Herpes is a sexually transmitted disease caused by two herpes simplex virus (HSV type I and type II). Herpes is transmitted from person to person via direct skin-to-skin contact during oral, anal and vaginal sex. HSV I usually causes fever blisters and cold sores on the mouth, but can also cause sores on the genitals. HSV II usually causes sores on the genitals (vagina, penis, anus) and the skin around those areas. The majority of oral herpes cases are caused by HSV I and the majority of genital herpes cases are caused by HSV II; however, since so many people are now having oral sex, type-I is increasingly appearing in the genitals. HSV is different from other common viral infections because once it is introduced into your system, it lives there forever, often with periodic symptoms or without symptoms at all.

About 50 to 80% of the adult population in the United States have oral herpes. About one in five adults in the United States has genital herpes; however, as many as 90% of these infected people don’t know they have the virus. There are no accurate numbers as to how many people in San Francisco have herpes as it is not a reportable STD.

Genital herpes is seldom a severe or dangerous infection by itself, although it can cause psychological distress because of the nature of the sores and the length of time the virus stays in your system.

The open sores of herpes do play a role in the spread of HIV. A person with a herpes sore is three to five times more likely to acquire HIV if exposed to an HIV-positive sex partner. Also, people with HIV and herpes have an increased amount of HIV fluid in their open herpes sores, which increases the risk of transmitting both diseases to a partner during unprotected sex.

Pregnant women who have a first episode of genital herpes near delivery may transmit herpes to their infant, which could be a serious, even deadly, problem. Fortunately, infection of infants is rare among women with recurrent genital herpes.

Many people have genital herpes but don’t know it because they have no symptoms. Others have very mild symptoms. For the third group, who are symptomatic, the first outbreak is usually the worst. It lasts the longest, is most severe and often very uncomfortable. The initial sores can last five to ten days, first “weeping”, then scabbing over, then healing. In addition to blisters or open sores, a person may have swollen glands, fever, and body aches. Women tend to have more severe symptoms than men.

Genital recurrences after the first outbreak seem to be linked to stress, fatigue, lack of sleep, menstruation, and genital friction (new sexual partner after a time of no sex), although more research is definitely needed about this subject. Usually recurrences are more frequent in the first year after the initial outbreak. Some people have tingling or itching at the site of the sores before they appear, which can help them prepare for an upcoming outbreak. For some people, the recurrences are so mild that they have been mistaken for jock itch, razor burns, insect bites, ingrown hairs, and the like. Outbreaks can appear in different locations over time.

In most cases, experienced clinicians can diagnose an initial herpes outbreak by its appearance. There are also viral culture tests available that can tell if herpes is present and which type (HSV I or HSV II). These tests use fluid from an open sore and are most accurate during initial outbreaks and when blisters are present.

There are several new blood tests that are very accurate for diagnosis. These tests also distinguish type (HSV I or HSV II). Speak to your medical provider about these tests if you’re interested.

There is no cure for herpes. However there are currently three FDA-approved antiviral medications that are available to treat herpes: Zovirax (acyclovir), Famvir (famciclovir) and Valtrex (valacyclovir). Using medication to treat genital herpes can help speed the healing process of an outbreak or be used as a preventative (when taken daily) to help reduce the frequency of future outbreaks.

Valtrex have also been proven effective when taken daily to reduce the risk of transmission of herpes to sex partners. The most common short-term side effects of these drugs are nausea and headaches. Thus far, no long-term side effects have been named.

In order to reduce outbreaks, keep your stress levels low, eat well, exercise regularly and get lots of rest. Learn to recognize the symptoms that occur during the period before the lesions appear. People often describe a tingling or burning feeling during this time. Taking medications in this time period before an outbreak can abort or reduce the duration.

In order to avoid transmission of the virus to your sex partners, we advise discussing your herpes diagnosis with a prospective partner before you have sex. A potential partner would need to understand that it’s possible for him or her to become infected even if you’re using condoms since not all affected areas can be covered by a condom. Most good relationships can weather the news. Your partner may want to gather information and take some time to adjust to the fact that you have herpes. If you’re in a serious, long-term relationship, your partner might want to test for herpes as he or she might already be infected, but without symptoms.

Condoms provides some, but not complete protection, against transmission of the herpes virus. If you or your partner has herpes, abstain from sexual activities when sores are present. Communication is a wonderful tool to help you and your partner(s) make decisions about what’s right for each of you at any given time.