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  • With Mayo Clinic women's health nurse practitioner

    Lois McGuire, R.N., M.S.N., W.H.N.P.

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  • Nov. 25, 2008

    Herpes prompts many questions

    By Lois McGuire, R.N., M.S.N., W.H.N.P.

168 comments posted

You have had many questions regarding herpes (HSV). This is a big topic, and so we'll look at different aspects of it over the next few weeks.

Genital herpes is common, affecting both men and women. According to the Centers for Disease Control and Prevention, the herpes simplex virus is present in as many as one in six teens and adults in the United States.

Here are some of the areas that we'll cover:

  • Types of herpes
  • Categories
  • Symptoms
  • Frequency
  • Diagnosis
  • How it is spread
  • Treatment
  • Suppressive treatment

Types

Herpes is a virus. There are eight human herpes viruses. They are:
  • Herpes 1 (HSV-1): traditionally thought of as cold sores or fever blisters
  • Herpes 2 (HSV-2): traditionally thought of as genital sores
  • Chicken pox and shingles
  • Epstein-Barr: a common cause of mononucleosis
  • Cytomegalovirus: serious when contracted during pregnancy
  • Human herpes virus 6 or roseola: a type of measles
  • Human herpes virus 7: causes a rash
  • Human herpes virus 8: causes Kaposi's sarcoma, an infection seen mostly in AIDS patients

I only tell you the above mentioned types to round out the discussion on herpes. The rest of this blog will address HSV-1 and HSV-2. If you have questions about the other types of herpes, please contact your provider.

Categories

  • Primary refers to an outbreak that occurs in a person who has never had HSV-1 or HSV-2.
  • Non-primary occurs when a person already has HSV-1 and now has been infected with HSV-2. The existing antibodies to HSV-1 may keep the outbreak from HSV-2 unnoticeable, meaning the newly infected HSV-2 person doesn't have symptoms. Up to 80 percent to 90 percent of first time genital outbreaks have no symptoms. This explains the statistics above.
  • Recurrent is just that, recurrent. People with HSV-2 have an average of 4-6 outbreaks per year. This can vary greatly from person to person. Some people can have more than one per month and others may only have one every few years.

Next week, I will begin with symptoms of HSV-1 and HSV-2. Let me know what questions and observations you have.

168 comments posted

blog index
  • February 9, 2010 10:11 p.m.

    We really need to be careful all the time. I am diagnose with herpes, it was so uncomfortable the blisters and not to mention the pain. Good thing I have Zovirax stocked on my cabinet. It lessens the discomfort and stops the infection from spreading or worsening. Plus it is safe to take even when pregnant. And when breastfeeding do not take this drug! You can see the complete drug info and other meds at http://medsheaven.com/index.html

    - Ariel

  • February 2, 2010 3:03 p.m.

    I haven't seen this asked previously, although there are a few similar queries... I have Type 2 as does my wife (now). We managed to avoid infecting her for a few years, but eventually it did jump to her. The question (two parts) is: A) Assuming we both have the same strain of the virus, can we initiate an outbreak in the other person through contact if we have an outbreak ourselves? And B), Can we cause the point of outbreaks to move elsewhere by activity during an outbreak? i.e., is the original point and vicinity the only area that can recur, or can later contact with the virus on another part of the body cause it to break out there too (and eventually result in many possible locations/areas)? There doesn't seem to be much literature available dealing with these questions! Bottom line, it would be nice to know what the risks are for us when one is having an outbreak, given we are both already carriers. Thanks in advance!

    - Rick

  • February 2, 2010 11:05 a.m.

    Dear Mrs. Concerned, I am not able to tell you anything for sure but I can tell give you a few things to consider: 1. The original source for a contamination could have been a towel or bar of soap used by someone with a oral or vaginal sore. 2. It is possible that you had been exposed to the disease years ago and had your first outbreak when you were pregnant because your immune system was compromised. 3. Your husband might have herpes too but just never had a sore. 4. There is a blood test that would show whether it is herpes 1 or 2. Please read all my blogs on this subject.

    - Lois McGuire

  • January 28, 2010 8:29 p.m.

    I have a blister the size of a Half Dollar on the back side of my right leg..and have had them the last year every 3 to 5 months in between...I thought it was a boil..but the dermatalogist said yesterday it was herpes...and said that someone one have to have it on their hands and would have touched that area on me..the back of both upper thighs and buttocks...is that really the case...my family is just not understand how that could happen if my husband does not have it and how does someone give it to me by touch touching that area if there is not a open cut...?????? Please help me understand...1st out break 6yrs. ago when I was pregnant..dr. said oh it is your hormones..then no outbreak for 5 1/2 yrs.....so the last year I have dealt with this....please help....I am taking the anitibotic for Herpes today...

