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  • Dec. 5, 2008

    Herpes symptoms, diagnosis and how it spreads

    By Lois McGuire, R.N., M.S.N., W.H.N.P.

92 comments posted

I started the discussion on herpes in my last blog. Today, I want to address herpes symptoms, diagnosis and spreading the virus. The symptoms can vary depending on the category of herpes. The categories are primary, non-primary and recurrent. I described these in more detail last week.

Herpes symptoms

Primary outbreak symptoms: Many people do not have symptoms. Others may have symptoms so mild that they do not recognize the symptoms as being from herpes. Still others may have painful attacks with whole body involvement and can feel very ill for a few weeks.

The symptoms may be flu-like including; headache, aching joints, tiredness, fever or pain in the legs. The lymph nodes in the groin are often enlarged and tender and may feel like large peas under the surface of the skin. Genital symptoms may include sores (often on both sides of the genitals), painful urination, itching and a discharge from the penis or vagina.

The sores begin as blisters and are often grouped in clusters. After the blister stage, they break open and form ulcers in the skin or mucous membranes. Crusts or scabs form over the ulcers and eventually fall off and the tissue heals. Women will usually have sores on the cervix and men may have them inside the penis. Infected cells are sloughed off from the cervix and inner penis causing a discharge in men and women. Frequently, a new crop of herpes lesions will appear 5-7 days after the first batch is seen. The typical primary outbreak will last 2-3 weeks.

Non-primary outbreak symptoms: Remember, this group already had HSV-1 or oral herpes and now is exposed to HSV-2 or genital herpes. The existing antibody to HSV-1 allows the symptoms of HSV-2 to be less severe or nonexistent. The sores will usually cover a smaller area. The whole body symptoms, described above, are less likely to occur. The time to recovery is generally shorter.

Recurrent outbreak symptoms: Most people do not experience the whole body symptoms like headache, fever, etc. with recurrent outbreaks. The sores cover a still smaller area; often the person will experience only one sore. Many people do not experience pain with their outbreaks. The average recurrence last about 2-10 days. Frequency of recurrence varies greatly.

Because the symptoms can be so mild or vague, men often self diagnose thinking one of these are the cause of his symptoms:

  • Jock itch
  • Zipper burn
  • Hemorrhoids
  • Acne
  • Tight jeans
  • Bug bites
  • Irritation from sex
  • "It's normal to itch"
  • Allergy to condoms (this is scary because then they don't use condoms and expose their partners to herpes)
  • Bike seat rubs

Women often self diagnose thinking one of these is the cause of her symptoms:

  • Yeast infection or some type of vaginitis
  • Bladder infection
  • Hemorrhoids
  • Irritation from sex
  • Heat rash
  • Irritation with her period
  • Allergy to sperm, condoms, spermicide, pantyhose or hygiene products
  • Bike seat rubs
  • Irritation from shaving

Herpes diagnosis

It is difficult to make a diagnosis of herpes by symptoms or looking at the sores. Sometimes the sores have a different look; they may be a small crack or fissure in the tissue or present as itching without a sore. Conversely, sometimes a sore can look very suspicious for herpes but is not herpes. Here are the most frequently used laboratory tests for herpes:

  • Culture or swab of the sore: This has a high false negative rate, which means it often reports a negative culture when the person really does have herpes.
  • Polymerase chain reaction (PCR): This test is very similar to a culture but it has a much higher sensitivity. It is 4 times more sensitive than a traditional culture. The PCR is more expensive than a traditional culture.
  • Blood tests: Herpes blood tests look for an antibody to herpes virus. The body develops antibodies to fight the virus but these antibodies can take a while to develop in the blood. It is important to wait 3-4 months from the time you think you were exposed to get a blood test. The newer blood tests are accurate and can tell the difference between HSV-1 and HSV-2.

How do you get herpes?

Most children with HSV of the mouth have acquired it very innocently. They have probably just kissed a family member that had a sore. Many people with "cold sores" don't realize it is herpes and can easily be spread from one person to another by kissing or sharing towels, etc. They also do not realize they are able to spread the virus without having a "cold sore" or other symptoms.

