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5 Conditions You Might Confuse for Genital Herpes

No one wants to discover they have herpes, especially genital herpes. And believe it or not, many people never do: An astonishing 80% of people with herpes simplex virus (refresher: HSV-1 usually causes oral herpes, while HSV-2 is usually to blame for the genital kind) never have any symptoms. The remaining 20% of cases that do bring symptoms can be—and often are—mistaken for other things.

For more on herpes, check out our Herpes Simplex Condition Center

“There are lots of asymptomatic infections and the occasional person who has a really horrible outbreak,” says Jeanne Marrazzo, MD, member of the board of the Infectious Diseases Society of America and director of the Division of Infectious Diseases at the University of Alabama at Birmingham.

Of course, you’ll want to take the necessary steps to prevent herpes, regardless of whether or not you’re infected. Condoms can reduce the risk of herpes transmission, especially for men. “In men, condoms cover the relevant portion,” says Dr. Marrazzo. “For women, it’s harder to cover everything, so condoms reduce the risk by one-third to one-half.” If you know you have herpes, you can also take medications that reduce the risk of transmission.

If you think you could have genital herpes, here’s what else might be to blame.

RELATED: Why Herpes Isn’t as Bad as You Think (and a Lot More Common)

Yeast infections

Some 75% of women will be diagnosed with a yeast infection in their lifetime, and it may be mistaken for herpes. “For women, the most common confusion is recurrent yeast infections, particularly when they infect the outer labia,” says Dr. Marrazzo. Most of the time, though, a yeast infection is just a yeast infection—and one that can be treated easily with over-the-counter meds.

If you already know you’re prone to yeast infections, “that’s probably what it is,” Dr. Marrazzo says. Warning signs that something else might be up down there include anything out of the ordinary for you, particularly “a recurrent pattern, for example every three to six months, or around stress. That’s a little bit unusual for a yeast infection,” she says. Symptoms that appear after having sex with a new partner may also signal herpes.

RELATED: Can Stress Give You a Yeast Infection?

Bacterial vaginosis

Bacterial vaginosis is basically an imbalance of the normal bacteria universe in your vagina. It’s not considered a sexually transmitted infection (STI), but it is more common in sexually active women, and it can increase your risk of contracting an STI.

Douching, vaginal deodorants, and other vaginal products seem to up the risk of BV. Like herpes, BV often has no symptoms, but when it does, you might experience vaginal discharge, pain, itching or burning, and a fishy odor. The external skin itching and discomfort are what many people mistake for herpes. Bacterial vaginosis is treated with antibiotics.

RELATED: 5 Things That Can Change the Way Your Vagina Smells

Trichomoniasis

Trichomoniasis is a sexually transmitted infection, one caused by a small parasite. Like both herpes and bacterial vaginosis, the infection often has no symptoms. When it does have symptoms, they can also be mistaken for herpes: itching, burning, and redness in the genital area; difficulty urinating; and vaginal discharge. It’s easily treated with medication.

But don’t assume that a discharge in particular is a sign of an STI like trichomoniasis or herpes. “The reality is most people having an increase in discharge are just experiencing cyclic changes with hormones,” says Dr. Marrazzo. “What’s not normal is an abnormal odor. That goes with bacterial vaginosis or trichomoniasis.”

RELATED: 4 Questions You Probably Have About Dating With Herpes

Syphilis

Once practically a death sentence, today the STI syphilis is easily cured with antibiotics like penicillin. Initial symptoms of syphilis (called primary syphilis) are one or more sores in or near the genitals, anus, or rectum that might be mistaken for herpes. Generally, the sores are round and firm, but they don’t hurt.

Once syphilis has progressed to the next stage (secondary syphilis), symptoms can include a skin rash as well as swollen lymph nodes and a fever as your body tries to fight the infection. Sometimes there are no symptoms in these first two phases, or the symptoms are tame enough to go unnoticed. It’s important to get syphilis treated as early as possible.

RELATED: You Can’t Be on ‘The Bachelor’ if You Have This STI—but That’s a Ridiculous Rule

Urinary tract infection

A UTI is less commonly mistaken for herpes, but it can cause significant pain in the genital region. Other symptoms should tip you off that it’s a UTI and not herpes though: Look for an urgent feeling that you need to urinate; only passing a small amount of urine at a time (even though it may feel like your bladder is full); and urine that is cloudy, discolored, red, pink, or smelly. If your UTI doesn’t go away, get treatment. Untreated infections can affect your bladder and kidneys

RELATED: 9 Home Remedies for Preventing and Treating UTIs

Frequently Asked Questions About Herpes

  • What is herpes?
  • Where does the herpes virus live in the body?
  • How common is genital herpes?
  • What if I don’t have lesions?
  • Can I spread genital herpes?
  • What are the symptoms of genital herpes?
  • I had lesions when I was evaluated, but my culture was negative. Does this mean that I don’t have herpes?
  • What are the different types of herpes?
  • Can herpes be transmitted by oral sex?
  • Can herpes be transmitted to other parts of my body?
  • Can genital herpes be treated?
  • Can treatment help prevent multiple herpes outbreaks?
  • Are there any side effects from the medications?
  • Can the drugs be used safely during pregnancy?
  • Can I be treated to prevent transmission to my partner?
  • Can I get herpes sores on other parts of my body?
  • Is herpes related to shingles?
  • Is herpes infection related to HIV?
  • I have cold sores in my mouth. Can I still get genital herpes?
  • This is the first outbreak I’ve had of genital herpes. When did I become infected?
  • I’m worried about recurrences.
  • Are condoms protective?
  • Do I have to use condoms forever?
  • What do I tell my partner?
  • Is there any resistance?
  • I’m thinking about becoming pregnant. What should I do?
  • I have herpes simplex, but my partner does not. Can I do anything besides use condoms in order to prevent transmission?

What is herpes?

Genital herpes is an infection caused by the herpes simplex virus. There are two types of herpes simplex viruses: herpes simplex type I and herpes simplex type II. Both can be transmitted by vaginal intercourse, oral sex and rectal intercourse.

Herpes simplex infections are characterized by three phases: an initial infection; latency, when the viral infection shows no symptoms; and recurrence. Recurrences are when an individual has repeated outbreaks, often at a substantial time after the initial infection occurs.

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Where does the herpes virus live in the body?

The herpes simplex viruses are latent. After the initial infection, the virus gets into the nerve roots and spreads to the sensory nerve ganglia. The ganglia are the nerve junctions in which nerves from different parts of the body come together. For the genital area, the ganglia are adjacent to the spinal cord in the lower back. For orofacial herpes (cold sores), the ganglia are located behind the cheek bone.

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How common is genital herpes?

Genital herpes is caused by herpes simplex type II. According to the Centers for Disease Control (CDC), approximately 40 to 50 million adults in the United States have genital herpes. HSV II infection is more common in women, but also is common in persons who have had more than five sex partners. Most people with HSV II do not know they have it, because it is asymptomatic and shows no symptoms.

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What if I don’t have lesions?

Most people with genital herpes don’t have lesions. Typical lesions with herpes are vesicles (little blisters) which then progress to genital ulcers (open sores). Many people don’t realize they have genital herpes and often find out when they have a serological exam.

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Can I spread genital herpes?

