Having sex with herpes

I went to the doctors a few days ago for what I thought was poison oak on my vulva, but the doctor said that she is pretty positive I have genital herpes so she gave me a urine test and some cultures. I have not recieved the results yet, but the more I look into information about herpes the more I notice that I have all the symptoms of the intial outbreak. Honestly I am terrified and I feel hurt and very confused. My question is how can I have sex with my boyfriend or anyone ever again without giving them the virus?

It’s normal to feel upset after a herpes diagnosis. Herpes is a very common infection. It remains in the body for life and can produce symptoms that come and go. For most people, the virus weakens over time and symptoms appear less and less frequently over the course of a few years.

In the meantime, there are three main ways you can prevent spreading genital herpes.

1. Stop having sexual contact as soon as you feel warning signs of an outbreak. Warning signs may include a burning, itching, or tingling feeling. Do not have vaginal, anal, or oral sex — even with a condom. Wait until seven days after the sore heals. The virus can spread from sores not covered by the condom. It can also spread in sweat or vaginal fluids to places the condom doesn’t cover.

2. Use condoms between outbreaks to reduce the risk of transmission.

3. Use herpes treatments. The risk of transmission can be greatly reduced if the partner with herpes takes a small daily dose of anti-herpes medication.

Touching any type of herpes sore may spread the virus from one partner to another or from part of the body to another, especially during initial herpes. If you have herpes sores

  • Don’t touch the sores. If you do, wash your hands with soap and water — this kills the virus. Wash your hands after going to the bathroom, before rubbing your eyes, and before touching a contact lens.
  • Don’t wet contact lenses with saliva — especially if you have oral herpes.
  • If you have a cold sore on your mouth, don’t kiss anyone — especially infants, children, or pregnant women.

Many Planned Parenthood health centers have support groups for people living with herpes.

The American Social Health Association sponsors a program that assists people with herpes — the Herpes Resource Center. It publishes a quarterly newsletter, operates a telephone hotline, and organizes help groups. The International Herpes Resource Center is another great place to check out for more information and support.

Tags: herpes, STDs

Question from practice: Herpes: when is it safe to have sex?

Counselling

There is considerable stigma among the general public about herpes, and many people with the disease encounter a great deal of distress while learning to live with it. Reassurance and teaching can help, along with patient information websites (eg, Patient.co.uk) and printed material, particularly on how to broach the subject with a partner.

Counselling should include how the disease progresses, how to reduce the risk of transmission, the relative protection of condoms and treatment possibilities, including suppressive therapies.

Sufferers need to know to avoid sex during an episode, and about the possible risk of transmission through asymptomatic shedding. They should also be aware of the complications in pregnancy.

A number of people have herpes without symptoms and this fact is particularly important when symptoms present some time into a monogamous relationship and worries about fidelity come to the fore. Partner notification is important and can clarify where the disease has come from so that asymptomatic carriers can be found.

Transmission

When blisters are present, the virus is highly contagious and the couple should avoid sex during an attack and until lesions have cleared.

Asymptomatic shedding makes avoidance of transmission difficult because it is not always possible to know when the virus is being shed. So, to answer this person’s question, there is still a chance of infection if the boyfriend does not have symptoms. There may be more asymptomatic virus shedding in the first year after acquiring herpes simplex type II, and in individuals who have frequent recurrences.

Condoms can be used to try to prevent transmission, but the area involved often does not lie within the area covered by the condom.

This couple needs to discuss the risks further and come to an informed decision together.

About the author

Sarah Pillai is a lead clinician at Central London Community Healthcare NHS Trust

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Everything You Need to Know About Herpes and Sex

The virus most easily enters the body through a break in the skin, Glatt says—say, an abrasion from rough sex, a cut in your mouth, or a sore from another condition. (Having any one STI increases your risk for acquiring a second.) However, herpes can also slip through the body’s normal defenses, especially through mucus membranes in the mouth, eyes, genitals, or rectum.

There’s no cure for herpes—and though your risk of spreading it tends to decrease over the years, it’s still possible for you to infect a partner. Here’s what you need to know to avoid sharing more than you bargained for.

Sex Isn’t The Only Way to Test Positive
If your doc gives you a herpes diagnosis, make sure you’re clear on exactly what you have, Glatt says. There are eight types of herpes simplex virus. One type, HSV-2, causes most cases of genital herpes. Another, HSV-1, most often causes cold sores—but perhaps due to all the great oral we’re giving and receiving, type 1 is increasingly causing genital infections too.

If you gave every American a blood test, nine out of ten would have some evidence of infection with one of the eight types, Glatt says. But only about one in six has genital herpes.

“Ask: What type of herpes, how did I get it, and is it sexually transmitted?” Glatt says. Your doc should be able to shoot straight with you. If you test positive but the infection doesn’t affect your genital area, chances are you were exposed in some other way—say, sucking on the same toy as an infected toddler way back in day care.