Genital herpes is spread through sexual contact, including:

  • Intercourse
  • Outercourse or rubbing genital areas together with direct skin contact or no clothing between partners.
  • Autoinoculation or transmitting the virus from one body part to another. For instance, if a person touched his or her mouth and then wiped his or her own genital area after urinating without good hand washing, he or she could spread the infection to another body part. This does not happen frequently.
  • Oral to genital contact: HSV-1 or oral herpes can be spread to a partner's genital. In this situation, the receiver of oral sex does not get HSV-2. The receiver will have HSV-1 of the genital area. The cold sore can recur in the genital area, acting the same way as HSV-2. Because oral sex has become more common, spreading herpes this way has increased significantly in the last 10 years. If you have HSV-1 of the mouth, it is important that you prevent an outbreak happening in the genital area to your partner.
  • Genital to oral contact: In this case, a person can acquire HSV-2 of the mouth. Once again, it is important to protect your partner.

In 70 percent of patients, transmission or spreading the disease happened when the person known to have HSV had no symptoms! The virus can be spread through microscopic breaks in the skin. This is called asymptomatic viral shedding. The next blog will cover treatment and prevention of spreading HSV.

Please share your questions or experiences with us.

92 comments posted

blog index

  • November 7, 2009 1:25 p.m.

    I have had HSV1 for years, I use ice and Famvir when I feel it comming. I dated one guy with HSV2, the scars from the herpes were only in the tip of his penis, he takes valtrex on a daily basis & we always used protection (condoms), we broke up 5 months ago. Then I started dating another person, I don't use protection with him. For months I have been going to the Gyn cause I have this recurrent "yeast infection", at least that's what I thought it was, a white discharge, didn't itch or smell, just uncomfortable and keeps comming back, I thought it could be the contraceptive pills. My partner, has been having some issues too, like he had an epididimous infection, then he thought he had hemorroids cause he had anal discomfort and jock itch. Four days ago, I started feeling sick, the next day, I had a few inflamated lymph nodes, fever, body, head, lowerback aches, etc. Next day I woke up and I noticed my vagina hurt a little, when I looked, I noticed I had blisters inside and outside, now the blisters look like open wounds with a yellow-whitish center. I get results in a few days, I've been crying an very sick with fevers, aches all over my body, stomach pain, I can't eat, I can barely walk, and my vagina hurts very much. I've wonder who could I've got this from the guy I broke up with (after 5 monts, since I already had HSV1, maybe it took longer to show) or the guy I'm dating now, and if I have it, does he have it too?

    - Lydia

  • October 20, 2009 4:10 p.m.

    See previous post. I was exposed to my sister's bodily fluids from the toilet seat. She was positive for HSV1 and HSV2. Because of her and her unclean ways, I became exposed to this forever disease. It does not matter that my husband and I are not physically able to be intimate (since 2005). He has dementia & I have multiple health problems. What does matter is that people are sooo misinformed, sometimes accidentally, about STD's. Why are we told to be careful about using public toilets? Why are we now being told to use antibacterial hand cleaners and/or to wash your hands very carefully with soap and water? Most doctors and nurses are able to give us very good health care advice, but they still do not know it all. I haved lived for 69 years and never had a cold sore, nor a sexually transmitted disease. I do not need this at this time in my life. Do I blame my sister? YES! She knew she had been infected and I wish she had been honest with me. I would not have used the same bathroom, but I would have used my husband's bathroom. When she moved into her own apt. in June, I spent 2 weeks scrubbing the bathroom and the bedroom. I threw away the bedclothes and bought new ones. I used lots of Lysol to clean with. Sounds like I was angry doesn't it? I was very angry. Now, I just want people to know the truth and to be very careful about where you use a bathroom.

    - Pat - cont.

  • October 20, 2009 3:47 p.m.

