What is Herpes?
There are 2 main types of herpes: type 1 (HSV-1) and type 2
(HSV-2). Most oral herpes is caused by HSV-1 while most genital
herpes is caused by HSV-2. Oral herpes is not necessarily caused by
sexual contact. In fact, many people contract oral herpes from a
parent or sibling. Actually, oral herpes is very common with about
65% of individuals being infected. However, genital herpes is a
sexually transmitted disease passed through direct skin-to-skin
contact with the genital area. Genital-to-genital and
oral-to-genital are the 2 most common ways genital herpes is
What are Symptoms?
Most individuals have no or only minimal signs or symptoms of
HSV-1 or HSV-2 infection. When signs do occur, they typically
appear as one or more blisters on or around the mouth, lips,
tongue, genitals, inner thighs, lower abdomen or rectum. These
blisters can be quite painful. If an individual is going to have an
outbreak, the first one usually occurs within two weeks of the
virus being contracted. The blisters may break, leaving tender
ulcers (sores) that may take up to two to four weeks to heal the
first time they occur. Other signs and symptoms during the primary
episode may include flu-like symptoms, including fever and swollen
glands. Typically, another outbreak can appear a few weeks or
months after the first, but it is almost always less severe and
shorter than the first outbreak. People who are diagnosed during a
first outbreak of HSV often have several more outbreaks in the
first year. Although the virus stays in the body indefinitely, the
number and severity of outbreaks tends to decrease over time as the
immune system releases antibodies to help fight the virus. Many
individuals who have HSV outbreaks mistake the blisters for acne,
ingrown hairs, insect bites or other minor skin irritations, which
is one reason why the virus is transmitted so frequently.
HSV infections can cause major complications for infants born to
mothers with the virus. Therefore, if a woman has an active genital
herpes infection at delivery, a cesarean delivery is usually
Herpes also plays a role in the spread of HIV. The skin is a
barrier that protects us from contracting some infections. Since
open sores on the body caused by herpes disrupt that barrier,
people become more susceptible to infections such as HIV if
exposed. An HIV-infected individual also becomes more infectious if
he or she has an outbreak of herpes sores.
How is herpes Transmitted?
Both types can be found in and released from the sore(s) that the
virus causes. A simple skin-to-skin contact with the sore(s) is all
it takes for transmission to occur. However, transmission can occur
from an infected partner who does not have a visible sore and may
not know that he or she is infected. When a person initially
becomes infected, the nerve endings that came in contact with the
virus are the ones that become infected. The herpes virus, when in
its dormant state, resides deep within the nerves of those infected
nerve endings. When an outbreak is triggered, the virus moves
through the nerve in an effort to get to the surface of the skin
(nerve ending) where it can cause a sore(s). The movement of the
virus between its dormant state and the surface of the skin is
called viral shedding. It is often asymptomatic. However, during
the shedding period, some individuals can feel a numbness,
tingling, itching and/or burning sensation at the surface of the
skin while no visible symptoms are seen. These sensations occur due
to the irritation of the nerve endings once the virus becomes
active. Viral shedding, although free of visual symptoms, is still
a contagious period. This is why it is said that individuals can
pass herpes without having visible sores.
Testing for herpes
A visual exam is not always accurate in diagnosing herpes because
the sores associated with the virus resemble several other skin
conditions, including, acne, allergic reactions, and even eczema.
Many people are misdiagnosed when only a visual exam is performed.
A viral culture test can be beneficial in diagnosing herpes.
However, an outbreak must be present in order to perform the
culture test. The culture is a common method used for identifying
the presence of a herpes infection, but it often fails to find the
virus even when it is present. HSV infections can best be diagnosed
during and between outbreaks by the use of a blood test. The blood
test, which detects antibodies to HSV-1 and/or HSV-2 infection, is
extremely accurate in detecting the presence of the virus. However,
the blood test can not tell you the location of either type 1
and/or type 2 when no symptoms are present.
The Herpes 1&2 Type Specific IgG test is an ELISA test that
detects antibodies specific to HSV-1 and/or HSV-2 infection. This
test will tell you which type(s) of the herpes virus you have, if
either. However, this test does not indicate the site of HSV
infection, absent of any symptoms. The IgG test should be taken at
least 3 weeks after a contact of concern. It is conclusive at 6
The Herpes Types I/II IgM Combination test is also an ELISA test
that detects herpes antibodies. The IgM is a non-type specific
herpes test and, therefore, cannot distinguish between types 1 and
2. However, IgM levels can provide useful information about a new
infection. The IgM may also detect antibodies from a recurring
outbreak since those levels may be elevated every time the virus
becomes active from its dormant state. The IgM can be taken
anywhere between 10 days and 4 weeks after a contact of concern.
After 4 weeks, the IgM antibody levels will more than likely not be
Unlike other sexually transmitted diseases, herpes cannot be cured
because medication that will attack the virus while it lies in it's
dormant state will also damage the nerve cells. However, there is
treatment available for acute outbreaks that involve the use of
anti-viral drugs such as Acyclovir, Valacyclovir (Valtrex) or
Famcyclovir. These medications are prescribed to help lessen the
severity and frequency of outbreaks, and in some situations, may
help to prevent outbreaks. Keep in mind, not every individual who
is positive for herpes requires treatment.
Can I have herpes even if I have never had any
Yes. In fact, up to 60% of people who have genital herpes show no
signs of the disease and are unaware that they are infected.
Can I give my partner herpes even if I have no
Yes. Herpes can be passed to others through asymptomatic viral
shedding. Viral shedding is when the herpes virus become active
from its previous dormant state and is "shedding" at the site of
infection. The herpes virus is considered contagious during this
"active" time and can therefore be spread through direct contact
with the infected area.
Does wearing a condom prevent the transmission of
No. Condoms have only a 30% rate of protection against contracting
genital herpes. Depending on where the outbreak or viral shedding
is taking place on the body, herpes can still be transmitted while
using protection if the infected area is not covered by the condom.
If the condom happens to be covering the affected area,
transmission will most likely be prevented.
Do I have to have a visible blister to get a herpes
No, you do not have to have a blister in order to get tested. In
fact, you can get tested for herpes when you have no symptoms at
all. A blood test must be performed so that the antibodies to the
virus can be detected. The blood test for herpes is the most
accurate way to detect the presence of the herpes virus whether
symptoms are present or not.
Is there a cure for herpes?
Currently, there is no cure for herpes. Once you have the virus,
it stays in your body and there is always a chance that you could
have outbreaks. However, there are many treatment options and the
virus is usually fairly easy to control for most individuals.