Individuals infected with HSV I and HSV II genital infections can spread it to their sex partners. Typically, the likelihood of spreading the infection from one partner to another is highest when genital ulcers or blisters are present. However, transmission during the asymptomatic period is extremely common as well. It is estimated that one to three percent of individuals with asymptomatic genital herpes are shedding the virus at any particular time. If you have sexual intercourse with an individual during that period, you have the risk of transmitting or acquiring the infection.

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What are the symptoms of genital herpes?

The symptoms of genital herpes are typically non-specific and quite mild. In the classic case, individuals have grouped blisters or genital ulcers. These burn and can be painful. Often–prior to the development of the lesions–patients describe a prodrome. A prodrome is a burning sensation in the area where the lesions will develop. This can be accompanied by a burning sensation during urination, itching or discomfort in the genital area.

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I had lesions when I was evaluated, but my culture was negative. Does this mean that I don’t have herpes?

One of the biggest problems in diagnosing genital herpes is test sensitivity. There are a number of reasons why cultures can be negative, one being that the disease may be caused by something other than herpes. Cultures also can test negative if the samples are not taken appropriately, if there is a long transport time between the clinic and the laboratory, or if cultures were taken late in the course of the lesions. Lesions that occur early in the course of a herpes outbreak are much more likely to have positive cultures than cultures taken after the lesions crust over.

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What are the different types of herpes?

There are two types of herpes simplex virus: HSV I and HSV II. HSV I is the cause of oral herpes, or cold sores. This is usually acquired as an upper respiratory tract infection during early childhood. HSV II is the cause of most cases of genital herpes. However, it is possible for HSV I to cause genital herpes and HSV II to cause oral herpes.

Clinicians cannot tell the difference between the two types by physical examination alone. The importance of understanding the different types, however, is in the area of prognosis. For example, genital herpes caused by HSV II is much more likely to cause recurrence later. This diagnosis can be helpful in establishing a health-care plan for an individual patient.

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Can herpes be transmitted by oral sex?

Genital herpes can be transmitted by oral sex and can be caused by HSV I or HSV II. The transmission of herpes can occur in the absence of lesions and during asymptomatic shedding. This is one of the reasons why the population of patients with genital herpes caused by HSV I is thought to be increasing.

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Can herpes be transmitted to other parts of my body?

If you have genital herpes or orofacial herpes, you cannot transmit the infection to another part of your body after the initial infection occurs. If you have genital HSV II, you will not get HSV II at another site in your body. The body produces antibodies that protect other parts of your body from infection. However, there are cases where an individual has multiple site infections from the same virus. This is usually acquired at the time of the initial infection. For example, if an individual has oral and genital sex with an infected partner, they can acquire the infection at both sites because they are susceptible at that time.

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Can genital herpes be treated?

Genital herpes can be easily treated with drugs that inhibit viral replication. Commonly used medications are acyclovir, famciclovir and valacyclovir. Treatment can reduce symptoms, the number of outbreaks and viral replication. Treatment does not cure the virus.

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Can treatment help prevent multiple herpes outbreaks?

Suppressive therapy can provide coverage for individuals who have frequent outbreaks. During therapy, an individual with frequent outbreaks takes a small dose of anti-herpes medication every day. It has been proven that suppressive therapy can reduce the number of outbreaks by over 90 percent. Patients have taken suppressive therapy for long periods of time, but in most cases, patients can be weaned from it.

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Are there any side effects from the medications?

The medications used to treat herpes have extremely low side effects. There are no major complications associated with these medications.

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Can the drugs be used safely during pregnancy?

The medications used to treat genital herpes have been safely used during pregnancy. The Centers for Disease Control (CDC) conducted a study of over 800 pregnant woman and their infants. The study found that women who were on medications early in their pregnancy had no increased incidence of fetal abnormalities or side effects.

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Can I be treated to prevent transmission to my partner?

If a couple is dichotomous–one partner is documented to have herpes and the other partner is documented to be uninfected–then therapy can be used to prevent transmission. By treating the infected partner with suppressive therapy, transmission of symptomatic herpes can be prevented in over 90 percent of cases. This is an option for couples who are interested in having unprotected sex or who are planning to become pregnant.

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Can I get herpes sores on other parts of my body?

Patients with genital herpes have infection of the nerve roots that supply those areas. The same nerve roots, commonly called L-4, L-5 and S-1, are located at the base of the spinal cord. They also innervate the rectal area, buttocks and lateral aspect of the thigh. In some cases, patients with genital herpes will have lesions and outbreaks at any of these areas, which are not a result of direct inoculation of the virus. These outbreaks can be part of the typical herpes outbreak.

Occasionally, patients can get herpes lesions at distant parts of their body. This is more common in immunocompromised patients. Outbreaks can occur in the trunk, arms or legs. This is a very serious condition called disseminated herpes and should be addressed immediately with your health-care provider.

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Is herpes related to shingles?

Shingles is also called herpes zoster. It is caused by the varicella zoster virus (VZV), which causes chickenpox earlier in life. The natural history of varicella zoster infection is similar to genital herpes infection in that VZV also becomes latent in the sensory nerve roots. Later in life the virus may exit, causing a recurrence.

Recurrences in shingles are typically characterized by appearance of vesicles and blister lesions in a single dermatome. This is a distribution in the nerve roots supplied by that segment of the spinal cord and is usually seen on one side of the body. Shingles is not a sexually transmitted infection and is independent from genital herpes.

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Is herpes infection related to HIV?

Herpes and HIV are caused by different viruses; however, patients infected with these viruses are more likely to transmit either disease to their sexual partners. Patients with herpes are more susceptible to acquiring HIV. Individuals newly diagnosed with herpes should be tested for HIV infection and other sexually transmitted infections.

Herpes and HIV are caused by different viruses; however, patients infected with these viruses are more likely to transmit either disease to their sexual partners. Patients with herpes are more susceptible to acquiring HIV. Individuals newly diagnosed with herpes should be tested for HIV infection and other sexually transmitted infections.

Patients who are infected with both herpes and HIV also may have higher HIV viral loads related to the interaction between the herpes virus and the HIV virus. When an individual becomes immunosuppressed from HIV, they may be more likely to shed herpes simplex virus asymptomatically.

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I have cold sores in my mouth. Can I still get genital herpes?

Cold sores are usually caused by HSV I. Individuals who have HSV I are susceptible to becoming infected with HSV II, the common cause of genital herpes. If you have cold sores, you are still at risk for getting genital herpes from HSV II.

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This is the first outbreak I’ve had of genital herpes. When did I become infected?

This is a difficult question. Initial outbreaks are often asymptomatic for most individuals. The only way to differentiate whether this is your first outbreak or if this is a recurrence of a prior asymptomatic infection is to perform a serological test. However, if the serology indicates that you have become infected in the past, it cannot tell you at what point in time you became infected.

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I’m worried about recurrences.

Patients with genital HSV II infection often have recurrences. Patients can detect the beginning of a recurrence because they develop symptoms, such as burning or itching. When an individual suspects a recurrence, they begin taking anti-herpes medications that alleviate symptoms and decrease the duration of the recurrence. Women often report that recurrences are most common immediately before they get their period.

Recurrent genital herpes is most common in the first year after the initial infection and decreases as time goes on. In many cases, patients may be candidates for suppressive therapy.