    I would like to respond to the statement about how HSV1 and HSV2 can be spread. My husband, 61, & I, 69, have been married for 13 years. Before we married, we were tested for HIV and STD'S & came up negative for anything. Jan. 2009, we took in my homeless sister, who has Bipolar Disorder. She had no job, no money, & multiple health issues that I was aware of some, but not of others. She & I shared the master bathroom & bedroom, taking turns sleeping on the couch. We got her free health clinic care. She was able to get some health issues taken care of, including GYN care. It was about the in May, that I discovered that I had 3 lesions, 2 in the left groin, 1 pea sized one on the labia. They were filling up with blood & pus & were very painful. I extracted this fluid every day. My sister informed me this was a common thing for her, that she had had this condition for years. She was tested for STD's at the clinic, & her test came back positive for HSV1 & HSV2. I was devastated, so I went to a walkin clinic & asked to be tested. The results were positive. My sister is a "picker" & was constantly picking the scabs off her sores, causing them to bleed. She was very careless about keeping the toilet seat clean & I would find bloody drainage on the seat. At night, I would go to the bathroom & not turn on a light. I did not know that she had used the toilet & did not clean it up. So, I would sit down & became exp

    - Pat

  • September 29, 2009 1:43 a.m.

    Your blog said that sometimes, when you think it looks or seems like herpes, it's not. If it's not herpes, then what could it be? I've had an occasional sore (not red, but white) in the same place on my labia off and on for many years, about once a year or less and typically right before my period. Although, now that I have reached menopause, I've had it twice in just the past year. I was not married and not sexually active for many of those years. I am now married and am very worried about giving my husband herpes. I don't want to go to a doctor and have myself labeled with herpes. I am using a homeopathic remedy for herpes. If it's NOT herpes, what could this one sore that comes and goes be from??

    - Rosa

  • September 19, 2009 6:47 p.m.

    My doctor told me that I was exposed to someone who had herpes and my ody fought it off. Does that mean I'm still infected and can pass it on to someonelse.

    - bill

  • September 14, 2009 5:54 p.m.

    I recently meet a woman that I have now started a relationship with. she has informed me that she has herpes. She was very open about it we discussed it. My question is, since we have been kissing I get this slight stinging sensation on my lips. Nothing painful just annoying. I am wondering if the herpes issue is causing this or any ideas what it may be?

    - Chuck

  • September 3, 2009 2:06 a.m.

    After my birth of my daughter I have been experiencing a clear white discharge that subsides prior to my period only to start again. I know to have the herpes virus with occassional lesions. But this discharge does not go away and after reading your article I ask if my body is continuously trying to shed infected cells. Is this possible?

    - cecilia

  • September 2, 2009 10:34 a.m.

    Can a person actually have herpes for 10-20 years and it lay "dormant"?

    - Brenda

  • August 27, 2009 10:18 p.m.

    I just found out that my spouse gave me herpes, but i am scared if my children has it. I know i kiss my children alot. I have never had a sore on my lips, but still i just wanted to know if it it possible? Also how can i live with such thing, i hope it is not deadly.

    - Mary

  • August 27, 2009 8:00 a.m.

    Hi. I am 25. I had herpes some 5 months ago. have had herpes on my thighs which then spread a bit to vagina and my bumps. are there any chances of recurrence coz my doc says it never recurs. 2ndly, i have got marks which are dark red in colour after herpes got cured. i m applying Hirudoid crem which has helped lessen marks to a bit, but not much. however some days i experience bit of itching where herpes hapened. what should i do? When I get married, will it affect my partner too? also will these marks ever go?

    - Kalpana

  • August 20, 2009 10:31 p.m.

    I HAVE H1 AND 2 .... MY HUSBAND DOES NOT HAVE IT... WE HAVE BEING SEPERATED FOR 4YRS AND HE NOW WANTS TO TRY TO GET BACK ONCE MORE... I DONT KNOW HOW TO TELL HIM... IF HE USES A CONDOM WHEN WE HAVE SEX, WILL HE GET IT EVEN IF I DONT HAVE AN OUTBREAK? WILL I BE ABLE TO HAVE ORAL SEX EVER AGAIN?

    - AMANDA

  • August 18, 2009 9:02 p.m.

