Find Dr. Cullins' Answers to Common Sexual Health Questions
Q&A with Dr. Cullins
STDs are very common. But we can protect ourselves and each other from STDs like herpes. Learning more about herpes is an important first step.
Here are some of the most common questions we hear people ask about herpes. We hope you find the answers helpful, whether you think you may have herpes, have been diagnosed with it, or are just curious about it.
Herpes is a very common infection. It is caused by two different but closely related viruses. The viruses are herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Both are easy to catch. They remain in the body for life and can produce symptoms that come and go.
Both forms of herpes can infect the oral area, the genital area, or both. When the infection is on or near the mouth, it is called oral herpes. Oral herpes is caused most often by HSV-1. When a herpes infection is on or near the sex organs, it is called genital herpes. Genital herpes is caused most often by HSV-2. More than half of American adults have oral herpes. And about 1 out of 6 American adults have genital herpes. Millions of people do not know they have herpes because they never had, or noticed, the herpes symptoms.
When a person has oral herpes, "cold sores" or "fever blisters" can show up on the lips or around the mouth. These sores may also show up inside the mouth, but this usually only happens the first time oral herpes symptoms appear. Symptoms may last a few weeks and go away. They may return in weeks, months, or years. They are annoying but usually harmless in children and adults. But cold sores can be very harmful to a newborn.
Most people with genital herpes have no symptoms, have very mild symptoms that go unnoticed, or have symptoms but do not recognize them as a sign of infection. The most common herpes symptom is a cluster of blistery sores — usually on the vagina, vulva, cervix, penis, buttocks, or anus. Symptoms may last several weeks and go away. They may return in weeks, months, or years.
The first time that genital herpes symptoms appear is called "first episode" or "initial herpes." The initial herpes symptoms are usually more noticeable than later outbreaks.
Genital herpes symptoms may include
During initial herpes, symptoms may also include
When there are initial herpes symptoms, they usually appear from 2 to 20 days after infection. But it may be years before the first symptoms appear.
Initial herpes sores usually heal in about 2 to 4 weeks. But the virus stays in the body. It can flare up and cause sores again. Symptoms from flare-ups usually heal in 10 to 14 days. Herpes symptoms may be more painful and last longer in women or men with illnesses that weaken the immune system — like leukemia and HIV.
If you have herpes or HIV, it is especially important to practice safer sex. Studies show that all sexually transmitted infections can increase the risk of getting HIV. People with genital herpes have at least twice the risk of getting HIV if exposed to it than people without herpes. And people with HIV and genital herpes are more likely to pass HIV to their partners than people without genital herpes.
Only a health care provider can diagnose herpes by performing a physical exam and tests. A blood test can tell if you are infected with oral or genital herpes — even if you don't have symptoms. Health care providers can also confirm herpes infection by testing fluids taken from the sores.
If you think you have herpes sores, get them checked out as soon as possible. It's important to be sure that the sores are herpes. Other serious sexually transmitted infections, like syphilis, may look like herpes but need different treatment.
Yes. If you have herpes, you can take certain medications to help manage the infection. Using herpes treatments is usually very effective in speeding up the healing of sores and preventing them from returning frequently.
Warm baths may give some pain relief. Cotton clothes will help prevent chafing. Keep the sores dry — moisture can slow healing. Holding cool compresses or ice packs to the sores may be soothing. Pain relievers such as aspirin, acetaminophen, or ibuprofen may help relieve discomfort and fever.
Although herpes treatment is helpful, there is no cure. However, in most cases outbreaks become fewer and weaker over the course of a few years.
Your local Planned Parenthood health center, many other clinics, private health care providers, and health departments offer herpes tests and herpes treatments.
Herpes is spread by touching, kissing, and sexual contact, including vaginal, anal, and oral sex. It can be passed from one partner to another and from one part of the body to another. Brief skin-to-skin contact is all that's needed to pass the virus. Because herpes may have no symptoms for years, sometimes it is very difficult to know who passed it to whom.
Although it is rare, genital herpes can also be spread from a pregnant woman to her baby during vaginal birth.
Herpes is most contagious when sores are open, moist, or leaking fluid — until the scabs heal and fall off. But herpes can also be spread when no symptoms are present — most people get genital herpes from people with no symptoms. And most people with oral herpes were infected as children.
The lining of the mouth, vagina, penis, anus, and eyes can become infected with herpes easily. Skin can be infected if it is cut, chafed, or burned, or has a rash or other sores.
There are three main ways you can prevent spreading genital herpes.
Touching any type of herpes sore may spread the virus from one partner to another or from part of the body to another, especially during initial herpes. If you have herpes sores
If you have a cold sore on your mouth, don't kiss anyone — especially infants, children, or pregnant women.
When herpes flares up again, it is called a "recurrence" or "outbreak." Herpes does not always recur, and if it does recur, the timing and severity are different from person to person. Some people rarely have recurrences. Others have them often. Herpes is most likely to recur in the first year after infection. Recurrences may be more frequent for people with weakened immune systems.
You may have some early warning signs before an outbreak occurs, like tingling, burning, or itching where sores were before. The warning signs may start a few hours or a day before the sores flare up. When symptoms recur, they are usually not as severe as symptoms during an initial herpes outbreak.
Oral herpes recurrences may be caused by sunburn, injury to the lips, or other infections. No one is sure what causes genital herpes to recur. Other infections, stress, surgery, menstruation, sexual intercourse, and skin irritations may bring on recurrences.
It's common for women with genital herpes to be concerned about what their infection might mean for their newborn. If you are pregnant and have genital herpes, you probably don't need to worry. A woman with recurrent herpes rarely passes the infection to her newborn.
Herpes poses the greatest danger to a newborn if a woman gets infected during her pregnancy. The most important thing you can do is to avoid becoming infected with genital herpes during pregnancy.
You may consider herpes testing if you have never had genital herpes symptoms and if your partner has a history of genital herpes. You should also consider testing if you have any concerns about being exposed. Testing is helpful because it is possible you have the virus but have never had or noticed symptoms.
If you do not have genital herpes but your partner does, avoid unprotected oral, vaginal, and anal sex. Your partner may also consider taking anti-herpes drugs throughout your pregnancy. Anti-herpes drugs reduce the risk of passing the infection to you.
Though rare, contact with herpes sores during delivery can lead to a severe, life-threatening infection for the baby. Let your health care provider know if you have herpes. If you have herpes sores when you begin labor, your health care provider may recommend a cesarean section to avoid infecting your newborn. Very rarely is a fetus infected earlier in pregnancy.
Work with your health care provider to plan the best care for yourself and your baby. Discuss any concerns you may have about herpes and pregnancy with your provider. Learning more about herpes may also help you make the best decisions about your health and the health of your baby.
If you have an outbreak of oral herpes while you are pregnant, don't worry. It shouldn't harm your pregnancy. However, after birth, if you have a cold sore, don't kiss your baby until it has healed completely to prevent giving the baby the infection.
Many Planned Parenthood health centers have support groups for people living with herpes.
The American Social Health Association sponsors a program that assists people with herpes — the Herpes Resource Center. It publishes a quarterly newsletter, operates a telephone hotline, and organizes help groups. The International Herpes Resource Center is another great place to check out for more information and support.
Q&A with Dr. Cullins