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Are condoms protective?

Condoms have been proven to prevent transmission of herpes simplex between partners in over 90 percent of cases where they are used consistently.

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Do I have to use condoms forever?

If you want to prevent transmission of herpes simplex between partners, we recommend that condoms be used 100 percent of the time. Many patients will shed the virus asymptomatically. Careful studies have shown that asymptomatic shedding occurs between one and three percent of the time in patients who have had previous HSV II genital infections. A large portion of new herpes infections occur from partners who are shedding the virus asymptomatically. Because of this, it is highly recommended that patients have protected sexual intercourse.

Condoms may not be an attractive option for monogamous couples or for couples who desire to become pregnant. Couples may opt to have serological tests that will determine whether or not both partners have asymptomatic infection. In close monogamous relationships, the risks of transmission can be weighed against other relationship issues such as intimacy. Couples may decide that the risk of transmission may be something that they want to consider.

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What do I tell my partner?

If you are entering into a relationship and are aware that you have herpes simplex infection, you owe it to your partner to notify them prior to initiating sexual intercourse.

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Is there any resistance?

Medications that are used to treat herpes are acyclovir, famcyclovir, and valacyclovir. Resistance to these drugs–even after 20 years of use–is very rare. Generally, resistance occurs in situations where the patient is profoundly immunosuppressed and has been treated with these drugs for a prolonged period of time. While there is very little resistance in the community, an individual’s response to treatment may vary. In some cases, patients may need more drugs to suppress their viral outbreaks than others.

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I’m thinking about becoming pregnant. What should I do?

Pregnancy is a major concern for all women who have herpes. The major risk is transmitting herpes to the newborn infant, which can cause neonatal herpes. In understanding the risk of transmission, there are several principles which are important.

  1. Transmission of herpes from a mother infected with herpes simplex type II prior to pregnancy to a newborn infant is extremely rare and occurs only when there are visible lesions at the time of delivery.
  2. The greatest risk of transmission of herpes from the mother to the baby is when a primary herpes infection occurs during the last trimester. Based on these principles, there are several strategies which are available, depending on the status.
    1. If the mother is previously known to be infected with herpes simplex type II infection, then the risk of transmission is related to presence of lesions at the time of delivery. No additional intensive screening of the mother or newborn is required. If there are open visible herpes lesions at time of delivery, then the recommendation is for caesarian section. Otherwise, normal vaginal delivery is recommended.
    2. If the mother continues to have herpes simplex recurrences during her pregnancy, then anti-viral treatment during pregnancy can be used. Acyclovir is extremely safe during pregnancy. A large CDC registry study conducted in cooperation with the manufacturer found that women who used acyclovir early in their pregnancy had no increased incidence of fetal abnormalities or side effects.
    3. If the mother has no history of HSV, but her husband/partner does, then there is major concern over whether transmission would occur from the infected male partner to the woman during pregnancy. It is important to document the serological status of both partners during the pregnancy. Sexual activity can continue during pregnancy; however, if discordance is demonstrated, (i.e. the male partner is HSV II seropositive and the pregnant mom is seronegative), then measures to limit transmission during pregnancy need to be implemented. These can include:
      1. Abstinence during pregnancy
      2. 100 percent condom use
      3. Preventive therapy to prevent transmission, such as treating the male partner with antiviral medications in order to prevent transmission

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I have herpes simplex, but my partner does not. Can I do anything besides use condoms in order to prevent transmission?

In this case, there is an option to take suppressive therapy in order to prevent transmission. A large study demonstrated that in discordant couples, treatment of the infected partner–even when that partner was asymptomatic–reduces transmission of symptomatic herpes to the uninfected partner by over 90 percent.

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Herpes simplex virus

Treatment Approach

There is no cure for herpes, so the goals of treatment are to reduce the number of outbreaks and to lessen symptoms when you do have an outbreak.

Cold sores usually go away by themselves within 2 to 3 weeks, however, they can last for up to 6 weeks. Using medications may shorten the outbreak and decrease discomfort.

Antiviral medications for genital herpes can reduce outbreaks and help speed recovery when an outbreak does happen. They can also reduce the chances of spreading the virus.

Coping with the emotional and social aspects of having genital herpes is part of treatment. Relaxation techniques and support groups can help.

Lifestyle

For cold sores, applying either heat or cold to blisters may help relieve pain. Try ice or warm compresses.

For genital herpes, wear cotton underwear and avoid tight fitting clothes as they can restrict air circulation and slow the healing of lesions.

Be sure to tell your partner or potential partner that you have herpes.

Medications

Antiviral medications may help shorten the length of a herpes outbreak and cut down on recurring outbreaks. These treatments can reduce outbreaks by up to 80%. For genital herpes, there are two types of therapy:

  • Episodic
  • Suppressive

With episodic therapy, you take medication at the first sign of an outbreak and for several days to shorten the length or prevent a full outbreak. With suppressive therapy, you may take medication daily to keep outbreaks from happening. Antiviral medications include:

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

Topical medications (for oral herpes), include the antiviral cream Penciclovir (Denavir) and an over-the-counter cream, docosanol (Abreva).

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider.

  • Lysine. Several studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores. A few studies also suggest that lysine may help shorten the length of an outbreak. Taking lysine supplements or getting more lysine in your diet (from foods like fish, chicken, eggs, and potatoes) may speed recovery and reduce the chance of recurrent breakouts of the herpes infection. If you have high cholesterol, heart disease, or high triglycerides (fats in the blood), ask your doctor before taking lysine because animal studies suggest that it may raise cholesterol and triglyceride levels. Lysine can increase the amount of calcium your body absorbs, so avoid high doses of calcium while taking lysine. Usually high doses of lysine are taken only for a short time.
  • Propolis. A resin made by bees, propolis is loaded with antioxidants that help fight infection and boost immune function. Test tube studies show it can stop HSV-1 and HSV-2 from reproducing. One small study of people with genital herpes compared an ointment made from propolis to Zovirax ointment. People using propolis saw the lesions heal faster than those using topical Zovirax. In another study, a 3% propolis ointment helped reduce the duration and pain or cold sores in some people. More studies are needed to say for sure whether propolis works. People with asthma and those allergic to bee products should not use propolis.
  • Zinc. In test tubes, zinc is effective against HSV-1 and HSV-2. In one small study, people who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream. In another study, people who used a proprietary topical formulation with zinc oxide, l-lysine, and 14 other ingredients saw a decrease in symptoms and duration of lesions. High doses of zinc can be dangerous. Zinc may interact with some antibiotics and with cisplatin, a chemotherapy drug.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.

