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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

  • February 2, 2009 9:56 a.m.

    Dear Dee, Please read the treatment options listed on December 19th. Sounds like you should be on suppressive therapy. This could give you a great amount of relief!

    - Lois McGuire

  • January 28, 2009 3:32 p.m.

    Ayssa, You need to have a definite diagnosis. A blood test won't be effective so soon. Did Planned Parenthood do a culture of the sore? If it is herpes, you must have your husband use a condom and you need to be on suppressive therapy. First you need to find out for sure. You need to go talk to your dr. about this.

    - Deb

  • January 27, 2009 4:31 p.m.

    i think that i might have HSV, but the thing is i also have genital warts and my dr gave me ALDARA to clear the warts up. So two weeks go by and the cream is working pretty good, but about 5 days ago this very painful sore showed up on my anus, so i went to plan parenthood and they took one look at it and said that it could be herpes or it could be a rash from the cream that i put on the warts. i have know idea what to do. i have so many questions to ask. if it is herpes do i always have to use a condom even with my husband? will i pass it on to my children? is my whole sex life gone? i just need someone to talk to that would tell me that everythings gonna be ok

    - alyssa

  • January 26, 2009 11:12 p.m.

    I believe that I have congenital herpes, from infancy I was told that I always had recurrent rashes, my mom said it was diaper rashes, I had the sores in my mouth and always had fever and inflammation when the sores occurred, I would go to the doctor and they would brush it off as nothing to worry about. By the time I reached my 20's the sores were so bad but still not diagnosed correctly-my mom passed away, my dad didn't know and my doctors passed it off as yeast infections and prescribed as such. I had been tested for herpes blood tests in the early 90's but the results were negative (Not very reliable) one doc performed a culture but improperly sent the specimen- I had never have sexual relations because of the recurrent problems that made me feel there was something wrong-and I got tired of going to doctors. It was not until my 40's that one doc finally diagnosed my Herpes type 2. I still get frequent attacks that affect my whole body. Sometimes I feel like bugs are biting all around my groin and I get feverish. I take Valtrex before outbreaks but it doesn't seed to alleviate the frequency and severity of the outbreaks. I am starting to feel weakness in my legs and it seems to be affecting my cognitive abilites and I am totally worn. I don't know how many more outbreaks I can take, I am almost 50 and worn out from the attacks on my body, it is affecting every part of my life, my job, my family. Can anyone give me hope, I am on my last resort here.

    - Dee

  • January 26, 2009 11:55 a.m.

    Very very scared, Your husband could have had herpes and not known. Has we had a blood test and been tested. That's why herpes is so prevalent because a lot of people do not know they have it and unwittingly infected others. Please do not feel dirty or nasty. This is a virus. A cold is a virus. Of course, this virus hides in your body and usually appears at times of stress, but there are medications available. So, yes your husband could be telling the truth and not been aware that he had it--the sypmtoms vary from person to person and the photos that I've seen on the internet are not like the outbreaks that I have, which are much milder. This is not worth divorcing over--would you get a divorce if one of you had cancer? You and your husband both need to get educated about herpes. Please take time to think this through and don't make any decisions until you have time to deal with herpes emotionally. There are a lot of us with this "condition" and we aren't bad, nasty or dirty people. You are still the same person that you were before you knew about the herpes. Good luck to you.

    - Deb

  • January 26, 2009 5:08 a.m.

    I just had a severe outbreak that my dr. tested that came back positive for herpes II. I have had one partner in my life, my husband. We have been married for 19 years. He has been married twice before, and I knew that when we were married. He has shown no symptoms of herpes in during our time together, but now this happens to me. I am so confused and hurt and mad -- I waited to have sex with my husband and now I am the one with an STD. I feel nasty, but even more, I don't know if I can trust him anymore. He swears that he has not cheated on me, but how do I know for sure? Is there any way possible he could be telling the truth? We have a child and I do not want to consider a divorce, but I am so confused as to all of this; could he be telling the truth? Could this all be something that lay dormant or so mildly active with him that just crops up now? Also, does a vaginal discharge last past the outbreak, or does that signal another one coming? I hate this feeling of distrust, and I hate feeling like I am so dirty and diseased. Any advice/comments would be appreciated...

    - very very scared

  • January 21, 2009 3:17 p.m.

