More Questions From Patients:
Many people with genital herpes have no symptoms, or have very mild symptoms that go unnoticed.
The first time genital herpes symptoms appear is called the “first episode” or “initial herpes.” Initial herpes symptoms are usually more noticeable than later outbreaks.
Symptoms of genital herpes in men may include
burning when you pee if you have sores
trouble peeing if you have sores covering your urethra
itching or pain around your genitals
During initial herpes, symptoms may also include
swollen, tender glands in the pelvic area, throat, or under the arms
Using Valacyclovir To Treat A Primary Outbreak Of Cold Sores
Valacyclovir is also used to treat primary outbreaks of cold sores, or oral herpes. The standard dosage of valacyclovir for managing a primary oral herpes outbreak is 2,000 mg every 12 hours for one day .
During a particularly severe or persistent outbreak, your doctor may recommend adjusting your valacyclovir dose or extending the dosage to provide greater relief. Follow your doctors advice and instructions for the best results from valacyclovir and other antiviral medication.
What Happens If I Dont Get Treated
Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems.
If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you do touch the sores or fluids, immediately wash your hands thoroughly to help avoid spreading your infection.
If you are pregnant, there can be problems for you and your developing fetus, or newborn baby. See Im pregnant. How could genital herpes affect my baby? above for information about this.
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Dear Scared And Desperate:
If you are now going from infrequent outbreaks to continuous outbreaks, there is something additionally going on. The presence of Seborrheic Dermatitis suggests again that there may be an immunologic problem that has been gone on undiagnosed. This may predisposing you to the constant outbreaks of herpes. Rather than just assume that this is recurrent herpes, and because you have 1 or 2 recurring all the time, which by the way, is uncommon, I would suggest a full work up to determine what is going on immunologically to lead to this sudden increase in the severity of your illness.
What Happens During An Outbreak
Genital herpes is an infection caused by the herpes simplex virus. You catch it by having intimate contact with someone who has the virus.
In between episodes, most people dont know they have been infected by it. The virus remains in your nervous system and can be reactivated from time to time to give you symptoms. Outbreaks can occur in the genital area if the first infection was in the genitals. They cause crops of small painful blisters in the genital area and back passage . Herpes can also cause recurrent cold sores if the primary infection was around the mouth.
No one knows why outbreaks occur, although sunlight, physical illness, excess alcohol, and stress are all thought to be trigger factors. They often do become less frequent over time.
Recurrent episodes of genital herpes generally dont last as long as the first outbreak. They are sometimes preceded by itching or tingling in the genital area. Recurrent outbreaks usually last about 7-10 days, shorter than the primary infection which can last up to two weeks. They are also often milder than a primary infection but as R35506 found, the shallow ulcers left when the blisters break can still be quite painful.
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Why Does Outbreak Frequency Vary
Its unclear exactly what triggers a herpes outbreak, although certain factors make them more likely. People without chronic physical and mental health conditions who exercise, practice good nutrition, and get adequate sleep are likely to have fewer herpes outbreaks. Women also usually have more frequent herpes outbreaks than men. Its thought the hormone fluctuations experienced during periods, pregnancy, and menopause may trigger herpes outbreaks.
Antiviral medications, like valacyclovir, can also help reduce the frequency of herpes outbreaks. People on these medications have up to 70-80% fewer outbreaks than they would without the medication. Their outbreaks also tend to be shorter than people who dont take these meds. If youve been previously diagnosed with herpes, Nurx can prescribe oral or genital herpes treatment online and deliver the medication to your door with free shipping. To request herpes treatment from Nurx, get started here.
Nurx offers prescription cold sore and genital herpes treatment for as little as $0 with insurance or $15 per month without insurance.
Pain And/or Itching In Or Around The Blisters
Lesions are usually very painful to touchespecially during the first herpes outbreak, which tends to be more severe. The main thing that brings women into the office with herpes is pain, says Dr. Shirazian. Bumps that you find just by chance when sudsing up in the shower or toweling off probably arent herpes. Herpes lesions will make themselves known and felt, she says. They can also itch, especially as they begin to scab over and heal.
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Whats The Typical Frequency Of Genital Herpes
The herpes simplex virus type 2, better known as genital herpes or HSV-2, is a sexually transmitted infection. Despite having no cure, a number of techniques are proven to reduce the frequency and duration of each genital herpes outbreak.
You may recognize a genital herpes outbreak by the appearance of blisters and lesions. Most people experience their first outbreak two to 12 days after initial exposure to the virus. After the blisters break, it may take up to four weeks for herpes ulcers to heal.
After the first outbreak, recurring outbreaks are common but dont last nearly as long. Sores tend to heal within three to seven days in recurring outbreaks, and the number of outbreak periods may even decrease over time.