  • Lemon balm (Melissa officinalis). Several studies suggest that topical ointments containing lemon balm may help heal cold sores. In one study, for example, people who applied lemon balm cream to their lip sores saw a reduction in redness and swelling after 2 days.
  • Aloe (Aloe vera). Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men. In 2 studies, men who used the aloe vera cream (0.5% aloe) saw lesions heal faster than those who used a placebo cream. It is not known whether aloe vera would also help heal cold sores.
  • Rhubarb cream (Rheum palmatum). In one Swiss study, a topical cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores. Sage by itself was not beneficial. More research is needed.
  • Eleutherococcus or Siberian ginseng (Eleutherococcus senticosus/Acanthopanax senticosus.). Although not all studies agree, one 6-month study of 93 people with genital herpes found that Siberian ginseng reduced the frequency, severity, and duration of outbreaks. People with high blood pressure, certain heart conditions; diabetes; obstructive sleep apnea; hormone-related cancers such as breast cancer, ovarian cancer, or uterine cancer; narcolepsy (frequent day time sleeping); mania; or who are pregnant or breastfeeding should not take Siberian ginseng. Siberian ginseng interacts with a number of medications, including digoxin (Lanoxin), lithium, diazepam (Valium), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), imipramine (Tofranil), olanzapine (Zyprexa), propranolol (Inderal), theophylline (Slo-bid, Theo-Dur, others), lithium, and others. Siberian ginseng can increase the risk of bleeding, especially if you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
  • Peppermint oil (Mentha x piperita). In test tubes, peppermint oil has stopped a number of viruses from reproducing, including herpes. However, it is not known whether peppermint oil, applied topically, would have any effect on the herpes virus in humans.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the remedies described below for the treatment of herpes based on their knowledge and experience. One study of 53 people with genital herpes found that those who were treated with homeopathy experienced improvement in their symptoms and were less likely to have recurrent outbreaks. Participants in this study were followed for up to 4 years.

Before prescribing a remedy, homeopaths take into account a person’s constitutional type. A constitutional type is defined as a person’s physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

For cold sores:

  • Natrum muriaticum. For eruptions at the corners of the mouth that occur during periods of emotional stress and tend to worsen in the daytime.
  • Rhus toxicodendron. For eruptions consisting of many small blisters that itch intensely at night.
  • Mercurius. For children who drool and may have a fever.
  • Sepia. For outbreaks that do not improve with other homeopathic remedies. This remedy is most appropriate for individuals who tend to have a lack of energy and do not tolerate cold weather.

For genital lesions:

  • Graphites. For large, itchy lesions in individuals who are overweight.
  • Natrum muriaticum. For eruptions that occur during periods of emotional stress and symptoms that tend to worsen in the daytime.
  • Petroleum. For lesions that spread to anus and thighs. Symptoms tend to worsen in winter and improve in summer.
  • Sepia. For outbreaks that do not improve with other homeopathic remedies. This remedy is most appropriate for individuals who tend to have a lack of energy and do not tolerate cold weather.

Mind-Body Medicine

  • Support groups. Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom you want to be intimate is also common. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. If you are in a committed relationship, seeing a couples’ therapist with your partner may also help.
  • Relaxation techniques. Using relaxation techniques, such as yoga, guided imagery, and meditation may help you feel better overall and cope with stresses related to having herpes.
  • Self hypnosis. Self hypnosis using guided imagery may also help relieve stress. In one 6-week training program, people with frequently recurring genital herpes were able to reduce outbreaks by nearly 50% and improve their mood, including reduced feelings of depression and anxiety.
  • Other. Individual therapy with a psychiatrist, psychologist, or social worker; and techniques such as biofeedback can help reduce emotional symptoms associated with herpes.

Cervical Infection with Herpes simplex Virus, Chlamydia trachomatis, and Neisseria gonorrhoeae among Symptomatic Women, Dubai, UAE: A Molecular Approach

Abstract

Tragically, genital tract infections are still a major public health problem in many regions. This study was undertaken to determine the prevalence of cervical infection with Herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) among married women referring to Iranian Hospital, Dubai, UAE. In a retrospective cross-sectional survey, 201 female patients aged 16–80 years who referred to the Obstetrics and Gynecology Department of Iranian Hospital, Dubai, UAE, in 2010 were enrolled. The patients were categorized into three age groups: 15–30 (group I), 31–40 (group II), and 41 years old (group III). A cervical swab sample was collected from each woman and the prevalence of cervical infection with HSV, CT, and NG was determined by PCR method. HSV, CT, and NG were detected in 6.5%, 10.4%, and 5.5% of swab samples, respectively. Regarding age, a significant difference was noticed for prevalence of NG and HSV between groups I and III. Because of public health importance of sexual transmitted diseases (STDs), their long-lasting impact on quality of life, and their economic burden, preventing measures and education of women seem necessary.

1. Introduction

Tragically, genital tract infections are still a major public health problem in many regions . Annually in the United States, more than 15 million new cases of sexually transmitted diseases (STDs) were reported . Among females, some of them may lead to long-term pelvic inflammatory diseases, infertility, ectopic pregnancies, dyspareunia, and cervical cancer . Every year, more than half of all new cases of STDs occur in young individuals between 15 and 24 years . In addition, in young and adolescent women, they may result in depression, low social support, and prominent stress .

The majority of STDs such as Herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) were shown to be asymptomatic in women . Genital Herpes is generally considered as a common chronic STD in both developed and developing countries with substantial morbidity . The infection is caused by two types of virus including HSV-2 (mainly) and HSV-1 (sometimes) while their prevalence and incidence have increased in the past three decades .

CT infection is the most frequent cause of bacterial STD in the world, especially in young women . The infection is asymptomatic in most cases and can be transmitted during vaginal, oral, or anal sexual contact and can be passed by the mother to newborn too .

Gonorrhea is caused by NG and this pathogen was demonstrated to have the potential to develop resistance to frequently used antimicrobial agents, especially in uncured patients. These cases may continue to transmit and facilitate the rapid emergence of antimicrobial resistance . The incidence rate of the disease is high; therefore diagnosis of both symptomatic and asymptomatic infections is of great importance .

In recent years, rapid detection kits and dipsticks have been used as common, convenient, and fast methods of screening for STDs. However, new molecular methods such as PCR, qualitative and quantitative real time PCR, and DNA hybridization were introduced as more reliable techniques in diagnosis of a wide variety of STDs in comparison to serological methods. Moreover, monitoring of DNA level of a pathogen in body fluids can reveal the status of the disease, its response to medication, and its resistance patterns .

In Dubai, UAE, the individuals’ lifestyle has changed. In addition, many migrant workers or investors were attracted from more than 100 countries from Asia, Africa, Europe, and so forth to this city. As Dubai is the 8th most visited city in the world by tourists and was shown to attract more than 15 million tourists from various countries till 2015, therefore, STDs can be an emerging public health concern in Dubai, UAE. Screening of STDs in Dubai population can be the first and very critical step of managing a public health problem. The objective of this study was to determine the prevalence of cervical infection with HSV, CT, and NG among married women referring to Iranian Hospital, Dubai, UAE.

2. Subjects and Methods

2.1. Study Population

The study involved 201 female patients aged 16–80 years old ( years) who referred to Obstetrics and Gynecology Department of Iranian Hospital, Dubai, in 2010 with symptoms such as itching in genital area, dyspareunia, dysuria, or abnormal vaginal discharges. The patients were from different nationalities (Table 1) and all of them were married. The patients were categorized into three age groups: 15–30 (group I), 31–40 (group II), and ≥41 years old (group III). A cervical swab sample was collected by sterile swabs from all patients and was transferred in a viral transport medium to the Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz, Iran, for further investigation. The study was approved in Office of Education and Research of Iranian Hospital, Dubai.