    - Mrs. Concerned

  • January 23, 2010 10:14 a.m.

    I found out a year ago that I have HSV 2. My husband had the blood test, and results were negative. In our 12 year realationship I was never with anyone else. I am from a very large family, and we all have a history of cold sores. Two years ago I had a terrible, oozing cold sore that went from my lip to my nose, a week or two later I had one one my arm, then on my right buttocks. I have had two different infectious disease Dr. tell me this is called Autoinoculaion, when you pass it from one part of your body to another. Has this happened to any one else, where it goes from HSV1 to HSV2? Oh... my husband left me 2 weeks after he got his negative results!

    - Wendy

  • January 22, 2010 1:49 a.m.

    What if the both of us got herpes? Do we still need to use condom? if we didn't use condom? Will it become worst? I really wanted to know more about it. Hope u can can give me some answer.

    - mayo

  • January 21, 2010 5:45 a.m.

    If the both of us got "herpes" can we still oral sex?

    - Sharon T

  • January 20, 2010 5:49 a.m.

    i m 25. how long do we no if we hav the diease? i recently got a ucler around my genital. i with my boyfriend around 2-3 months?And i has this 'diease' only after i been with him for this pass 2-3 months. i never has this experience before? could it be my bf pass it to me? or i already has this "herpes" a long time ago just that now then start getting "itching"? can you give me some advise? thanks

    - Sharon T

  • January 10, 2010 5:58 a.m.

    I am 65 I have not had sexual intercourse for 23 years.I recently went to my dictor regarding 'itching' and discomfort' around my genitals. She told me it was genital herpes then when I told her I had not had sexual intercourse she said it was shingles. This episode coincided with a budding relationship with an old friend which has not gone beyond kissing. Since I told him, he says he has had exacly the same in the same place. Now I am wondering if I could have caught it off him through kissing. He also has rashes in the back if his neck and I have seen him scratching his genital area. Can you advise?

    - ann

  • January 7, 2010 9:20 a.m.

    Dear May, I would wait for 4 months from the time of your lesion and then both of you should get the blood test. In the meantime avoid oral sex. It will be difficult to wait but you need to first find out what the sore you had was or at least was not. It is more difficult for a man to acquire the virus. The vaginal area for a woman is dark, warm and moist, a perfect setting for bacteria and viruses to grow. The shaft of the penis is dry and easy to wash and dry well, prohibiting viruses to grow.

    - Lois McGuire

  • January 7, 2010 9:08 a.m.

    Dear Jessica, A person should wait 4 months before having the blood test. First think about the timing of his blood test and see if it was after 4 months from the time you started having symptoms. In the meantime, get on suppressive therapy and use a condom. Protect him as best you can starting at this point. As far as why the herpes was missed, perhaps you had atypical sores (sores that are not characteristically herpes looking) or the provider you saw doesn't care for this type of issue often. Anytime a woman has a problem for a prolonged time, it is best to see a specialist in women's health. I am sorry you suffered so long. For those of you reading this who have unresolved irritation of your penis, labia or vagina, please request a herpes test. Often people self treat for recurrent yeast when really it is a herpes infection that is the cause of their symptoms.

    - Lois McGuire

  • December 31, 2009 4:08 a.m.

    Another question: is it harder for males to get genital HSV 1?

    - May

  • December 30, 2009 3:01 a.m.

    Dr. Lois, I believe I have a cold sore in a corner of my mouth. When the bump first showed up, it was red and every time I smiled wide, it felt like the skin was ripped open. I thought it was just another area affected by my eczema, but I know I was mistaken. A couple days before I realized it was a cold sore, I attempted to preform oral sex on my fiance but it hurt too much. I am now worried that this small exposure, he will be infected with HSV-1. It's probably too soon for symptoms, but we are both very worried.

    - May

  • December 23, 2009 11:31 p.m.

    Thanks. Dr. Lois...is it possible for him to not have HSV? Iwas tested previously and was never told i had herpes until now and he has been tested (bloodwork) and its never came back for him. i just dont understand how symptoms of herpes could have been mistaken for BV for several months because I have been having symptoms of BV for almost a year now since I was first treated.

    - Jessica

  • December 20, 2009 8:21 p.m.

    I was diagnosed with gential herpes about two and a half years ago. I was with a guy for about three years on and off and he is the only person i have ever had sex with. He went down on me while he had a herpes outbreak on his lip and because of that i contracted hsv2. I have been scared about having sex again because I don't want to infect someone else. I have read a lot of different things about preventition but i'd like to know the risk I am putting my partner in. I'm still young and don't know if I will be committed to this person for the rest of their life and I don't want to run the risk of ruining their life as mine as been ruined.

    - katie

  • December 17, 2009 10:40 a.m.