    I have H1 and have had it ever since I can remember. Every picture day-wham! A fever sore. I recently slept with a guy who I think now is a pig who I fear may have something. 3 days after, my vagina doesn't feel right. No symptoms other phantom pain and dryness. It's been a week and 1/2 since our encounter. (I hadn't had sex in 1 1/2 yrs.) I have been to the doctor twice. I can't sleep. I am having anxiety attacks. I have a large lump and I think it's a Bartholin cyst which I understand can be from H2. They did a skin test and took the blood but I need to know how to cope. The doctor didn't tell me about the cyst. I found out here on Mayo. Can Elizabeth P talk about dosages? I take Valtrex for the mouth sores and it's pointless.

    - Scared

  • August 10, 2009 10:43 p.m.

    I had known my partner for almost 7 years now, he has never told me that he have herpes, i only found out when i feel something was wrong with my genital area and went to see the doctor. I had been confirm as herpes type 2 and when i confront him he admit that he knew all along that he have it. He has never been faithful towards me and i have also been diagnose with another std infections. but what bother me is that he seems to never have such outbreaks whereas i have many outbreaks. He has never take any medications and when ask he said he doesnt need to as he doesnt have any outbreaks. So my questions is this. he always have this rash around his genital area and he had some sort of red rash all over his body especially his buttock side at one time and he also claims that he had some kind of rash infections all over his crotch which he puts the blame on the new swimming costumes which by the way has already been washed before used. Does this means he have herpes outbreaks during this time?

    - any

  • August 8, 2009 2:07 a.m.

    I am responding to -V. I was in the same boat that you are in for years and years but then I started looking for alternative treatments because Acyclivor and Valtrex did nothing for me. I thank god that I discovered Red Algea (safe, natural and cheap), BHT (also cheap but use with caution), L-Lysine(which did nothing for me when used alone but works great when combined with some or all of the other supplements) Herbalcidin (fairly inexpensive and works well. It's supposed to prevent viruses from replicating and improve liver function too!) Viralprin works really well but is expensive. I now use Viralprin on rare occasions, because my other regime works so well. It took some time, playing around with the dosages but now I think I've got what works for me. I took my regime everyday for 8 months and never had any symptoms. I've only had signs when I've forgotten to take a dose. I take one Red Algea in AM and one in PM along with the others meds as needed. If you try nothing else, please try Red Algea. I truly hope this helps you as it has helped me and more.

    - Elizabeth P.

  • July 27, 2009 11:46 p.m.

    Heres something to think about. I had a high risk pregnancy had test after test ran. When I went into the hospital 6 weeks early to have her by c-section. I was released after 3 days and within 10 hours my knee swelled up 3 times as big as normal. She was still in icu and on my visit to her the infectious disease doctor saw me and within 2 hours I was admitted. After tests were ran I was told that I had genital herpes in my knee. After 4 long and painful days I was released and sent home. After following up with my doctor she said she was so sorry that I contracted this in the hospital. After 2 days BAM there it is where I never wanted it. So know I am living the rest of my life with vaginal herpes. I have an outbreak about every 3 to 4 months. So everyone be careful.

    - mommy of 2

  • July 27, 2009 6:29 a.m.

    what is considered suppressive therapy and how to start and what medicien?

    - James

  • July 18, 2009 12:53 p.m.

    i got a sunburn through my bathing suit on top of my very low stomach. now i have 3 seperate blisters. my dr. said without even looking at them, that i had "sun induced herpes"!!!!! nobodys even heard of such a thing. is this true? by the way i do have fibrobmyalgia. what do i do? please help.

    - jacque

  • June 28, 2009 7:43 a.m.

    can you pass herpies by sharing drinks

    - dan

  • June 26, 2009 8:47 a.m.

    Karen, I think you are right to be concerned about your friend. She maybe does have oral herpes but that is probably not the cause for the sores that you are seeing. Herpes comes and goes. It does not stay. She needs a second opinion and perhaps a biopsy of the sores. Thank you for being a good friend to her.

    - Lois McGuire

  • June 21, 2009 3:11 p.m.