Country Number Percent
Iran 82 40.8
Indonesia 2 1.0
Philippines 15 7.5
UAE 25 12.4
Egypt 8 4.0
Oman 7 3.5
Canada 1 0.5
France 2 1.0
India 9 4.5
Jordan 3 1.5
Pakistan 5 2.5
Syria 3 1.5
Afghanistan 6 3.0
China 2 1.0
Ethiopia 2 1.0
Sri Lanka 1 0.5
Lebanon 1 0.5
Thailand 1 0.5
Nigeria 3 1.5
Somalia 3 1.5
Iraq 5 2.5
Russia 2 1.0
Togo 1 0.5
Congo 1 0.5
Uzbekistan 1 0.5
Sweden 1 0.5
Australia 2 1.0
Algeria 2 1.0
Bangladesh 1 0.5
USA 1 0.5
Morocco 1 0.5
Sudan 2 1.0
Total 201 100

Table 1 Different nationalities of studied population enrolled for detection of Herpes simplex virus, Chlamydia trachomatis, and Neisseria gonorrhoeae infection among married Women, Dubai, UAE.

2.2. DNA Extraction

DNA was extracted from swab samples in 200 μL of viral transport medium by Invisorb spin virus DNA Mini Kit (Invitek, Berlin, Germany) according to the manufacturer’s protocol. For detection of CT, a standardized amount of internal control DNA, supplied with the real time PCR kit, was added to the lysis buffer kit to monitor the efficiency of extractions. Negative and positive controls were included in the extraction process.

2.3. Real Time Quantitative PCR for Detection of HSV and CT

The real time quantitative PCR was performed using oligonucleotide primer pairs and probes specific for the region of HSV1 and HSV2 glycoprotein B (gB), as reported previously . The primers used were HSVFP (5′TCC CGG TAC GAA GAC CAG3′) and HSVRP (5′AGC AGG CCG CTG TCC TTG3′), and the probe was HSVTCP (5′FAMTGG TCC TCC AGC ATG GTG ATG TTG/C AGG TCGTAMRA3′). The reaction was carried out with the following protocol: 2 min of incubation at 50°C for AmpErase activation, 10 min at 95°C for polymerase activation and for 45 cycles, 15 seconds at 94°C for denaturation, and 60 seconds at 58°C for annealing, extension, and data collection. Each 50 μL of PCR mixture contained 10 μL of purified DNA, 840 nM concentration of each primer, and 100 nM probe in 1x TaqMan universal PCR master mix (Applied Biosystems, Branchburg, New Jersey, USA).

For detection of CT, a real time quantitative PCR was carried out with oligonucleotide primer pairs and probe specific for CT genome by Advanced Kit (PrimerDesign Ltd., Millbrook Technology Campus, South Hampton, UK). Amplification was performed using TaqMan universal real time PCR master mix reagents (Roche, Branchburg, New Jersey, USA). It was done with the following four steps protocol: 2 min of incubation at 50°C for AmpErase activation, 10 min at 95°C for polymerase activation and for 45 cycles, 10 seconds at 95°C for denaturation, and 60 seconds at 60°C for annealing, extension, and data collection.

All amplifications were carried out in an Applied Biosystem Sequence Detector 7500 machine (Applied Biosystems, USA). Negative controls were included in the extraction process between every 20 clinical samples. All of the negative samples were tested twice.

2.4. Detection of NG

NG was detected with a PCR detection kit (CinnaGen Inc., Iran) according to the manufacturer’s protocol. The reaction mixture was heated at 94°C for 3 min and then incubated for 35 cycles of 94°C for 45 seconds, 50°C for 20 seconds, and 72°C for 30 seconds and for 5 min at 72°C for an additional extension. The PCR products were analyzed on 1% agarose gel.

2.5. Statistical Analysis

Differences in prevalence of HSV, CT, and NG between age groups were analyzed with chi-square test. Moreover, the association between HSV, CT, and NG and the occurrence of fungal-bacterial cervical infection were analyzed with chi-square test. The entire data were analyzed by SPSS software (SPSS for Windows, version 16, SPSS Inc., Chicago, IL, USA). All values of were considered statistically significant.

3. Results

Candida spp. and Coccobacilli cervical infection were considered as fungal-bacterial infection with a prevalence of 45.3% and non-fungal-bacterial infection with a prevalence of 54.7%. HSV and CT were positive in 13 (6.5%) and 21 (10.4%) swab samples, respectively. The copy number of HSV DNA measured by the real time PCR assay ranged from 3.11 × 103 to 7.18 × 105 copies/mL in the viral transport medium (median of 4 × 104 copies/mL) and CT DNA copy number ranged from 3.48 × 103 to 7.11 × 106 copies/mL in the viral transport medium (median of 3.33 × 105 copies/mL). NG was detected in 11 (5.5%) patients.

Table 2 presents the prevalence of the diseases in different age groups. None of the patients had mixed infections. There were no significant differences in prevalence of CT between different age groups (). The prevalence of NG and HSV was not significantly different between groups I and II and II and III (); however, there were significant differences between groups I and III (). Moreover, the differences in prevalence of HSV, CT, and NG infections were not statistically significant between fungal-bacterial cervical infection group and non-fungal-bacterial group (). Table 3 compares our data in Dubai, UAE, for prevalence of HSV, CT, and NG with different studies.

Table 2 Prevalence of Herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) in different age groups among married Women, Dubai, UAE. Table 3 Comparison of our data in Dubai, UAE, for prevalence of Herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) with different studies.

4. Discussion

In the current study, out of 201 women, 6.5%, 10.4%, and 5.5% were infected with HSV, CT, and NG, respectively. Our present findings on HSV, CT, and NG infection are consistent with previous surveys on the prevalence of STDs. More recently, similar survey found HSV-2 DNA in 7% of 509 women in the USA . Earlier study in Turkey showed that 12.7% of the low risk women were infected with CT . Gaydos et al. reported that 3.8% of their female studied populations were infected with NG .

Previous literatures indicated that the majority of HSV, CT, and NG infections may be asymptomatic and with a long-term duration . Similarly, in the present study, none of the women was aware of her infection before undergoing screening; however, some clinical symptoms were visible. Prevalence of STDs was consistently more in high risk populations compared with those considered at a lower risk. Commonly cited risk factors associated with STDs include unmarried status and multiple sexual partners . In Amsterdam, The Netherlands, the highest prevalence of HSV-1 or HSV-2 was noticed in the youngest age groups while teenagers and adults in the twenties had a prevalence of 5.26% and 4.31%, respectively . In Peru, the prevalence of infection in women with CT infection was 6·5%, and with NG infection was 0·1% . In South Korea, the overall detection rate for CT was 2.4% and for HSV type II was 0.8% . In Tunisian female sex workers, CT, NG, and HSV-2 PCR were positive in 72.9%, 11.2%, and 1.1% of women, respectively .

Although previous studies have shown that young age is associated with positive results for CT, there are some surveys that reported no correlation between age and the prevalence of disease . Similarly, our findings showed that there was no significant difference in prevalence of CT between different age groups.

Various studies showed that HSV prevalence consistently increased with age in most geographic areas . As expected, the results of the present study indicated that the prevalence of HSV was significantly higher in group III when compared with group I. A similar study in Bangladesh revealed that the prevalence of HSV-2 antibodies was low among married women younger than 20 years old . Consequently, this prevalence increased with age which might be related to the duration of sexually active years in women.