If you do have sores on your private parts, ask your doctor to take a swab. He or she can test the fluid from the sores for the virus, rather than just looking for antibodies the way blood tests do, Glatt says.

When those swabs come back positive, it doesn’t really matter if you have type 1 or type 2, he says. You have genital herpes—most likely acquired through sexual contact with an infected person. The steps for stopping its spread are the same for both types.

You Can Pass It On Even If You’re Not Having an Outbreak
Clusters of red, blistery bumps serve as the telltale sign of oral or genital herpes. When you’re first infected, they usually show up within two to ten days. The sores may burst, crust over, then heal—only to come back. Recurrent outbreaks are most common during the first year, Glatt says.

The pus that oozes out of these sores contains millions of viruses, says Philip Werthman, a urologist and director of the Center for Male Reproductive Medicine in Los Angeles. “That’s the most contagious time during an outbreak, when the blisters pop.”

But even when your skin’s clear, you’re not off the hook. You might still be shedding the virus, Werthman says. Though the counts are smaller—likely in the hundreds instead of millions—herpes can still infect your partner.

In fact, about 70 percent of transmissions occur during asymptomatic periods, says James Whiteside, an obstetrician/gynecologist at the University of Cincinnati College of Medicine.

Often, this occurs soon before or after an active outbreak. Most people have a tingly, aching, itching, or stinging sensation when they’re about to develop sores—a phenomenon experts call “prodrome.” If you avoid sex from the moment you feel these symptoms through a couple of weeks after your sores heal, you’ll reduce the risk of infecting your partner, Whiteside says.

Condoms Work—To a Point
When you’re not in the midst of an active outbreak, wrap it up. Consistent condom use reduces your risk of passing along the virus by about 30 percent, according to a study in the Archives of Internal Medicine.

But of course, condoms can break and are prone to user error. Even when operated flawlessly, they’re not as effective against herpes as they are against pregnancy, Glatt says. Skin-to-skin contact before the condom goes on, or between uncovered areas, still leaves the uninfected partner vulnerable.

Women Face a Greater Risk
Speaking of vulnerable—women’s larger expanses of mucus membranes in and around the vagina increase their odds of catching herpes. That’s especially true when they have sex with men, who are more likely than women to shed the virus even when they don’t have symptoms, Whiteside says.

In fact, rates of transmission from men to women stand at about 10 percent, while women pass herpes to uninfected men only about 4 percent of the time, he says.

You Can Give It To Yourself.
Autoinoculation might sound like a scene from the new 50 Shades movie—but in fact, it’s a term for the uncommon but possible circumstance of reinfecting yourself with the virus, Werthman says.

Say you have an open sore and you touch it with your hands. If you have a cut or scrape, the virus can re-enter your skin and cause painful blisters called herpetic whitlow on your fingers. If you then touch your eyes, you can also get herpetic keratitis.

You could even infect another person by touching your sores and then shaking hands, Werthman says. So, keep your hands off your junk when you have an active outbreak—or at the very least, wash or sanitize them afterward.

Antiviral Drugs Help Reduce Symptoms
If your outbreaks are frequent or severe, your doctor may prescribe medications that suppress the virus and relieve herpes symptoms. This also reduces the chances of spreading the disease. In fact, daily doses of a drug called valacyclovir cut your risk of infecting your partner by about half, according to a study in the New England Journal of Medicine.

And even more effective options may be on the horizon. In a recent JAMA study, an experimental drug called pritelivir reduced both the frequency of outbreaks and the number of days the infected person shed the virus. However, it’s not yet available here in the United States.

Researchers are also working to develop a vaccine for the condition. Unlike, say, a flu shot that prevents you from catching a virus, this vaccine is given to people who already have genital herpes.

In early studies, three shots over the course of three weeks reduced the number of days in which an infected person shed virus by about half over the course of the year—potentially cutting the odds of transmission, too. However, it could be years before such methods are FDA-approved, Glatt points out. In the meantime, good old monogamy—or condoms—remain your best bet.

This article originally appeared on VICE US.

You can have a fulfilling sex life if you have genital herpes, even though it may be more complicated than it was before your diagnosis. Now, you must be careful about what you do and when you do it.

Avoid these sexual activities when you have sores on your genitals, or when you feel a herpes outbreak coming on:

  • Vaginal sex
  • Anal sex
  • Receiving oral sex (fellatio, cunnilingus, and analingus)

Between outbreaks, it’s OK to have sex, as long as your partner understands and accepts the risk. For example, as long as you don’t have herpes sores on your mouth, you can perform oral sex on your partner, including when you have an outbreak of genital symptoms.

But your partner can be infected with herpes even when you don’t have symptoms or sores. To help prevent that, always use a latex condom for vaginal sex, anal sex, and receiving fellatio. Condoms are not guaranteed to prevent infection, but research has shown that they provide some protection. Use a dental dam for cunnilingus and analingus.

