genital herpes also tends to be more painful than future outbreaks. Many people develop flu-like symptoms during their initial outbreak. These can include headache, fever, body aches, swollen lymph nodes and tiredness.
The first outbreak of HSV-2 can last between two and four weeks.
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Home Remedies For Genital Herpes
In addition to medication treatment, there are many natural remedies that effectively soothe herpes sores quickly. An infected individual may be able to reduce inflammation, irritation and other symptoms by implementing a mix of the following solutions.
- Hot compressThe application of a warm compress may be helpful as soon as a sore is detected. In the event of a fully-formed sore, heat may help to minimise pain and reduce itching.
- Cold compressEffective in reducing swelling, an ice pack or clean, soft washcloth filled with ice applied to the affected area can relieve discomfort, although ice should never be directly applied to herpes blisters, bumps or ulcers.
- Vaseline or petroleum jellyAlthough Vaseline can ease the pain associated with crusting sores, it should be noted that herpes thrives in moist areas, and so applications should be sporadic and only in cases of extreme sensitivity. If possible, it is recommended to let the sores dry out on their own.
- SudocreamAn antiseptic healing lotion, Sudocream helps to heal sores by forming a protective layer over the vulnerable area. Sudocream helps reduce the risk of infection and contains a mild local anaesthetic to soothe discomfort.
What Can You Do About A Herpes Outbreak
Despite herpes being a lifelong infection, there are treatments that can reduce the number of outbreaks and give symptom relief. Sometimes treatments can actually stop outbreaks from happening altogether. However, itâs still important to remember that there is still a risk of transmission between outbreaks.
The faster you treat a herpes outbreak, the quicker it will resolve. Herpes treatments are most effective when taken within 48 hours of first symptoms.
Some treatment options are:
These three treatments work basically the same, and tend to speed up healing time by about one or two days. Acyclovir is a topical ointment used to treat lesions and works on both oral and genital herpes.
If youâre experiencing considerable pain, these treatments can be taken with painkillers. For some individuals, you may need your healthcare practitioner to prescribe a painkiller, but some individuals can manage their pain with over-the-counter pain medications.
You can also apply a cold compress to the affected area, wear loose clothing and underwear that breathes , and make sure to keep the lesion clean and dry.
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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 I Treat Herpes Simplex At Home
Avoiding known triggers, such as illness or stress, can help reduce how often you have herpes outbreaks.
How can I ease my symptoms during an outbreak of HSV-1 ?
- Over-the-counter creams such as L-lysine, benzocaine or docosanol .
- Applying ice to blisters or sores.
How can I ease my symptoms during an outbreak of HSV-2 ?
- Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
- Keep your genitals dry. Wear cotton or other nonsynthetic underpants and avoid tight-fitting clothes. Moist sores take longer to heal.
- Soak in a warm bath.
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How Long Before The First Outbreak
If someone has contracted HSV but not yet experienced a herpes outbreak, truthfully theres no 100% accurate way to determine when one will occur. An outbreak can occur within a week of exposure, or years later.
First, consider that everyones body is different, as is their immune system. If a person has a strong immune system, then it can be possible for an outbreak to occur years after contracting the virus.
Whats more, some strains of HSV are more forceful and aggravating than others.
There is what is considered typical, and that is that people often have their first outbreak two weeks after contracting it. But this just isnt reliable, because its equally accepted that people can often have outbreaks after two years.
Thats why so many people will have trouble pinpointing when they got herpes at all. There are varied statistics and possibilities:
Stress is a common trigger for an outbreak.
What Are The Signs Of Herpes In Pregnant Women
If you are pregnant and have genital herpes, there may be a risk of your baby being infected with the virus during delivery. This condition is called neonatal herpes and can be serious or fatal.
Neonatal herpes can result in damage to the central nervous system and can cause mental retardation. Only about 0.1% of babies born in the United States are infected with neonatal herpes even though about 25% to 30% of pregnant women have genital herpes.
Generally, if you are infected with herpes, your doctor will deliver your baby by cesarean section to avoid any risk to your newborn infant.
Women who have herpes before becoming pregnant are at very low risk of transmitting the herpes virus to their babies. If a woman is infected with the herpes virus after becoming pregnant, her baby faces a higher risk of contracting neonatal herpes. Women who are newly infected havent had time to develop the antibodies against the virus and cannot pass them on to the baby for protection.
Talk with your OB/GYN and let them know if you have genital herpes. At the time of your delivery, ask your doctor to examine you early in labor to make sure you dont have any sores or signs of infection like pain, tingling, or itching.
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What Are The Types Of Herpes Viruses
Herpes is a group of contagious viruses that cause blisters and sores. Some of the more common herpes viruses include:
- Type 1: HSV-1, or oral herpes, causes cold sores to form on your lips, gums, tongue and inside of your mouth. It can cause genital herpes in some cases. This type usually spreads through saliva when you kiss someone with open herpes sores. You can also get HSV-1 by sharing items like toothbrushes, lipsticks or eating utensils.
- Type 2: HSV-2 causes genital herpes.
- Herpes zoster: This virus causes chickenpox and shingles.
How Long Do Herpes Outbreaks Last
When you hear the word herpes, the image that comes to mind is probably one of a sore at the edge of your lip that crops up every time you have a cold or a fever. But herpes is a little more complicated that that. Believe it or not, most people who have herpes have absolutely no idea. Thats because, for the most part, the virus can be entirely asymptomatic. Usually the first infection when it comes to oral herpes happens sometime during childhood and not from sexual contact, and the symptoms are a lot more like a cold. In severe cases, the initial outbreak can involve a fever, swollen lymph nodes, swollen gums, and sores in your mouth, throat, or on your tongue. An initial herpes outbreak lasts around 14 days but can take up to six weeks for sores to fully heal .
While oral herpes is most commonly caused by herpes simplex virus 1 , genital herpes is more frequently cause by herpes simplex virus 2 .
Much like oral herpes, an initial genital herpes infection can last a lot longer than subsequent outbreaks and may be accompanied by fever and other whole-body symptoms and some symptoms may persist for weeks. Recurrent genital herpes outbreaks cause symptoms like itching, redness, and irritation in the genital area, but like oral herpes, genital herpes can also be asymptomatic . A genital herpes outbreak may begin with pain in the genitals and shooting pains or tingling in your legs, hips, or butt. These symptoms usually occur before you can see any blisters or lesions .
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