In contrast, our findings demonstrated that the prevalence of NG decreased with age and there was a significant difference in prevalence of the infection between groups I and III and the infection was more prevalent in young women. This result is inconsistent with another study . In Nigeria, NG infection was more common in women at age of 25 .

A study in China among female sex workers demonstrated that 8% of the studied populations were infected with NG which was near to the rate of infection in young women. Although all of the women in the present study were married and they did not have sexual relationships outside the family, the prevalence of STDs in these patients was high. However, the sexual relationship of the partner needs to be evaluated. Earlier survey in France indicated that among 111 asymptomatic male partners of infertile couples, CT was detected by the PCR COBAS AMPLICOR and serology tests in 6.3% and 4.5% of patients, respectively . Therefore, it seems that monitoring of sexual partners is essential for prevention of STDs.

Fungal-bacterial cervical infection was found in 45.3% of the studied population, but there were no significant differences in prevalence of HSV, CT, and NG infections between fungal-bacterial cervical infection group and non-fungal-bacterial one. It was shown that mixed infections with bacterial or fungal vaginosis and STDs may happen such as HSV, CT, NG, and T. vaginalis . Additional investigations are needed to evaluate comprehensively the role of bacterial and fungal cervical infection in the pathogenesis of HSV, CT, NG, and other STDs. Monitoring the prevalence and incidence of STDs among the population and especially among youngsters would help the governmental authorities to perform and evaluate the preventive strategies and efforts. Because of considerable and long-lasting impact of STDs on quality of life and the economic loss of STDs due to high medical costs, there is a need for an accurate evaluation of STDs all over the world. Jerman et al. reported that 1.1 million new cases of STDs occurred among young patients in California in 2005, with a direct medical cost of 1.1 billion US$ . Moreover, symptomatic STDs are merely the tip of the iceberg and most of these diseases are asymptomatic. So screening programs on STDs are important in all countries to prevent the transmission of the disease and help the scientists to plan for new treatment protocols. Because of public health importance of STDs, preventing measures and education of women seem necessary.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Acknowledgment

The authors appreciate the Iranian Hospital cooperation especially the Departments of Pathology and Obstetrics and Gynecology.

Is It a Rash or Is It Herpes?

Herpes

If you have “wet looking” fluid-filled blisters in the vicinity of your mouth or genitals, chances are you’ve been infected with the herpes virus. When popped, the sores will crust over.

There are two types of herpes:

  • HSV-1 (Herpes simplex virus type 1) causes sores (cold sores or fever blisters) around the mouth and lips.
  • HSV-2 (Herpes simplex virus type 2) causes sores around the genitals.

Although many people with the herpes virus never experience noticeable symptoms, the most common symptoms include:

  • fluid-filled blisters
  • itching, burning skin before the sores appear
  • flu-like symptoms
  • discomfort while urinating

Rashes

A rash is an inflammation of the skin caused by a number of factors ranging from skin irritants to sickness. Rashes are commonly identified by symptoms including:

  • redness
  • swelling
  • itching
  • scaling

The symptoms of specific rashes are typically different from herpes, even though they might appear in similar areas of the body. Common conditions that may cause a skin rash include:

Dermatitis

Dermatitis is a skin condition that causes red, itchy, flaky skin. There are two types of dermatitis: contact and atopic.

Contact dermatitis is a rash that appears after your skin touches an irritant, such as a perfume or chemical. You’ll notice a rash appear where you touched the irritant, and blisters may also possibly form. A rash after exposure to poison ivy is one example of contact dermatitis.

Atopic dermatitis is also known as eczema. It’s a rash that occurs after exposure to an allergen. Symptoms include thick, scaly, red patches of skin across the body.

Unlike herpes, dermatitis can occur anywhere on the body. Contact dermatitis will likely go away after exposure to the irritant has stopped and the skin is cleaned with a mild soap. Atopic dermatitis can be prevented by moisturizing the skin and avoiding triggers like hot showers and cold weather.

Shingles

Shingles is a painful skin rash that is believed to be caused by the same virus that causes chicken pox — the varicella-zoster virus. Although shingles symptoms often include itching, fluid-filled blisters like herpes, the blisters usually appear in a band or in a small area on one side of a person’s face, neck, or body along with an angry rash.

  • Treatment for shingles. There is no cure for shingles, but there are antiviral drugs such as Acyclovir (Zovirax) or Valacyclovir (Valtrex) that your doctor may prescribe to shorten healing time and reduce your risk for complications. Your doctor may also prescribe pain medication such as the topical numbing agent, lidocaine.

Jock itch

Jock itch is a fungal infection that typically looks like a red rash with a few small blisters near the edge of the rash. Unlike herpes, these blisters typically do not crust over. Also, herpes blisters often appear on the penis, while the rash associated with jock itch typically appears on the inner thighs and groin, but not the penis.

  • Treatment for jock itch.Jock itch is often treated with two to four weeks of washing with an antifungal shampoo and the application of a topical antifungal cream.

Scabies

Scabies is a highly contagious skin infection caused by the Sarcoptes scabiei mite that burrows into your skin to lay eggs. While herpes is typically found in the mouth and genital area, scabies can be found anywhere on the body. A scabies infestation appears as redness or a rash, sometimes showing signs of small pimples, bumps, or blisters. Sores may appear when the area is scratched.

  • Treatment for scabies.Your doctor will most likely prescribe a scabicide topical lotion or cream to kill the scabies mites and their eggs.

Genital warts

Resulting from infection from the human papillomavirus, genital warts are typically flesh-colored bumps that resemble cauliflower tops as opposed to the blisters caused by herpes.

  • Treatment for genital warts.Along with prescription topical medications, your doctor might suggest cryotherapy (freezing) or laser treatment to remove the warts. There is no cure for the human papillomavirus, so no treatment is guaranteed to remove the warts and keep them from coming back.

Razor burn

Shaving your pubic hair can often create skin irritation and ingrown hairs, resulting in red bumps that can be mistaken for herpes sores. Razor burn is an acne-like rash. Ingrown hairs look like pimples with a yellow center, while herpes sores look more like fluid-filled blisters with clear liquid.

  • Treatment for razor burn. There are a number of ways people address razor burns, ranging from over-the-counter topical creams with hydrocortisone to home remedies such as the topical application of witch hazel or tea tree oil.

Shop for hydrocortisone.

Shop for witch hazel.

Shop for tea tree oil.

PMC

Diagnosis

When the medical history is incomplete, the lesions are atypical, or a quick diagnosis is needed because the patient is immunocompromised, has severe or disseminate disease, or has incurred serious repercussions from a previous incorrect diagnosis or treatment, additional tests should be ordered to confirm the diagnosis of herpesvirus (Table 1).

Table 1.

Laboratory tests available for the diagnosis of herpesvirus infections

TEST EFFICACY
Histology or Tzanck test Screens for herpesvirus in general, but is not useful in differentiating among different types of the virus
Antibody testing Useful in the diagnosis of primary, but not recurrent, herpes infections
Tissue culture The most specific test for diagnosis; however, it is not the most sensitive and often takes too long
Immunofluorescence Quick, sensitive, and economical; it can distinguish between HSV types 1 and 2
PCR Quick, sensitive, and expensive; it can distinguish between HSV types 1 and 2, but is rarely necessary in routine practice

HSV—herpes simplex virus, PCR—polymerase chain reaction.