Otherwise, use your imagination. There are many ways people can express themselves sexually without having genital-to-genital or mouth-to-genital contact. Exploring them can enrich your sex life and make up for having to avoid other activities because of genital herpes. Consult a health care professional if you have any doubts about what’s safe and what is not.

For example, you could try mutual masturbation, which poses almost no risk: You could masturbate together — side by side, facing each other, or back to back — or masturbate each other manually. Just make sure you don’t have any broken skin on your hands, and wash hands with soap and warm water afterward. Also, never touch a herpes sore and then touch your partner, and make sure no bodily fluids could be exchanged by accident. If you and your partner like vibrators or dildos, you could try using them on each other. Make sure you wash the toy before and after, and don’t share it.

The Complete Guide to Having Sex With Herpes

Learning that you have genital herpes can be a difficult experience. Although herpes is very common, many people assume that a positive HSV-1 or HSV-2 diagnosis spells the end of a normal romantic and sexual life. The reality is that it’s completely possible to have a fulfilling sexual and social life if you have herpes, whether you have HSV-1 or HSV-2. In fact, while many people with herpes panic upon experiencing initial symptoms of the virus, most people with herpes find that maintaining romantic and sexual relationships is far easier than expected. Having sex with herpes is normal, so long as you take the right precautions.

In this guide, we’ll cover everything related to having sex when you have herpes, from letting your partner know about your HSV-1 or HSV-2 infection status, to using antiviral medications, condoms and other methods of protection to reduce your risk of transmitting the virus.

First Off, Having Herpes Isn’t as Uncommon as You Might Think

What we call “herpes” is actually several different types of the herpes simplex virus. These are HSV-1 (herpes simplex virus type 1) and HSV-2 (herpes simplex virus type 2). Each type of the virus acts differently in the body, infecting different nerves while causing identical symptoms.

HSV-1 is the most common form of the herpes virus. It affects anywhere from 50% to 70% of the world’s population under 50 years of age, meaning about half of the people you talk to every day are likely to be infected.

HSV-1 usually affects the skin on or around the lips, causing cold sores. However, it’s possible (albeit rare) for HSV-1 to spread to the genitals and cause genital herpes outbreaks.

Despite being extremely common, most people with HSV-1 never experience any symptoms as a result of being infected with the virus. This means you can have a lifelong HSV-1 infection but never notice a single cold sore outbreak.

HSV-2 is the form of herpes most commonly associated with genital herpes. While it isn’t quite as common as HSV-1, it’s still an extremely common infection. Study data from the WHO data shows that more than 400 million people worldwide have HSV-2, or 11% of all people aged 14 to 49.

In short, if you have herpes, you’re not unusual, unclean or unhealthy. You also shouldn’t feel as if you developed the virus because of unsafe or unsanitary sexual behavior. Herpes is by far the world’s most common sexually transmitted infection and anyone can become infected.

Before You Think About Sex, Focus on Treating Your Herpes

While herpes doesn’t need to limit your sexual or romantic life in the long term, it’s best to take a break from sexual activity once you first find out that you’re infected.

Most people with an active herpes infection find out about their status during the initial outbreak of the virus. Initial herpes outbreaks (often called “primary herpes”) usually happen within two to four days after you become infected with the virus, and can take two to four weeks to heal.

During these initial days, the virus undergoes a replication process in your body, taking over cells and spreading at a rapid pace.

Genital herpes eventually spreads to the spinal ganglia, where it stays as a dormant virus in the body. Oral herpes settles in the ganglia (a junction of nerves) behind the cheek bone. It can take up to two weeks for herpes to “set up camp” in your body before an initial outbreak.

During an initial outbreak, you’ll notice a variety of symptoms, from flu-like fatigue and muscular aching to a fever. The most obvious sign of a herpes infection is the development of sores on the lips (cold sores) or on the genitals, groin, legs and buttocks.

You should avoid having sex during an initial outbreak of herpes. This is because the virus is at its most contagious during a physical outbreak. During the first outbreak, your body also hasn’t had time to prepare its own immune response to the virus.

Combined, this makes your risk of infecting other people with herpes very high during the first outbreak.

Instead, you should speak to your doctor. Initial outbreaks can be painful and unpleasant, both for oral and genital infections. Antiviral medications such as valacyclovir can be used to speed up the rate of healing, allowing your body to recover from the initial outbreak faster.

Many doctors will also recommend the use of pain medication to control the headache, muscle pain and other discomfort that can occur during an initial herpes outbreak.

In summary, during an initial herpes outbreak you should avoid all sexual activity. If you have an oral herpes infection, you should also avoid kissing your partner, as well as sharing glasses and utensils. Focus on treating the outbreak. Once it’s healed, you can refocus on your sex life.

Recurrent Herpes Outbreaks and Their Effects on Sex

While some people with herpes never experience any symptoms, many people will experience occasional outbreaks of oral or genital herpes.

Because herpes is an incurable virus, these outbreaks can continue to occur for life, making it important that you have a treatment plan worked out with your doctor.

