Herpes

A viral infection that is easily spread through kissing and sex. Herpes causes painful ulcers on the genitals, mouth and anus. There is no cure, but drugs can help reduce the number and severity of ulcers.

Last updated: 19 June 2008

What is herpes?

Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). There are two types of HSV: HSV1 and HSV2. HSV1 is usually found around the lips and mouth and is often referred to as cold sores; HSV2 more commonly infects the genital and anal areas. However, both HSV1 and HSV2 can occur on either the lips, mouth, genital or anal areas, and one person can be infected by both HSV1 and HSV2.

It is estimated that 76% of Australian adults are infected with HSV1, and 12% are infected with HSV2. Women are twice as likely as men to be affected by HSV2.

HSV enters the body through the skin of the genitals, mouth and anus, or through tiny cuts and abrasions in the skin anywhere on the body. It lives in the nerves beneath the skin and can remain there, inactive and unnoticed, for many years.

What are the symptoms?

People can develop symptoms days, weeks or even months after infection. Many people with herpes have no symptoms and are not aware that they have it.

When symptoms do occur they can begin with subtle early warning signs that include tingling sensations, itching or pain in the area of the infection. This may be followed by the appearance of blisters that burst and become painful ulcers. The ulcers heal by themselves over time but may cause itching. The outbreak lasts for about one week from the first symptoms to the time the ulcers are healed.

The first outbreak of symptoms is usually the longest and the most painful. Some people may only ever have one outbreak of symptoms, while other people have occasional outbreaks throughout the remainder of their lives. A small number of people have frequent outbreaks but, over time, the number of outbreaks usually declines.

How is it spread?

HSV is transmitted through skin-to-skin contact during vaginal, anal or oral sex, through kissing and by direct contact between your genital/anal skin and the skin of another person, for example, during foreplay or non-penetrative sex. HSV can be transmitted even when no signs or symptoms are present.

If a pregnant woman has a genital herpes outbreak when she gives birth she can pass the virus to her baby when the baby passes through the birth canal. Herpes transmission at birth can cause severe complications for babies, so women who are pregnant should advise their obstetrician or midwife if they have ever had a herpes outbreak or diagnosis. An initial outbreak of herpes during pregnancy can cause premature birth, so pregnant women who suspect they have caught herpes during pregnancy should seek immediate medical advice.

Who is at risk?

• All sexually active people are at risk of HSV infection.
• People with a sex partner infected with herpes have an increased risk.
• Women are about twice as likely as men to be affected by HSV2.

How is it prevented?

People who already have herpes should:
• avoid sex from the first sign of an outbreak until the ulcers have healed (a week or so after an outbreak)
• avoiding kissing and oral sex during an outbreak on the mouth and lips
• avoid genital contact with the mouth, genital or anal area of other people during a genital outbreak
• use condoms during oral, anal and vaginal sex to help prevent transmission, though condoms may not entirely cover the affected areas
People with herpes sometimes take the antiviral drugs used to treat herpes outbreaks every day to reduce the risk of infecting others.

People who don't have herpes should:
• use condoms for oral, anal or vaginal sex because this can reduce the risk of catching herpes and other sexually transmitted diseases from infected people who do not have any noticeable symptoms
• Avoid kissing, sex and other activities that involve direct contact with the infected area of a person with HSV when symptoms are present

How is it diagnosed?

During an outbreak, genital herpes is diagnosed by taking a swab (using a long cotton bud) from the ulcer or blister and testing it in a laboratory. A doctor may also be able to diagnose herpes by a physical examination. It is important to see a doctor as soon as possible while the symptoms are present.

When no symptoms are present, or between outbreaks, a blood test can be used to test for HSV antibodies. This test cannot tell where the infection is (in the mouth, genitals or anal area), and it may not reveal an infection until some time after it occurs because HSV antibodies can take between 3 to 6 months to develop.

Neither test can determine when the infection first occurred because herpes can lie unnoticed for months or years before an outbreak of symptoms.

How is it treated?

Antiviral drugs help reduce the number, duration and severity of ulcers, but there is no cure for herpes. The drugs should be started as early as possible, shortly before or after the blisters emerge. This makes them more effective in controlling outbreaks. People who experience regular outbreaks of herpes can take antiviral drugs every day.

Managing herpes symptoms is important. Keep the area dry, bathe ulcers daily in salt water and take paracetamol for the pain. Your doctor or sexual health clinic staff can tell you about medicines which reduce symptoms and transmission, and they can also give advice on how to manage the psychological and emotional impact of herpes.

What is the public health response?

If you have been diagnosed with herpes it is important to tell anyone you may have infected so they can also be tested and treated, and so they do not infect others. Your doctor or sexual health clinic can help you decide who may be at risk and help you to contact them. If you wish, this can be done anonymously by your doctor.

Further Information

Sexual Health Information Line (02) 9382 7440 or Freecall 1800 451 624 (outside Sydney).
Ask at your local sexual health clinic or contact the Sexual Health Information Line to find out about herpes support groups.

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