How Is Herpes Simplex Treated
Some people have few to no herpes outbreaks and choose not to have treatment. But many people prefer to use medications that shorten outbreaks and reduce symptoms.
During an outbreak, you may use an antiviral ointment or cream to help lessen your symptoms and help them go away faster, but it only works if you start it soon after you start an outbreak. Many people with HSV-2 take daily oral medications to keep outbreaks at bay.
Your provider may prescribe a topical medication or oral medication such as:
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How Often Do Outbreaks Occur
The number of outbreaks someone has varies from person to person. The average number of outbreaks for a person with genital HSV-2 is four to five per year. The average for genital HSV-1 is less than one outbreak per year.
Usually, there are more outbreaks during the first year, and many people find that outbreaks become less severe and less frequent with time.
Herpes triggers are highly individual, but with time, many people learn to recognize, and sometimes avoid, factors that seem to reactivate HSV in their own bodies. Illness, poor diet, emotional or physical stress, friction in the genital area, prolonged exposure to ultraviolet light , surgical trauma, and steroidal medication may trigger a herpes outbreak.
The frequency of outbreaks can often be managed through effective stress management, and getting adequate rest, nutrition, and exercise. For people with frequent outbreaks, suppressive therapy with any one of the antiviral treatments can reduce outbreaks by as much as 80%.
Types Of Tests Used To Diagnose Herpes
There are a number of tests used to diagnose herpes, depending on whether lesions are present.
- Symptomatic testing: Samples taken from lesions can be used to detect the virus with a viral culture or nucleic acid amplification test . Of the two, NAAT is more sensitive . A polymerase chain reaction test may be used if herpes is suspected as the cause of a systemic or central nervous system infection, such as encephalitis or meningitis.
- Asymptomatic testing: A blood test may be used to detect HSV antibodies. This is an option for people who had a previous outbreak or had recent exposure. Very recent herpes infections may not be detected. Retesting in a few months may be necessary for accurate results. Some blood tests can also specifically identify an HSV-1 or HSV-2 infection.
Due to the high rates of false-positives, screening for genital herpes in asymptomatic adults and adolescents is not recommended.
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Im Pregnant What Do I Need To Know
To get the best care, tell your doctor you have genital herpes, because it could make you more likely to have a miscarriage or give birth too soon.
Its possible to pass along the virus to your baby. For infants, it can be life-threatening. Your doctor can talk to you about how to lower the chances that this will happen.
If you have an outbreak while youre pregnant, your doctor can give you medicine to treat your symptoms and stop them sooner.
Your doctor may give you a drug to prevent an outbreak as your due date gets closer. This is because your baby could get herpes by passing through your birth canal if youre having an outbreak when you go into labor. If thats a possibility, your doctor will most likely want to do a C-section, which is surgery to deliver the baby.
Preventing The Spread Of Herpes
Even when you do not have sores, you can pass the virus to someone during sexual or other close contact. To protect others:
- Let any sexual partner know that you have herpes before having sex. Allow them to decide what to do.
- Use latex or polyurethane condoms, and avoid sex during symptomatic outbreaks.
- Do not kiss or have oral sex when you have a sore on the lips or inside the mouth.
- Do not share your towels, toothbrush, or lipstick. Make sure dishes and utensils you use are washed well with detergent before others use them.
- Wash your hands well with soap and water after touching a sore.
- Consider using daily antiviral medicine to limit viral shedding and reduce the risk of passing the virus to your partner.
- You may also want to consider getting your partner tested even if they have never had an outbreak. If you both have the herpes virus, there is no risk for transmission.
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Prevent The Spread Of Herpes
If you have herpes, . Talk about what it is and what you and your partner need to know and do to protect themselves. Avoid skin-to-skin contact during outbreaks and refrain from all sexual activity during these times. In between outbreaks, you should still because there is still the potential of spreading the virus.
This is an update of an article originally written by HealthCentral contributor Penelope James.
Initial Outbreaks Of Hsv
If youve been infected with HSV-1 or HSV-2, youll usually go through an initial outbreak. Your first herpes outbreak is also referred to as the primary outbreak, which usually happens one to two weeks after your virus exposure, and tends to be the most severe physical experience from the virus.
Not everyone with HSV-1 or HSV-2 will have an initial outbreak. Some people are completely asymptomatic, which means they can be infected with the virus without experiencing any real herpes symptoms.
During a first herpes outbreak, most people experience the physical effects of herpes , plus additional flu-like symptoms, including fever, chills, sore throat and general body aches.
Herpes outbreaks usually start within several days of exposure. If youre worried that youre going through an initial outbreak of herpes, the best thing to do is check your symptoms and talk to your doctor about testing and treatment options.