The most common medication used to treat herpes (both oral and genital) is valacyclovir. Our guide to valacyclovir explains more about how this drug works to treat herpes outbreaks, with information on common dosage protocols for oral and genital herpes.

Your risk of infecting your sexual partner with herpes is as its highest during an outbreak, since the herpes sores that can develop during this period contain large amounts of highly infectious viral fluid. As such, it’s best to avoid all sexual activity during recurrent outbreaks.

This can sound frustrating, but the reality is that herpes outbreaks tend to become less frequent as your body develops its immune response. Most people with HSV-1 only ever experience one to two outbreaks per year, which typically take one to two weeks to heal.

People with HSV-2 usually experience outbreaks four to five times per year, with each outbreak lasting for one to two weeks.

Once you have a prescription for an antiviral drug like valacyclovir and understand how to use it to treat herpes symptoms, treating herpes outbreaks becomes fairly easy, making the impact on your ability to maintain a normal sex life much less serious than you might think.

How to Tell Your Partner You Have Herpes

Before we get into the practical side of having sex with herpes, it’s important to cover another topic that many infected people worry about—telling their sexual partner about their infection status.

If you are aware that you have herpes, you need to tell your sexual partner. Even when you avoid sex during outbreaks, use condoms and follow other safe sex practices, there’s still a risk of transmitting the virus. This makes it essential that your sexual partners are informed.

Many people feel anxious about telling their romantic interest that they have herpes, for reasons that are very understandable. Nobody likes to disclose that they have an STD, especially to the person they’re sexually and romantically interested in.

However, done the right way, letting your partner know that you have herpes doesn’t have to be a stressful or negative experience, and they should know that dating someone with HSV-2 or HSV-1 is still worthwhile.

First, before you disclose to anyone that you have herpes, it’s important to check which type of the herpes virus you’re infected with. Our guide to herpes tests covers the most common herpes testing methods and explains how you can get tested to see if you have HSV-1 or HSV-2.

If you have HSV-1 and only develop herpes sores on your lips, disclosing your status to your sexual partner is fairly straightforward. After all, upwards of 50% of the population has HSV-1, meaning there’s a good chance that your partner as has the virus.

If you have HSV-2 or an HSV-1 infection that affects your genitals, disclosing your status could be more challenging. The best approach is to explain how common herpes is and focus on how manageable and mild the virus typically is.

It’s also important to explain how the herpes virus spreads, and how safe sex practices such as using condoms or dental dams in combination with suppressive herpes medication like valacyclovir can help lower the risk of spreading the virus.

Finally, it’s important to pick the right setting. Don’t tell your partner you have herpes when the two of you are in bed together about to have sex, and definitely don’t be irresponsible by telling them about your herpes status after you’ve already had sex.

Instead, choose a natural moment in conversation to quickly, clearly and casually explain your situation. Share statistics about how common herpes is and stay upbeat—statistically speaking, there’s a chance your partner might also have been waiting to tell you the same thing.

If you’re considering a serious relationship with someone, it can also be worth getting tested for herpes together. If your partner already has the same type of herpes as you (remember, many people with herpes don’t even know they have it), your situation is a lot less complicated.

Explaining to your partner that you have herpes doesn’t need to be difficult. Most people are kind, sympathetic and understanding, especially after you put the virus in context by sharing statistics about how common herpes really is. Though HSV-1 and HSV-2 transmission probability is still existent, it’s generally not as serious as reactionary internet articles would have you believe. Just be open, honest and safe.

How to Have Safer Sex if You Have Herpes

Even if you have herpes and your partner doesn’t, you can easily have a fulfilling sex life while minimizing your risk of spreading the virus.

It’s important to note the use of the word “minimizing” above. Even if you follow every safe sex guideline and use antiviral drugs to suppress herpes within your body, it simply isn’t possible to completely eliminate the risk of spreading the virus to your partner.

However, a few small steps can go a long way towards reduce your transmission risk. These steps include:

  • Never having sex during a herpes outbreak. Outbreaks are when the most “viral shedding” occurs, meaning your risk of infecting someone else with herpes is higher when you have blisters, open sores or herpes scabs on your genitals.
    This is also true for oral herpes, which can spread to the genitals through contact and cause genital herpes to develop.
  • Use antiviral medication. Antiviral medications such, as valacyclovir, stop the herpes virus from spreading within your body, reducing the level of viral shedding that occurs even when you aren’t experiencing an outbreak.
    Studies show that you’re 48% less likely to transmit herpes to your partner if you take valacyclovir for suppressive herpes therapy—a reduction in virus acquisition risk from 3.9% to 1.9%. HSV 2 transmission probability drops drastically, but it’s still worth noting that there will always be some level of risk.
    This is particularly important for men, since women are more likely to catch HSV-2 from men than vice-versa.
  • Use condoms. While condoms don’t completely eliminate the risk of transmitting herpes to your partner, they do make a huge difference.
    Study data shows that condom use reduces the per-act HSV-2 transmission probability from male to female by 96%, and by 65% from female to male. In short, using a condom cuts your risk of herpes transmission to one third or one twentieth of what it would be without protection.
  • Use a dental dam. Dental dams protect you or your partner’s genitals against diseases that can spread through oral contact, such as oral herpes.
    If you have infectious oral herpes and have oral sex with your partner, there’s a risk that it could causing genital herpes to develop. A dental dam acts like a condom for oral sex, shielding your partner from direct contact and reducing the risk of transmitting the virus.
  • Accept that there’s still a risk of infection. Finally, it’s important to be aware that even with the safe sex practices listed above, it’s still possible for the herpes virus to spread to your partner.
    This means that both you and your partner need to understand and accept the risks and implications that come with a herpes infection before having sex.