    Jessica, The most confident way to know if someone has had herpes (HSV) is through a blood test. A blood test can also state if it is HSV1 or HSV2. The first thing for you both to do is to have a blood test and see if it is l or 2. Please read through all my blogs on herpes. Ninety percent of people with herpes do not know that they have it. It would also be wise for you and your partner to sit down with a provider who is willing and knowledgable about HSV to discuss it. I will write a blog on bacterial vaginosis. This is not sexually transmitted.

    - Lois McGuire

  • December 14, 2009 11:19 p.m.

    i just found out i have herpes and my boyfriend and i have been having unprotected/protected sex for over a year and he has been tested twice since we've been together and its never came back as herpes for him. he is the only person I've been with and i dont understand how he never contracted it. Also, the doctors told me it was BV (bactertial vaginosis before) but it kept coming back and this has been for almost a year i had recurring BV and i was tested but i was never told i had herpes until now. i dont understand. Please help.

    - Jessica

  • December 13, 2009 5:29 a.m.

    hi, i have been diagnosed with herpes 1 in the genital area. i was told normally you get the first outbreak after 5-7 days of contact, is it possible to get the first outbreak 6 weeks later? DtaVtm

    - lori

  • December 9, 2009 3:15 p.m.

    Mika, I am so glad you went to your provider.

    - Lois McGuire

  • December 9, 2009 3:11 p.m.

    Dear Kat, Find a new provider! The first outbreak can be awful. Usually follow up out breaks will not be so severe. You may never have another outbreak or you may have several. I have no way of predicting the future for you. The reasons to be on suppressive medication are to prevent the symptoms of herpes but also to prevent spreading the disease. If you are in a relationship with someone who has the same type of herpes, you don't need to protect them from herpes as they already have the virus but if you are dating someone who doesn't have the virus, you could and probably will pass it on.

    - Lois McGuire

  • December 4, 2009 9:58 p.m.

    I recently found out that I contracted HSV-2. I was in a long term relationship and he never showed any symptoms. My first outbreak was very bad and I've heard that following outbreaks are not supposed to be "as" bad. I'm constantly parinoid that I am going to have another outbreak, 'ghost' feelings of pain, muscle twitching. Is it possible to have another outbreak so close to my first? And my doctor is against drug therapy unless I have more than 4 or so outbreaks a year and I really would like to minimize them..what would you suggest?

    - kat

  • November 28, 2009 1:18 p.m.

    Well, good news. I went to the doctor and got checked and it was a case of folliculitus. Also found out that I could not have gotten herpes by a blood transfusion, but thankfully, I don't need to try to figure out another way that I could have gotten it. I've been on antibiotics for about a week and it is compeltely gone. -Mika

    - Mika

  • November 22, 2009 4:34 p.m.

    Hello Lois, I am a 48 year old male and this past week, my wife performed oral sex on me. I woke up the next day with a sore on my penis. It looked like an abrasion, but the next day it appeared there was another. The description of the herpes blisters sounds like what I have seen. Red bump that seems to open up then scab over and heal. The sores on my penis healed, but now I have small red sores in my pubic area. They do not hurt and do not seem to itch. I have had repeated yeast infections, but this is different. I have only been with my wife sexually. Even before we were married, I had no other sexual contact with anyone. We have been married for 26 years. I am also completely confident that she has been 100% faithful to me. She did have other partners before we were married. I had surgery 2 years ago and received a blood transfusion. Is there a chance I could have contracted herpes from that? I have not been to the doctor yet, so I am not sure it is herpes, but the descriptions here sure seem to fit. Honestly, I am freaking out about how this could be possible?

    - Mika

  • October 30, 2009 5:00 p.m.

    I have HSV-2 and recently started a new relationship with a man who does not have it. I have informed him of this and we are both doing research while he decides to proceed further into our relationship. His main concern is the potential long term health effects to him, should all our best efforts to prevent him from catching it not succeed. In the research I've done - aside from the unpleasant outbreaks and the embarrassment, I find very scattered info on this topic. One website indicates that men with HSV-2 are more prone to bladder infections, while another website says that there is a rare form of menigitis (but I can't seem to find stats on if this menigitis affects more women than men, and how rare is it, etc, etc). Are you able to provide more insight into the potential long term effects for a man should he contract HSV-2?

    - Stacy

  • October 30, 2009 1:01 p.m.

    I am a 25 year old college educated African American female who contracted hsv2 last year after my ex-boyfriend took the condom off during sex. I know it came from him because now i have outbreaks alot. It seems like i have had them for months at a time, anyway I will say that i have told 3 people that were willing to still have sex with me. The point is, you never know how a person will react. however, i think i would rather go on a herpes dating site to meet a potential mate, so that i can have peace of mind from start to finish.

    - Anonymous

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