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.
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Genital Herpes During Pregnancy
Prevention of neonatal herpes depends both on preventing acquisition of genital herpes during late pregnancy and avoiding exposure of the neonate to herpetic lesions and viral shedding during delivery. Mothers of newborns who acquire neonatal herpes often lack histories of clinically evident genital herpes . The risk for transmission to the neonate from an infected mother is high among women who acquire genital herpes near the time of delivery and low among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy . Women who acquire HSV in the second half of pregnancy should be managed in consultation with maternal-fetal medicine and infectious disease specialists.
All pregnant women should be asked whether they have a history of genital herpes or genital symptoms concerning for HSV infection. At the onset of labor, all women should be questioned thoroughly about symptoms of genital herpes, including prodromal symptoms , and all women should be examined thoroughly for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not eliminate the risk for HSV transmission to the neonate , women with recurrent genital herpetic lesions at the onset of labor should have a cesarean delivery to reduce the risk for neonatal HSV infection.
Acyclovir 400 mg orally 3 times/dayORValacyclovir 500 mg orally 2 times/day
Is There A Cure For Herpes Simplex
There is no cure for herpes simplex. Once you have the virus, its a lifelong infection.
What is the outlook for people with herpes simplex?
For many people, the first herpes outbreak is the most severe. Many outbreaks are less frequent and milder after the first year of infection. Some people may have only one outbreak and never have another again.
Herpes infection doesnt usually pose a serious health risk. The risk of a health complication due to herpes is higher in infants and if you have HIV/AIDS, cancer or an organ transplant.
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Does The Vaccine Help Prevent It
The CDC suggests getting the shingles vaccine Shingrix if you’re a healthy adult ages 50 or older, or if you are19 years of age and older and are or will be immunodeficient or immunosuppressed due to disease or therapy.. It was approved in 2017 and has been found to be more than 90% effective in preventing shingles and the complications caused by the disease. Even if you’ve already had shingles, the CDC says the vaccine can help prevent a second round of it. Shingrix is preferred over an earlier vaccine, Zostavax, which was removed from the market in 2020. You should also get it if you previously had the Zostavax vaccine.
Shingrix is also approved for those 18 years or older who may be immunodeficient or immunosuppressedbecause of an illness or treatment.
Talk to your doctor about when to get the vaccine. If you’ve just gotten over shingles, the CDC recommends waiting at least until the shingles rash has disappeared.
You should not get the Shingrix vaccine if you:
- Are pregnant or nursing
- Are allergic to the vaccine
- You tested negative for immunity to chickenpox if so, you should ask about the chickenpox vaccine.
Does A Cold Sore On My Mouth Mean I Have Genital Herpes
No, a cold sore on your mouth usually means you have herpes simplex virus type 1 . You can get HSV-1 by kissing someone or sharing utensils, towels, razors, or lipstick with someone who has HSV-1.
HSV-1 cannot turn into HSV-2 , but you can get a cold sore on your mouth from HSV-2 if you give oral sex to someone with HSV-2. Cold sores caused by HSV-1 or HSV-2 are contagious. You can spread it to other people or other parts of your body if you touch an open sore and then touch another part of your body. That means if you have a cold sore and give oral sex to someone, that person will get the herpes virus on his or her genitals.
Avoid touching your cold sore as much as possible. If you touch your cold sore, wash your hands right away to avoid spreading the infection to other parts of your body or other people.
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What Happens During An Outbreak
During a herpes outbreak you may feel the following symptoms:
- flu-like symptoms like fatigue, fever, headache
- difficulty in peeing or finding it painful to pee
- vaginal discharge
Your first outbreak of herpes will last around 2 to 4 weeks. Recurrent outbreaks after this are usually much shorter with less severe symptoms.
The blisters that form may break and cause ulcers. These ulcers can be painful and will take a few weeks to heal completely.
If you are pregnant and have herpes, you should speak to your doctor or midwife immediately. The infection can potentially spread to your newborn baby during childbirth. Babies do not have a well developed immune system like adults, so neonatal herpes can be very serious for a baby. Depending on how far along you are in your pregnancy, your doctor might consider starting you on antiviral medication.
If youre pregnant, avoid having sexual contact with partners you know to have genital herpes or any other STI.
Request fast, effective antibiotic medication to treat current or future outbreaks or suppress outbreaks if you get these regularly. Get started by completing a short online medical questionnaire so our doctors can check your symptoms and confirm that treatment is suitable. All prescribed medications are sent out in discreet, unmarked packaging.
Can Genital Herpes Be Treated
Your physician can prescribe different medications to help reduce your symptoms and speed up the healing of an outbreak. These medicines work best when you start them soon after an outbreak occurs.