Herpes affects billions of people worldwide, with HSV-2 alone affecting more than 400 million people. This means that if you have herpes, you’re definitely not the only person who’s had to have a pre-sex conversation with your partner about the virus.

With the right combination of a positive attitude, antiviral drug use and safe sex, having herpes doesn’t need to spell the end of your sex life. Having sex with herpes is still possible, so long as you follow the advice above and, like millions of other people with herpes, be smart, safe and open with the people you love about your status.

International Perspectives on Sexual and Reproductive Health

Three-fourths of individuals who know that they have genital herpes either abstain from vaginal sex or always use condoms when they have symptoms, but only one-fifth do so when they are free of symptoms.1 In an international cross-sectional study of individuals with genital herpes who were in monogamous, heterosexual relationships, only about half knew that the infection could be transmitted between outbreaks. Participants’ odds of having sex (vaginal, oral or anal) during symptomatic periods were elevated if they or their partner used an IUD, if they were Latin American or European (rather than North American) and if they had previously had an STI. Their odds also increased with the number of sex acts per month and with the number of outbreaks per year.

The study was conducted between 1998 and 2001 among clinic clients who were being screened for participation in an international trial of drug therapy to prevent transmission of genital herpes. In 17 countries in North America, Latin America and Europe, researchers gave questionnaires to individuals visiting clinics who were infected with herpes simplex virus type 2, reported having had symptoms and had partners who had never had symptomatic genital herpes. Participants provided information about their demographic characteristics and their sexual behavior (including whether they practiced abstinence and used condoms during symptomatic and asymptomatic periods), and answered questions testing their knowledge about genital herpes.

Analyses were based on a total of 1,193 individuals, 88% of whom were white and 60% of whom were female. The median age was 36 among men and 33 among women. Six in 10 participants had attended college, and seven in 10 were employed. The median number of outbreaks of genital herpes each year was five. Some 87% of participants said that they were able to recognize early symptoms of an outbreak.

Participants had sex with their partner a median of 6–7 times per month. During periods when they had no symptoms of genital herpes, 98% of individuals had vaginal sex, 76% had oral sex and 25% had anal sex. In contrast, during periods when they had symptoms, 40% of individuals had vaginal sex, 29% had oral sex and 11% had anal sex.

For certain types of sex, regular condom use was more common during symptomatic periods than during asymptomatic ones. Specifically, 20% of individuals used condoms for every act of vaginal sex when they did not have symptoms, but 35% did so when they had symptoms. Similarly, 2% always used condoms when having oral sex during asymptomatic periods, whereas 7% did so during symptomatic periods. The level of regular use of condoms when having anal sex did not vary with the presence of symptoms.

An analysis of overall changes in behavior between asymptomatic and symptomatic periods showed that most participants (89%) engaged in some type of sex without always using condoms when they had no symptoms, and a substantial proportion of this group (38%) continued to do so when they were symptomatic. Nonetheless, the majority of individuals modified their behavior, either abstaining from sex or always using condoms, when herpes symptoms were present. Whereas only one-fifth (21%) of participants abstained from or always used condoms during vaginal inter-course when they were free of symptoms, three-fourths (74%) did so when they had symptoms. The patterns for oral sex (26% vs. 73%) and anal sex (78% vs. 91%) were similar.

Nearly all individuals (97%) knew that genital herpes is sexually transmitted, and two-thirds (66%) were aware that the disease is incurable. Most knew that medication can prevent outbreaks (91%) and can speed the healing of sores (96%), and that condoms can help prevent the spread of the disease between partners (92%). However, only 67% knew that a person can still transmit the virus after a sore has completely healed, and only 53% were aware that the virus can be transmitted between outbreaks.

In a multivariate analysis, individuals who currently used an IUD or whose partner did had higher odds of engaging in any kind of sexual activity during symptomatic periods than did nonusers (odds ratio, 3.0). The odds of having sex despite the presence of symptoms were higher among Latin American and European participants than among their North American counterparts (2.2 and 1.7, respectively), and higher among individuals who had previously had an STI than among those who had not (1.4). The odds also rose with each additional sexual act per month (1.1) and with each additional recurrence of symptoms per year (1.1).