    I have a friend who is 84 years old.She has been told she has oral herpes. She was given a cat scan by one doctor and a ear nose and throst doctor got blood for 13 items to check. They came back and told her she has this oral herpes. Her tongue has three little places on it that are not healing. She says she can eat oranges but not salt, sugar, and no fruit lile apples. She has had this for a year. I have seen it. I looked up pictures on the internet and the place on her tongue is not at all like the photos. My daughter gets the lesions on her mouth when she is under stress so I know what those look like. The doctor gave her dexamethasone o.5mg to wash her mouth with. Her mouth is very dry but she will find she drools at night. I hope I have given you enough information to help decide what she should do. I feel she is being given the run around because she is 84. Please help

    - Karen

  • June 16, 2009 10:32 p.m.

    My 20-year-old daughter recently acquired HSV-1. There are other family members at home that share the same bathroom with her. Can it spread through sharing a toilet seat? Can it spread by sharing a drinking glass? This is all very new and scary to us. We don't know what to expect.

    - Maria

  • June 13, 2009 6:29 p.m.

    Wow! I was very pleased to read on how some innocently get herpes from a kiss. That's how I obtained this life changing disease at such a young age. The problem now that I am older is my whole face swells, lymph nodes, facial numbness, tongue too, and these sores are increasing with each breakout, nothing seems to help, not even the prescription Valtrex or th generic drug. What is a girl to do with this virus?

    - V

  • June 12, 2009 7:52 p.m.

    so - here is part 2....my "EX" and I have been on again off again for the last 6 years...been very stressful - doesn't help my Fibromyalgia symptoms at all...the last couple of months have gotten a little worse - I think we both realize we need to end it but it just hasn't been easy......in our off again stages I know he's been with other women....he assures me he wore a condom but he has NEVER used 1 with me - and 1 of our biggest issues has been the fact that I don't find him to be the most trustworthy person I've known...roughly a month ago I noticed something 'different' on the tip of his penis...he assured me it was nothing - told me not to worry...I've had blinders on - obviously - and now feel like such an idiot....when I told him what I suspect - and accused him of passing it to me he became irate and started blaming me - called me a 'whore' - I've only been intimate with 1 other during this rocky relationship.....before him I was pretty careless and promiscuous....how do I know if I gave it to him or he gave it to me? I have not had blisters that I feel are worsening as I type until earlier this week and it was approx. 2 months ago that I noticed the bump(?) on his penis.....unfortunately - and I don't know what I was thinking...we've had unprotected sex 3 or 4 times - the last couple of times was the week before last....any comments? I'd appreciate it-if not thx for letting me vent - good luck to all of us xo

    - Debbie

  • June 12, 2009 7:37 p.m.

    Help!! I haven't been diagnosed yet - seeing my doc next week but I feel like I don't need him to tell me what I already know:0( Jen: When I read your post my heart stopped - I never knew that testing for std's did not include testing for this...........I was diagnosed with Fibromyalgia in Nov'04-have been off work since May'05..last 2 years I've had my gallbladder removed & still experience the pain in my right rib area-the same complaint that brought my gallstones to their attention....I also started experiencing severe pain in my upper right thigh - in my groin area.....I have been tested, scanned, x-rayed and was even sent to physio with a diagnosis of bursitis.....which seemed to help to a certain degree -until I could hardly move and went to the emergency room approx. 3 months ago - after an ultrasound I was told I have swollen lymph nodes and still haven't been told why.Pap test& blood tests normal...however, I have no idea if I was tested for HSV2...cold sores started roughly when I turned 30 - I'm 45.. I guess that means I have HSV1..I am scheduled for a hysterectomy on 17th July-my uterus is closed up due to another procedure I had done many years ago and they can't tell me if there's anything wrong in there that could be causing the nodes..but this past week I've been experiencing symptoms that I'm sure means herpes..I'm running out of letter space here and still feel the need to go on..which I will do-I think it's helping me-venting...

    - Debbie

  • June 12, 2009 2:57 a.m.

    Can I get it if she has it and we used a condom

    - Jonson

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