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How Common Is Genital Herpes
Genital herpes infection is common in the United States. CDC estimated that there were 572,000 new genital herpes infections in the United States in a single year.1 Nationwide, 11.9 % of persons aged 14 to 49 years have HSV-2 infection .2 However, the prevalence of genital herpes infection is higher than that because an increasing number of genital herpes infections are caused by HSV-1. 3 Oral HSV-1 infection is typically acquired in childhood because the prevalence of oral HSV-1 infection has declined in recent decades, people may have become more susceptible to contracting a genital herpes infection from HSV-1. 4
HSV-2 infection is more common among women than among men the percentages of those infected during 2015-2016 were 15.9% versus 8.2% respectively, among 14 to 49 year olds. 2 This is possibly because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. 5 HSV-2 infection is more common among non-Hispanic blacks than among non-Hispanic whites . 2 A previous analysis found that these disparities, exist even among persons with similar numbers of lifetime sexual partners. Most infected persons may be unaware of their infection in the United States, an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never received a clinical diagnosis. 6
The age-adjusted percentage of persons in the United States infected with HSV-2 decreased from 18.0% in 19992000 to 12.1% in 2015-2016. 2
Usual Adult Dose For Herpes Simplex
Treatment of First Episode of Genital Herpes:200 mg orally every 4 hours 5 times a day for 10 days 400 mg orally 3 times a day for 5 to 10 days Severe Disease or Complications Requiring Hospitalization:5 mg/kg IV every 8 hours for 5 days 5 to 10 mg/kg IV every 8 hours for 2 to 7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy Episodic Therapy: Effective treatment requires therapy initiation within 1 day of lesion onset or during the prodrome preceding an episode/recurrence200 mg orally every 4 hours 5 times a day for 5 days 400 mg orally 3 times a day for 5 days OR 800 mg orally 2 times a day for 5 days OR 800 mg orally 3 times a day for 2 days
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Why Do I Get Herpes Outbreaks So Often
Primary Genital Herpes Outbreak
For people with symptoms, the first outbreak usually occurs in or around the genital area 2 days to 2 weeks after sexual exposure to the virus. The first signs are a tingling sensation in the affected areas and groups of small red bumps that develop into blisters. Over the next 2 to 3 weeks, more blisters can appear and rupture into painful open sores. The lesions eventually dry out, develop a crust, and heal rapidly without leaving a scar. Blisters in moist areas heal more slowly than those in dry areas. The sores may sometimes itch, but itching decreases as they heal.
About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, and fever. Swollen glands may occur in the groin area or neck. Some women may have difficulty urinating and may, occasionally, require a urinary catheter. Women may also experience vaginal discharge.
Recurrent Genital Herpes Outbreak
In general, recurrences are much milder than the initial outbreak. The virus sheds for a much shorter period of time compared to an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men.
The Differences Between Hsv
Well discuss two main strains of the herpes virus that affect humans: herpes simplex virus type 1 and herpes simplex virus type 2 .
While both forms of the virus belong to the herpes family and have certain similarities, they also have a few key differences that are important to understand.
The biggest difference between the two herpes viruses is the location where they most often cause outbreaks. HSV-2 commonly causes genital sores, while HSV-1 more commonly causes cold sores around the mouth.
Both herpes viruses spread through close contact with an infected person, especially if theyre experiencing an active outbreak. HSV-1 spreads mostly through activities like kissing, sharing a cup or straw, or sharing lip balm or lipstick. HSV-2, on the other hand, is classified as a sexually transmitted infection and spreads primarily through sexual contact.
There is no cure for herpes, so both strains of the virus are lifelong diseases. Outbreaks of both types also share certain triggers, such as lack of sleep, stress, poor diet, hormonal changes, menstruation and illness.
Other triggers differ between the two types of herpes. For example, chewing on the lips, harsh sunlight, or injury around the mouth can irritate the mouth and cause an oral herpes outbreak.
Similarly, irritation to the genitals caused by frequent sexual activity, irritating products, or tight clothing can trigger a genital herpes outbreak.
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I Had Lesions When I Was Evaluated But My Culture Was Negative Does This Mean That I Dont Have Herpes
Not necessarily. Although lesions can be caused by something other than herpes, false negative herpes tests can occur if the samples are not taken appropriately, if there is a long transport time between the clinic and the laboratory, or if cultures were taken late in the course of the lesions. Lesions that occur early in the course of a herpes outbreak are much more likely to have positive cultures than cultures taken after the lesions crust over.
Stages Of Herpes Outbreaks
Like any other infection, every case is different. The duration of a herpes outbreak will depend on factors such as:
- Your individual immune system
- How many outbreaks youâve had in the past
- Treatment history
Keep in mind that no matter your history or treatment, thereâs help.
The stages of a herpes outbreak can last between two and 14 days and can be broken down into stages:
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