In patients with HSV, histology will reveal intraepidermal blistering caused by keratinocyte necrosis and grayish nuclear inclusions with a ground-glass appearance, together with chromatin margination. Multinucleated giant cells and epithelial cells containing eosinophilic intranuclear inclusion bodies can be identified with the Tzanck test. Neither test is useful in differentiating between lesions caused by HSV-1 and those caused by HSV-2. Blood tests (ie, antibody tests) are only useful in the diagnosis of primary, but not recurrent, herpes infections. In the present case, the patient was positive for HSV-2 immunoglobulin M, confirming the diagnosis of primary infection.

The criterion standard for diagnosis of an HSV infection is the isolation of the virus in tissue culture; this method can yield positive results within 48 hours of inoculation. Characteristic cytopathic effects, with ballooning of cells and cell death, are observed; immunofluorescent staining of the tissue culture cells can quickly identify HSV and can help distinguish between types 1 and 2. Viral antigen detection by direct immunofluorescence of a specimen from a fresh vesicular lesion is an economical, rapid, and sensitive diagnostic tool. Other tests examine viral genetic material using in situ hybridization or polymerase chain reaction. These tests are quick and sensitive but rarely necessary in routine practice.

The differential diagnosis for genital herpes includes syphilis, candidiasis, herpes zoster, hand-foot-and-mouth disease, chancroid, and granuloma inguinale. Primary syphilis is characterized by one or more painless, indurated ulcers occurring at the site of inoculation; chancroid ulcerations, caused by Hemophilus ducreyi, are typically painful, tender, nonindurated lesions covered with gray or yellow necrotic purulent exudates. Noninfectious conditions that can mimic genital herpes include Reiter syndrome, contact dermatitis, Crohn disease, Behçet syndrome, trauma, erythema multiforme, and lichen planus.

Oral Herpes

Whether you call it a cold sore or a fever blister, oral herpes is a common infection of the mouth area that is caused by herpes simplex virus type 1 (HSV-1). Fifty percent to 80 percent of U.S. adults have oral herpes. According to the National Institutes of Health, about 90 percent of adults have been exposed to the virus by age 50.

Once infected, a person will have herpes simplex virus for the rest of his or her life. When inactive, the virus lies dormant in a group of nerve cells. While some people never develop any symptoms from the virus, others will have periodic outbreaks of infections.

Causes of Oral Herpes

Oral herpesis spread most commonly from individuals with an active outbreak or sore. You can catch oral herpes by engaging in intimate or personal contact (e.g., kissing or oral sex) with someone who is infected.

Prevention of Oral Herpes

Since oral herpes is spread through direct, physical contact, the best method of prevention is to avoid physical contact with a person’s herpes sores when they are having an outbreak.

Oral Herpes Symptoms

The initial (primary) infection of oral herpes is usually the worst. It may cause severe, flu-like symptoms, including swollen lymph nodes and headache. However, some people have no symptoms at all. During the initial infection, sores can occur on and around the lips and throughout the mouth.

Recurring infections tend to be much milder, and the sores usually erupt on the edges of the lips. Some people never have any additional outbreaks beyond the initial infection. The following are the most common signs and symptoms of a recurring oral herpes simplex virus infection.

  • Initial redness, swelling, heat/pain or itching may develop in the area where the infection will erupt.

  • Painful, fluid-filled blisters may appear on the lips or under the nose. The blisters and fluid are highly contagious.

  • The blisters will leak fluid and become sores.

  • After about four to six days, the sores will start to crust over and heal.

The signs and symptoms of an oral herpes outbreak may look like other conditions or medical problems. Always consult your health care provider for an accurate diagnosis.

Diagnosing Oral Herpes

Since oral herpes can be confused with many other infections, including allergic reactions, a virus culture (PCR), blood test or biopsy are the only ways to confirm your diagnosis. However, your health care provider may also diagnose your condition based on the location and appearance of the blisters.

Recurrence of Oral Herpes

Although the specific triggers that cause oral herpes to recur are unclear, several factors may play a role. These include:

  • A recent fever

  • Emotional stress

  • Menstruation

  • Physical injury

  • Prolonged or intense exposure to sunlight

  • Surgery

While recurrent outbreaks are more common in the first year after the initial episode, they tend to lessen as the body builds antibodies to the virus.

Oral Herpes Treatment Options

Your health care provider will recommend treatment options based on your:

  • Age

  • Expected outcome

  • Overall health and medical history

  • Personal preference

  • Tolerance for specific medicines, procedures or therapies

Your specific treatment plan may involve:

  • Keeping the infected area clean and dry

  • Taking antiviral oral medications, such as acyclovir, famciclovir and valacyclovir (these medications are traditionally the most effective)

  • Applying antiviral topical ointments, such as acyclovir and penciclovir

  • Using over-the-counter topical anesthetics or anti-inflammatory agents to alleviate symptoms

While some people realize that they have genital herpes, many do not. It is estimated that one in five persons in the United States has genital herpes; however, as many as 90 percent are unaware that they have the virus. This is because many people have very mild symptoms that go unrecognized or are mistaken for another condition or no symptoms at all.

Because signs can vary a great deal, we recommend that an individual see a healthcare provider to be tested if they have a lesion of any kind. This can be swabbed for a culture test or for other sensitive tests.

A person may show symptoms within days after contracting genital herpes, or it may take weeks, months, or years. Some people may have a severe outbreak within days after contracting the virus while others may have a first outbreak so mild that they do not notice it. Because of these possibilities, it can be difficult for people to know when and from whom they may have contracted the virus.

The First Episode

First episodes usually occur within the first two weeks after the virus is transmitted.If you were diagnosed with genital herpes in the last few days, you may be experiencing a number of uncomfortable or painful symptoms. Or, perhaps the symptoms are rather mild, barely noticeable, and resemble an insect bite or a rash.

The “classic” symptoms that most people associate with genital herpes are sores, vesicles, or ulcers – all of which can also be called “lesions.” (The scientific literature on herpes uses the term “lesion” to describe any break or irregularity in the skin.) These classic lesions of genital herpes often resemble small pimples or blisters that eventually crust over and finally scab like a small cut. These lesions may take anywhere from two to four weeks to heal fully.

During this time, some people will experience a second crop of lesions, and some will experience flu-like symptoms, including fever and swollen glands, particularly in the lymph nodes near the groin. Headache and painful urination also sometimes accompany full-blown symptoms of first episodes.

Some people will experience a second crop of lesions or experience flu-like symptoms after their initial first episode. These symptoms include fever and swollen glands, particularly in the lymph nodes near the groin.

For many people, herpes lesions can so mild that they may be mistaken for:

  • insect bites
  • abrasions
  • yeast infection
  • “jock itch”

. . .and other conditions. In other words, the signs go unrecognized as being caused by genital herpes. Signs and symptoms can be found on the penis and vulva, near the anus, on the thigh, on the buttocks, and virtually anywhere in the genital area.

Treatment with antiviral drugs is standard during first episodes and can speed healing significantly. If you haven’t already, you may want to discuss treatment with your healthcare provider at this time.