A final, multinomial analysis examined factors associated with individuals’ risk of transmitting genital herpes, as defined by their sexual behavior and condom use during asymptomatic and symptomatic intervals. The lowest risk (characterized by having vaginal sex only during asymptomatic periods and always using condoms) was associated with high levels of education and of knowledge about genital herpes. The highest risk (marked by frequent sexual activity with irregular condom use during both symptomatic and asymptomatic periods) was associated with being in a long-term relationship.

Study participants, the researchers acknowledge, were interested in preventing transmission of genital herpes and may not be representative of other populations. Nevertheless, although the majority of this group either abstained from sex or always used condoms when they had symptoms, their level of consistent condom use during asymptomatic periods was fairly low, suggesting that individuals with genital herpes may believe that they have little or no risk of infecting others at such times. “A focus of prevention must continue to highlight the importance of regular and consistent condom use during both symptomatic and asymptomatic periods,” the researchers conclude.—S. London

REFERENCE

1. Rana RK et al., Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes, Sexually Transmitted Infections, 2006, 82(1): 69–74.

Herpes Simplex Virus

Herpes can be managed. It is a very common STI in British Columbia.

There are two types of herpes simplex virus: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2).

HSV-1 is commonly found around the mouth and is often called “cold sores”. It can be passed orally by kissing and it can be passed to the genitals through oral sex. HSV-2 is commonly found in the genital area and is passed through vaginal and anal sex, but it can also be passed to the mouth through oral sex. It is uncommon for HSV-2 to be found on the lips, but it is becoming more common to find HSV-1 in the genital area. Both types are sometimes passed to other areas of the body through skin-to-skin contact.

After the first outbreak, herpes stays in the body and becomes inactive. The virus may become active from time-to-time. When this happens, symptoms usually show up in the same general area as the first time. There is no way of knowing if, or how often, a person will have future outbreaks. For most people, outbreaks happen less often over time.

Causes

Herpes is passed through vaginal, oral, and anal sexual contact. This includes both penetrative sex and sexual activities where there is skin-to-skin contact. The contact needs to be directly with the part of the body where a person has the virus.

Herpes can be passed to others even if you don’t have symptoms. The virus can be found on the skin even when there are no symptoms, called “asymptomatic shedding”. However, it’s more likely to be passed when symptoms are present.

Once you have one type of HSV, it is unusual to get the same type on another area of your body. The exception is within the first few months after you are exposed to HSV, while your body is building up antibodies to the virus. HSV can be passed to other parts of the body during this time. Try not to touch the sores and wash your hands often, to lower the chances of passing it to another part of your body.

If you have one type of herpes, then it is not possible to get that same type again.

Symptoms

If you have herpes, it is common to not notice any symptoms. If you do get symptoms, they will most likely show up between 2 to 21 days after sexual contact.

The first time you come in contact with the virus and get symptoms is called a primary outbreak. The first outbreak can last longer and be more severe than future outbreaks. Early symptoms include itching, burning, or tingling at the site where blisters or sores may appear, followed by painful red sores or tiny blisters and sometimes swollen glands, fever and body aches. You may have severe flu-like symptoms, such as fever, headache and muscle aches. Over time, outbreaks usually happen less often and the symptoms are milder.

Herpes outbreaks may be triggered by different things. These can include sun exposure, lack of sleep, alcohol use, skin irritation, and stressful events. Symptoms may be reduced by using sunscreen, getting enough sleep, drinking water, using lube, eating well and using coping strategies for stress.

Tests and Diagnosis

Most testing for herpes is done by an exam and a swab taken from a blister. Results are the most accurate if you see a health care provider as soon as a sore develops. They will look at the sore to determine what it is. If possible, they will take a swab.

There is a blood test for herpes but it is not routinely done. The patient guide at the bottom of this page has more information on blood testing for herpes.

It is best to get tested for herpes when you have symptoms.

Window Period (how long you should wait to get tested): Most swab tests are accurate once you have symptoms. Most blood test results are accurate 12 to 16 weeks after you come in contact with herpes. In British Columbia, most test results should be ready in 10 days.

Treatment

You can choose if you want to treat herpes. Symptoms will go away without treatment, though they may go away sooner with treatment. Herpes is treated with prescription antiviral medications. These medications can lessen the severity of an outbreak and lower the chances of passing it to sexual partners. Medication works best if it is started as soon as possible after an outbreak begins.

To help with the symptoms of a genital outbreak, you can try the following:

  • wear loose-fitting clothing and cotton underwear
  • bathe in warm water to soothe sores
  • keep the area dry
  • apply an ice pack, wrapped in a clean covering, to sores
  • take acetaminophen or ibuprofen (over-the-counter pain medication) if needed
  • drink plenty of fluids to keep urine diluted (to lower pain when urinating)
  • if urinating is painful, try urinating in a warm shower or bath, or try pouring warm water over the genitals when urinating
  • only use medications, ointments or creams as directed by your health care provider

Sexual Partners

It is your choice if you talk to your current sexual partners about herpes. Telling your partners lets them make informed choices, but you may not want to or you may not feel safe telling your partners. You need to make the decision that is best for you.