To reduce pain during an outbreak:
- Sit in warm water in a portable bath or bathtub for about 20 minutes. Avoid bubble baths.
- Keep your genital area clean and dry, and avoid tight clothes.
- Take over-the-counter medications, such as acetaminophen or ibuprofen. Avoid aspirin.
Let your physician know if you are worried about your genital herpes. He or she can recommend a support group to help you cope with the virus.
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How About People With A Weakened Immune System
Six studies looked into whether aciclovir can prevent cold sores in people with a weakened immune system. The participants had cancer treatment with chemotherapy or a bone marrow transplant during the studies. They also took aciclovir two to five times per day over 4 to 11 weeks. The maximum dose was 2,000 mg per day.
The results showed that aciclovir prevented cold sores in about half of the people while they were having the cancer treatment. So antiviral drugs can clearly reduce the risk of cold sore outbreaks in people who have a weakened immune system. They can also reduce the severity of outbreaks if someone gets a cold sore.
How Does Herpes Simplex Spread
Herpes spreads through close contact with a person who has the infection. The virus can be found in skin and saliva. If you have herpes simplex, you are most likely to pass the virus to another person when you have sores. But you can infect someone else even if you have no symptoms. Healthcare providers call this asymptomatic viral shedding.
People may get HSV-1 through
- Touching a persons skin near the mouth.
- Sharing food utensils, lip balm or razors.
- If you receive oral sex from someone who has a cold sore, it may spread a herpes infection to your genitals.
People may get HSV-2 through
- Oral sex with someone whos infected.
- Touching open sores, including while breastfeeding.
- Childbirth by a mother or gestational parent who has an active infection.
You cant get genital herpes from objects like toilet seats. But you could pass genital herpes through shared sex toys.
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Can I Be Treated To Prevent Genital Herpes Transmission To My Partner
Yes. A large study showed that if one partner has herpes and the other partner is uninfected, treating the infected partner with suppressive therapy can prevent transmission of symptomatic herpes in over 90% of cases. This is an option for couples who are interested in having unprotected sex or who are planning to become pregnant.
If you are entering into a new relationship and are aware that you have herpes simplex infection, you owe it to your partner to notify them before having sex.
How To Prevent Herpes
But most people have sex at some point in their lives, so knowing how to have safer sex is important. Using protection like condoms and dental dams when you have sex helps to lower your risk of getting an STD.
Herpes can live on areas of your body that arent protected by condoms , so condoms wont always protect you from herpes. But they do lower your chances of getting herpes.
Dont have sex with anyone during a herpes outbreak, because thats when it spreads most easily. But herpes can also spread when there are no sores or symptoms, so its important to use condoms and dental dams, even if everything looks and feels A-OK.
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Prevention Of Genital Herpes
The best protection against STIs is to always use barrier protection such as condoms, female condoms and dams . Because herpes is spread by skin-to-skin contact, condoms will reduce the risk of transmission, but it will not protect sexual partners completely as condoms do not cover the entire genitals.
Using lubricant with a condom during sex will also reduce the risk of trauma to the genital skin. This has been shown to reduce HSV transmission, especially in the first six months of a sexual relationship. Silicone-based lubricants are recommended.
Remember that herpes transmission can occur when symptoms are present , but may also occur even if there are no genital symptoms through asymptomatic viral shedding.
For people who have frequent episodes of genital herpes, antiviral medication, taken daily, helps to reduce transmission of herpes to a sexual partner.
Try An Herbal Approach
Try echinacea to stimulate your immune system and burdock root as a gentle cleansing tonic. Heres a recipe by herbalist Aviva Romm. Toss 1 ounce each of dried echinacea and burdock root into a quart of boiling water. Let the herbs steep for 4 to 8 hours, then strain the liquid. To treat an outbreak, drink 4 cups a day until the blisters disappear. To prevent recurrent outbreaks, drink 1/2 cup two to four times a day. You can use this infusion for up to 3 months. After that, take a 3-day break after each 27-day stretch.
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When Should I See A Doctor
See your doctor at the first sign of shingles. Getting treated early can help it go away faster and may help you avoid related problems. For instance, shingles on the face can cause hearing or sight problems, including blindness.
If you have a weak immune system and can’t get the vaccine, early treatment is your best defense against shingles.
Sometimes what seems to be shingles is really herpes simplex. Though it usually appears as “cold sores” around the mouth or genitals, this form of herpes can show up elsewhere. A different treatment is used to clear it up. Your doctor can do tests, such as a viral culture, to confirm whether you have shingles and to get you the right treatment.
How To Prevent Genital Herpes Outbreaks
Medically reviewed by
Last reviewed: 03 May 2022
Genital herpes is a common type of sexually transmitted infection. While there is no cure for genital herpes, there are steps you can take to prevent further outbreaks of the virus. Over time, your body will clear the virus on its own. You can take antiviral medication during an outbreak to treat the symptoms of genital herpes.