Recurrent Genital Herpes

If you have recently made it through a first episode that consisted of full-blown symptoms, you know something about signs and symptoms already. The good news is that the first episode is almost always the worst that HSV throws your way. Signs and symptoms of recurrent episodes (when they occur) tend to be milder and heal much more quickly, typically within two to twelve days.

If the first episode produced fairly mild symptoms, then subsequent recurrences will not usually increase in severity. But, as noted earlier, when genital herpes recurs after a first episode, it doesn’t always cause recognizable signs and symptoms.

Some people have recurrent outbreaks with the so-called “classic” blister-like herpes lesions that crust over, or with painful sores. In recurrent herpes, however, this process usually takes about half the time it does in first episodes. In addition, many people have very subtle forms of recurrent herpes that heal up in a matter of days. Lastly, herpes is capable of reactivating without producing any visible lesions (asymptomatic reactivation).

Much of the broad description of herpes “lesions” included above applies to recurrent herpes as well. Lesions may take the form of something resembling:

  • a red spot
  • a pimple
  • an ingrown hair
  • razor burn
  • hemorrhoids
  • insect bite

There’s quite a variety, in short. And while genital herpes certainly can and does cause these signs of infection on the genitals (the penis or the vulva) it also can produce signs of infection nearby. Herpes sores on or between the buttocks are common (and sometimes slow to heal), as are lesions on the thigh. Herpes can bring about what feels like a tiny fissure around the anus, something easily confused with hemorrhoids. So remember: recurring signs and symptoms in the genital or anal area could well be herpes lesions.

But what if you don’t see any lesions nor have other symptoms? In some studies, people with herpes were completely unaware of lesions about one-third of the time that the virus was found to be active in the genital area. While recognizing lesions and other symptoms is important, this cannot always tell you when the virus is active.

Prodrome: Early in the phase of reactivation (also called an outbreak), many people experience an itching, tingling, or painful feeling in the area where their recurrent lesions will develop. This sort of warning symptom – called a “prodrome” – often comes a day or two before lesions appear. To be on the safe side, it’s best to assume virus is active (and, therefore, can be spread through direct skin-to-skin contact) during these times.

Where do symptoms appear?

When a person has genital herpes, the virus lies dormant (sleeps) in the bundle of nerves at the base of the spine. When the virus reactivates (wakes up), it travels nerve paths to the surface of the skin, sometimes causing an outbreak.

The nerves in the genitals, upper thighs and buttocks are connected; therefore, a person can experience outbreaks in any of these areas. Such areas include the vagina or vulva, penis, scrotum or testicles, buttocks or anus, or thighs.

Genital herpes, regardless of whether it is HSV-1 or HSV-2, does not cause symptoms on the mouth or face. For more on oral-facial herpes, see the Oral Herpes section.

How often do outbreaks occur?

The number of outbreaks someone has varies from person to person. The average number of outbreaks for a person with genital HSV-2 is four to five per year. The average for genital HSV-1 is less than one outbreak per year.

Usually, there are more outbreaks during the first year, and many people find that outbreaks become less severe and less frequent with time.

Herpes “triggers” (determining exactly what leads to an outbreak) are highly individual, but with time, many people learn to recognize, and sometimes avoid, factors that seem to reactivate HSV in their own bodies. Illness, poor diet, emotional or physical stress, friction in the genital area, prolonged exposure to ultraviolet light (commonly for oral herpes, such as a beach trip or skiing weekend), surgical trauma, and steroidal medication (such as asthma treatment) may trigger a herpes outbreak.

The frequency of outbreaks can often be managed through effective stress management, and getting adequate rest, nutrition, and exercise. For people with frequent outbreaks, suppressive (daily) therapy with any one of the antiviral treatments can reduce outbreaks by as much as 80%.

ASHA’s publications website has many resources available on herpes, including the popular book, Managing Herpes: Living and Loving with HSV.

What does herpes look like?

Genital herpes is a common sexually transmitted infection that causes a recurring rash of red blisters around the genitals. It is more commonly referred to as “herpes”. Genital herpes is caused by the herpes simplex virus type 2. The herpes simplex virus type 1 causes cold sores, but can also cause genital herpes.

Because genital herpes is caused by the herpes simplex virus, which is incurable, it’s not a condition that will go away after treatment. Instead, you can expect repeated bouts of the symptoms, followed by long periods in which you have no symptoms at all. Over time, the symptoms will ease and become less painful and problematic.

Herpes blisters

The main symptom of genital herpes is painful blistering around the genitals. Blisters caused by genital herpes develop around the:

  • Genitals
  • Rectum
  • Thighs
  • Buttocks

In women, the blisters can also develop on the cervix.

Herpes blisters are small, red and painful. They will burst, leaving open sores that are very infectious. After this they will scab or crust over and heal without leaving any scarring. The blisters can sometimes last for as long as three weeks without any treatment.

Other symptoms of genital herpes

A primary herpes infection can come with flu-like symptoms such as aches and pains. Recurrent infections also normally start with an itching, burning or tingling sensation in the affected area.

Painful urination can be a symptom of genital herpes, due to the soreness of the blisters. In women, unusual vaginal discharge can also be a sign of genital herpes.

Other STIs causing similar symptoms

If you have sore, red blisters around your genitals then it’s very likely that you have herpes. However, there are some other infections that can cause symptoms you might mistake for herpes.

Genital warts

Genital warts are small, fleshy growths that develop around the genitals. They are usually painless (unlike herpes blisters) but they can become itchy and inflamed, and in some cases they can bleed.

Syphilis

The first symptom of syphilis is a painless sore on the genitals. It is normal to have only one sore, although some people have several. If you have several sores and they are painful, it is more likely to be herpes than syphilis.

Trichomoniasis, pubic lice and scabies can cause itching and inflammation around the genitals. Scratching the affected area can cause soreness and break the skin, which you might mistake for herpes. However, if there are no blisters present then it is unlikely that you are infected.

How is herpes diagnosed?

If you become infected with genital herpes, there is a good chance you will not notice any symptoms at first. Many people are not affected until months or years after exposure.

The first time you experience symptoms (i.e. an outbreak of blisters), you should visit a sexual health clinic or GP. The test for herpes involves an examination of the affected area, and a swab of the blisters that will be screened for the herpes virus. You may also be tested for other sexually transmitted infections.

How is herpes treated?

Genital herpes can be treated whenever you experience an outbreak. The standard treatment is an antiviral tablet called aciclovir, which works by preventing the virus from multiplying.

How to avoid herpes

Herpes is spread through skin-to-skin contact. The virus is most infectious when the blisters have burst leaving open, weeping sores. However, it can be transmitted from the point that a tingling or itching sensation is felt in the area. Remember too that herpes blisters can break out on the thighs, buttocks and around the anus. For this reason, oral sex is risky and using condoms during sex cannot provide 100% protection from the virus.

If your sexual partner is experiencing an outbreak, you should refrain from any sexual activity until the blisters have cleared up and healed completely.

If you have symptoms that you think might indicate herpes, you can use Online Doctor’s secure photo assessment service to get advice from one of our doctors. We also offer prescription treatments for herpes. Visit our sexual health treatments page to find out more.

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