Current partners can check themselves regularly for herpes. If they notice any symptoms, they can see their health care provider for testing. Once your outbreak is over, it is less likely that you can pass herpes to sexual partners.

Complications

Herpes does not usually cause any other health problems. Serious complications, although extremely rare, may include:

  • higher chance of getting and passing HIV
  • ongoing, frequent and painful outbreaks
  • eye herpes
  • brain infection and inflammation (encephalitis or meningitis)

Pregnancy: Tell your health care provider if you are pregnant and have herpes. You can pass herpes to your child during birth.

Prevention

To lower the chances of passing or getting herpes:

  • you can still be sexual when you have an outbreak, but take care to avoid skin-to-skin contact in the area where you have sores (for example, do not give oral sex when you have a sore on your mouth)
  • consider antiviral medication if you have frequent outbreaks

It is a good idea to be tested regularly for STIs, especially if you have new sexual partners or open relationships. Talking with partners about safer sex makes sure everyone knows what to expect. Condoms are great if they work for you – the correct use of condoms might reduce your chance of getting and passing herpes (depending where outbreaks are located).

Resources

These two resources – a detailed 25-page patient’s guide and a 4-page handout – have been produced by the BC Centre for Disease Control. You can download or print these booklets for more information on herpes, including testing, treatment, and talking to your partners about herpes.

HealthLink BC – Information about herpes in multiple languages
SmartSexResource – If you are worried or have anxiety about herpes
Trans Care BC – Gender-affirming sexual and reproductive health information

Download and print this page (below).

How I Enjoyed Sex Again After My Herpes Diagnosis

My First Time is a column and podcast series exploring sexuality, gender, and kink with the wide-eyed curiosity of a virgin. We all know your “first time” is about a lot more than just popping your cherry. From experimenting with kink to just trying something new and wild, everyone experiences thousands of first times in the bedroom—that’s how sex stays fun, right?

This week, we’re talking to writer and herpes activist Emily Depasse. You can listen to My First Time on Apple Podcasts, Google Play, Spotify or wherever you get your podcasts.

I went to a Catholic high school, and the sex education there was abstinence-only. Marriage was seen as something sacred, and sex was only for procreation. When I went to college I had my first experience with sex education. It was all very clinical, run of the mill sex education, where you learn about contraceptives, IUDs, and how you prevent yourself from getting STIs (sexually transmitted infections).

Before I contracted herpes, I didn’t realize that I was carrying STI stigma around with me. I felt that people who contracted STIs were dirty or diseased and didn’t take proper precautions sexually. The stigma is debilitating, and it’s something I had to unlearn myself. I think it comes from the media: Characters like Coach Carr from Mean Girls is a great example, or The Hangover, which has jokes about herpes. There’s never anything in the media that says, “One day you may get an STI, and it’s actually really common, and you’ll still be worthy of pleasure.” I never got that message. No-one ever told me I could still have a loving relationship, or even a casual relationship, with someone after I got diagnosed.

I contracted herpes in 2015. I had consensual sex with someone I’d know for a while, and about two weeks later I ended up with excruciating pain in my vulva region. The doctor took a swab to test the legion, and it was extremely painful. I remember crying and a nurse looking at me with pity in her eyes. They did a test and it came back positive for herpes.

From that moment on, I felt completely unloved, betrayed, disgusting, and hopeless about my future. My dad was with me at the doctor’s office when I was diagnosed. I remember crying as we left and repeating over and over again, “Who will love me now I have this?” I didn’t want to blame my partner for giving me herpes, because we hadn’t talked about contraception. So that was another wakeup call for me, in terms of how I communicate around sex with other people. The thing I always say about being diagnosed with any STI is that it forces you to have the health conversations you should have been having with your sexual partners, but probably weren’t having.

Herpes is a skin infection that comes in two strains. There’s HSV1 and HSV2. HSV2 typically revolves around the genitals and is transmitted there, and HSV1 is generally known as oral herpes, and can be seen when you get cold sores. When it comes to have sex, you can still shed asymptomatically even if you don’t have an outbreak. It’s important that you take precautions if you’re engaging in sexual activity with someone who doesn’t have herpes. Some people go on suppressive therapy when they’re in relationships . Condoms—both internal, and external—are also great, but as herpes is transmitted through skin-to-skin contact, you can get it from grinding on someone’s genitals if you have an outbreak, so condoms won’t necessarily prevent you catching it.