Key takeaways
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Know what triggers can cause a herpes outbreak and avoid them if you can.
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Taking care of your body will always help in the long term to protect yourself against further outbreaks.
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If you know your sexual partner has herpes, wait until their sores or blisters have healed completely before you have sex.
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You can prevent the spread of herpes by using condoms when having sex.
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If you have a new sexual partner, its best for both of you to get tested for genital herpes.
Genital herpes is caused by the herpes simplex virus . There are 2 types of HSV, HSV-1 and HSV-2. Both types of the virus can cause genital herpes. You can also get cold sores on your mouth from HSV-1.
You can get genital herpes from any direct skin to skin contact with the blisters. This includes kissing and sharing sex toys. This can also happen if you and your partners genitals come into contact but you do not have penetrative sex. Your partner does not need to have the symptoms of genital herpes to pass the virus on to you.
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What Can Increase The Likelihood Of Cold Sore Outbreaks
Cold sores are caused by viruses in nerve cells in the lips. These are usually kept in check by our immune system. They are more likely to lead to cold sores if your immune system is weakened. The main possible triggers are:
- Sunlight and artificial UV light
- Minor injuries and cracks in the lips
- Physical strain
- Womens monthly period
Most of these potential triggers can’t be avoided, or are difficult to avoid. There is a lack of good research on whether cold sores can be prevented by steering clear of avoidable triggers, such as tanning beds and strenuous sports.
Some people think that the feeling of disgust can trigger cold sore outbreaks. But there is no scientific proof that this is true.
What Does Genital Herpes Look Like
While some people with genital herpes will never have any symptoms, other people can develop symptoms within a few weeks of being infected.
Often, before the lesions appear, patients describe a prodrome, characterized by a tingling or burning sensation in the area where the lesions will develop that can be noticed during urination, along with itching or discomfort in the genital area.
You can also have the following symptoms:
- Blisters on the mouth or lips
- Fever, headache or pain in the joints
- Trouble urinating
The symptoms of genital herpes often go away and come back as recurring outbreaks. For most people, the first outbreak is the worst, and can last from two to three weeks. Future flare-ups are often less severe and do not last as long. Still, some people shed the virus regularly. The following triggers can make outbreaks more likely to occur:
- Viral or bacterial infections
- Menstrual periods
Recurrent genital herpes is most common in the first year after the initial infection and decreases as time goes on.
In many cases, anti-herpes medicine can help patients. When a person experiences a prodrome and suspects a recurrence is going to happen, they begin taking anti-herpes medications that lessen symptoms and shorten the time of the outbreak.
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Treatment Of Primary Infection
Antiviral therapy is recommended for an initial genital herpes outbreak, especially if the patient has systemic symptoms or is immunocompromised.2 Oral acyclovir is effective in reducing symptoms1. Intravenous administration may be required in immunocompromised patients and those with severe disseminated infection.1 Topical acyclovir reduces the duration of viral shedding and the length of time before all lesions become crusted, but this treatment is much less effective than oral or intravenous acyclovir.1
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Expect The First Outbreak To Be The Worst
Remember that although herpes lasts a lifetime, the first outbreak typically causes the most pain, while later outbreaks tend to be much milder.
You will always have herpes, and the sores will come and go, but you can decide not to treat the current outbreak. If its not that unpleasant or uncomfortable, some patients will do that, says Gade.
Some people never have symptoms after the first outbreak, according to the Cleveland Clinic.
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What Is A Herpes Outbreak
A herpes outbreak happens when lesions called blisters or sores start to form on your genitals, bottom or mouth. If you have oral sex, you can also get oral herpes in the mouth. Your first outbreak of genital herpes will generally last longer with more severe symptoms, such as a fever or muscle aches.
Recurrent infections happen because the virus stays dormant in your body. Once triggered, the virus reactivates which leads to an outbreak. Triggers for recurrent infections can include being stressed, being on your period or feeling run down.
You might have an outbreak of herpes a long time after youve had unprotected sex. The virus can stay in your body and not cause symptoms straight away.
Risks And Side Effects
The three main treatments for herpes acyclovir, famciclovir, and valacyclovir are all FDA approved, though there are side effects and interactions to be aware of.
Common side effects of these antiviral medications include headaches and nausea. Famciclovir can cause dizziness or sleepiness, and confusion is mainly seen in older adults.
Acyclovir and valacyclovir, which are very similar to each other, can cause your kidneys to stop working. If you have kidney issues, your doctor may prescribe a lower dose. These medications can interact with other medications, such as nonsteroidal anti-inflammatory drugs like ibuprofen. This may weaken kidney function.
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