Herpes is easily spread through kissing and sex. It can cause painful ulcers on the genitals, mouth and anus. There is no cure, but medications can help. Condoms and medication can help to prevent transmission.
Herpes is a sexually transmissible infection caused by the herpes simplex virus (HSV). There are two types of HSV: HSV1 and HSV2. Both types of herpes can occur on the lips, mouth, genital or anal areas, and one person can be infected by both HSV1 and HSV2. Herpes on the lips and mouth is known as cold sores and is more often caused by HSV1. Herpes on the genital and anal areas is known as genital and anal herpes and is more often caused by HSV2. Around 75 in every 100 Australian adults have been infected with HSV1, and around 12 in 100 have HSV2. Many people with herpes never have symptoms and do not know that they have it.
Symptoms can appear days, weeks or months after infection. Subtle early warning signs include tingling, itching or pain in the infected area that may be followed by blisters that break and become painful ulcers. A typical episode lasts for 7-10 days from the first symptoms to the time the ulcers heal. The first episode of symptoms is usually the longest and the most painful.
Recurrent episodes are usually milder and clear up more quickly. HSV1 tends to be associated with less severe and less frequent recurrences compared to HSV2. Recurrences normally occur in the same part of the body as in previous outbreaks, but in some people blisters may appear nearby. Medication helps reduce the duration and severity of symptoms.
Herpes enters the body through tiny scrapes in the skin or through the moist soft lining (mucous membranes) of the mouth, genitals, anus, or urethra. It lives in the nerves beneath the skin and can remain there, inactive and unnoticed, for many years. Herpes is usually transmitted in the following ways:
In some people, the body can shed the virus from the skin or mucous membranes without there being any signs or symptoms of cold sores or genital herpes (called asymptomatic shedding or viral shedding). Shedding is higher in the first year after infection and in people who experience frequent outbreaks. It is possible to pass the virus on during periods of asymptomatic shedding, but for most people the risk is low.
If a pregnant woman has a genital herpes episode at the time she gives birth, she may pass the virus to her baby when the baby passes through the birth canal. Herpes transmission during birth can cause severe complications for babies, so pregnant women should tell their obstetrician or midwife if they have ever had a herpes diagnosis. Pregnant women who suspect they have caught herpes during their pregnancy should seek immediate medical advice. Pregnant women without symptoms whose partners have a diagnosis of herpes should also consult their doctor or obstetrician.
Avoiding skin contact from the time of first symptoms (warning ‘tingle’) on the mouth, genitals or anus, and for a week after the symptoms have gone helps prevent herpes transmission. If it is not possible to avoid sex, using condoms or latex dams for vaginal or anal sex can reduce the risk of herpes transmission. Preventive antiviral medication when recurrences are frequent (also called ‘suppressive’ therapy), reduces the risk of transmission.
If there are symptoms, a doctor can test for herpes by taking a swab (using a long cotton bud) from the ulcer or blister, or make a diagnosis by physical examination. It is important to see the doctor as soon as possible, while the blisters are present. If there are no symptoms or the blisters have healed, a blood sample may be taken to test for herpes antibodies. If herpes is strongly suspected but the blood test is negative, a repeat test may be needed to confirm the diagnosis because herpes antibodies can take between 3 to 6 months to develop after infection. Herpes tests cannot tell when the infection was acquired.
Antiviral medications help to reduce symptoms and transmission, but there is no cure for herpes. To reduce the duration and severity of symptoms, treatment should start as early as possible before or after the blisters emerge. It is advisable to talk to a doctor about treatment options, such as daily preventive antiviral treatment, when recurrences are frequent.
Managing herpes symptoms is important. Keeping the area dry, wearing loose clothing and resting allow the ulcers to heal. Salt water baths and paracetamol can help reduce the pain. Your doctor can help you manage the psychological and emotional impact of herpes, or can refer you for counselling.
If you have symptoms, you need to get a sexual health check as soon as possible so that you can be treated, if needed. Even if you don’t have symptoms, the Australasian Chapter of Sexual Health Medicine recommends annual screening for sexually active young people, gay men, men who have sex with men, and people who inject drugs, and every 3-6 months for people at higher risk such as sex workers and people with frequent changes in sexual partners. Always use condoms or dams with new or casual partners.
If you have herpes, it is important to tell your sexual partner/s so they know about the transmission risks and consider being tested. Your doctor can help you to decide who may be at risk and help you to contact them. If you wish, your doctor can make contact for you, while keeping your identity confidential.
The information in this fact sheet is general and you should talk to a doctor, sexual health clinic or contraception clinic if you are worried about herpes or other sexually transmissible disease. Contact the NSW Sexual Health Infoline freecall 1800 451 624 about herpes support groups.
For further information please call your local Public Health Unit on 1300 066 055.