Emily Depasse. Photo courtesy of subject

After my diagnosis, I felt like I didn’t know who I was. when I looked in the mirror. I’d just graduated from college; I had this great internship, but I just lost myself. It was really hard telling the person I’d contracted herpes from about the diagnosis. I tried to meet up with him to tell him in person, but he kept telling me that he was too busy, so in the end I had to tell him via text. That was the beginning of the end. We carried on having sex afterwards, but I wouldn’t call the sex acceptable or fulfilling. I think I was just trying to make myself feel like I was still worthy, and deep down I wanted him to be there for me. He was someone I’d felt a real connection with when we first met, and I liked a lot.

He ended up breaking up with me via Snapchat messenger. That experience set me on my own journey of self-acceptance and self-love. I’m someone who believes that everything happens for a reason—even if it was painful at the time. I took baby steps back into exploring my sexuality after that relationship ended. Masturbation is a great reintroduction into sexual pleasure after an STI diagnosis, because it creates a bit of distance between yourself and your body, whilst allowing you to receive pleasure.

My current boyfriend is someone I knew from college. I’d been open about my herpes status online, so all my Facebook friends knew. We started talking and flirting online, and then we went to a house party together and hooked up. We didn’t actually have sex that first time after the party, but we messed around a bit, and it was so simple. He didn’t think the herpes was a big deal—he just asked me how he should protect himself, and didn’t make a thing out of it. That was so important to me. His acceptance played a really pivotal role in rekindling my sexual self. The first time we ever had sex, it wasn’t anything extravagant. It was in his bedroom, and we used a condom, and it was nice, and gentle, and soft. It was a reintroduction to sex. I felt worthy of pleasure again.

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It has been a long journey for me to get to the point where I am comfortable talking about my herpes diagnosis, and advocating on behalf of others to erode STI stigma. After I was first diagnosed, I spent hours on the internet. The internet can be your best friend, and your worst enemy! I came across the work of herpes activist Ella Dawson, and I admired her honesty and commitment to tackling stigma. At that point in my life, I was deciding that I wanted to train as a sex therapist, so I thought, You know what? I’m tired of keeping this darkness inside me. I want to take this darkness public.

I’ve since learned that vulnerability creates change. By being vulnerable, and honest, you can help other people to make positive changes in their lives. So that’s how I came to publicly disclose my herpes status, and work with other activists to educate the public about the reality of life with an STI. I never thought this would be my life’s work; I just wanted to give people access to the resources that I never had, when I first got my diagnosis. I just wanted to change one person’s life. But now it’s become my life’s work. I get messages every day from people saying, “Thank you for being there.”

I Test Positive for Genital Herpes, and I Still Have a Great Sex Life

My herpes journey began on April 26, 2014, with irritation in my left eye. It turned out to be a case of shingles, which was excruciatingly painful, by the way.

This may seem unrelated to genital herpes story, but stay with me…

7-months later, I had my first herpes outbreak. I remember feeling an itch, at first. Next, the lymph nodes in my groin became inflamed and I felt downright shitty. Everything hurt. My whole body ached and I was extremely fatigued.

A bump appeared on the bottom-left side of my vulva. Near my perineum, on the inside of my labia minora (inner pussy lips). It was uncomfortable to touch, but it didn’t hurt until it became ulcerated… and then holy hell! It hurt so effing bad!

It felt like I was going to die every single time I peed! I kid… I kid! But it did hurt a lot.

From the looks of it, I was fairly certain that it was herpes. So I went to see a gyno. This was the first and only time that I saw this particular doctor. She was professional, but not at all personable. She had the bedside manner of a very old rock.

“I’m pretty sure it’s herpes, but I’m going to send a swab and bloodwork to the lab anyway. I’ll put in a script for antivirals so that you can get started on them right away.” She said.

That was it. No discussion. She was totally blasé. Almost dismissive.

I received a telephone call from her two days later with the confirmation.

“The labs confirm that you have herpes. So finish the antivirals…” she said.

“Is there anything else I need to know or do?” I asked, surprised at how cavalier she was about the whole thing.

“Not really. If or when you have another outbreak, you should refill the antivirals. You may have another outbreak or it may never show up again. There’s nothing you need to worry about.” She said before ending the call.

She offered no suggestions with regard to telling my current or future partners. She did not inquire about my state of mind.

She did not tell me that more than one out of six people test positive for herpes in the United States. She did not discuss potential outbreak triggers.

“There’s nothing you need to worry about.”

Thankfully, I was already very familiar with herpes, so the diagnosis didn’t jar me as much as it could have.

And in case you’re wondering, yes, I was in a relationship at the time. Which meant that I had to tell my partner. He listened, without making any assumptions, and he passed no judgment. He didn’t get grossed out and he did not overreact. He treated it like I had a cold or something. “Not a big deal.” To date, he has not tested positive for the virus.

The reason that I mentioned shingles at the start of this story is that shingles is also a herpes virus. It’s just a different strain. Of course, nobody shames you for having shingles, right?

And for the record, in the 5 years since my diagnosis, I have actively dated and been sexual. And I ALWAYS DISCLOSE MY STATUS.

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