    I have been in a relationship for 10 years though we are not married we have two beautiful children. About two years ago we were going through a rough patch. I made a mistake and had unproteted sex. The person did not tell me he had herpes, and from one night i now have herpes for the rest of my life. I was really devestated with myself when I found out. I was ashamed and felt dirty, eventhough he was only the 3rd person I have been with sexually. My doctor gave me some info to read about herpes. I know realize that there are so many people who have herpes but do not know. I still am ashamed, but have come to terms with my situation. Fortunately a few months after that I got back with my fiance. Life is back to normal, except one thing. I am so scared of giving it to my children. My doctor told me that they can get it (it doesn't just have to be through sex)I am freaking out. I will be soooo upset if I give it to my two innocent children. I don't want them to have to pay because of my own STUPID mistake.I always make sure I wash my hands, I don't share towels, and soap, etc. and if I do get an outbreak I am so much more cautious. I need to know am I being too dramatic,is it that easy for my children to get it?

    - Nervous mother

  • January 18, 2009 11:19 p.m.

    Life does go on. 17 years ago I was diagnosed with HSV-2. One enormous painful blister. My boyfriend of 5 years had cheated and given it to me. I was given medicine and immediately started vomiting and passed out from it. 3 days later I found out I was pregnant. I had several outbreaks during my pregnancy (my boyfriend has never had one in all these years). The plan was to have a C section if and blisters were present...none were and I delivered my son vaginally...3 weeks later, he had a blister on his little penis and it was confirmed HSV-2. Devistating. Through toddler stage and gradeschool he would have break-outs about twice a year. Once puberty started, they really became severe. My outbreaks have lessened over the years and I can't remember the last time I had one...at least 8 years ago or more...but a lot of guilt for passing it on to my son and having to explain to him what is happening to his body and why. The virus, probably because he had it at infancy and I got it during my 1st tri-mester...attacks his immune system...twice a year where he has mono like symptoms. I've had chicken pox, mono (more than once, yes you can,) plus Herpes and it does take a toll on your body, beyond the outbreaks...and emotionally. Obviously, I'm not with the cheating boyfriend from 17 years ago, but I have had 2 wonderful relationships since then...you have to be honest and upfront. We used condoms all the time. Lots of sex didn't cause more outbreaks....lots of stress does

    - LA

  • January 15, 2009 9:08 a.m.

    I was just dx with HSV-2. My doctor took a culture and blood work. He says this is my first outbreak and I was exposed to the virus 3-6 months ago. I am married and have only slept with my husband. Naturally he claims he doesnt have HSV and if he does I gave it to him. I know I've been faithful. Could he have it and transmit it to me if he never had an outbreak? I'm so upset!

    - ann

  • January 13, 2009 11:45 a.m.

    If my partner has herpes and I do not, is there any kind of meds that I can take to prevent getting the disease? Since finding out I have been worried to death about getting it....Thanks

    - Worried

  • January 8, 2009 9:17 a.m.

    Blood test positive for HSV-1 and negative for HSV-2. I know that I will not know if I have oral or gential, but to my knowledge I have never had a outbreak with blisters or sores in or around the vagina. I have read that people can confuse an outbreak with hemorroids, which I have also. I went to the dr. on Monday because I found a lump or bump on the opening to my rectum. It was a little red and sore but I had been going to the bathroom non stop for 24 hours. She said that it was hemorroids, but how do I know for sure she is correct. She gave me hydrocortizone cream and suppositories which have relived the symptoms. I am just so confused.... Any help is greatly appreciated.

    - Confused

  • January 7, 2009 4:57 p.m.

    Samantha, Shingles is caused by the same herpes virus that causes chicken pox. In fact, you have to have had chicken pox to later get shingles. So that is a different issue from Herpes I and II. As a carrier I think you could probably have an outbreak if your immune system gets down or you have an emotional crises. I went for years without outbreaks until I got older and then going through the death of my husband triggered more severe outbreaks until I was emotional back to more normal (I'll never truly full recover from the death of my husband). I believe that herpes can present in the mouth and esophagus. Have you had the mouth sores cultured or assessed by a medical professional? I can have an outbreak whether or not I have sex. Usually if I do get an outbreak it is because of emotional issues. I'm on suppression therapy now and hopefully I'll be outbreak free. Acyclovir is cheap now that WalMart has it as one of their $4 generic drugs. Additional unprotected sex with your husband could probably cause you to eventually have outbreaks, although some people never do have outbreaks. Too bad your husband didn't take responsibility and try to protect you like I am trying to protect my partner.

    - Deb

  • January 6, 2009 9:22 p.m.

    At the start of our relationship, the man I am now married to told me he had no STDs. Months and sexual encounters later, one day he shamefacedly declined sex, admitting he was having an outbreak, and feigned knowledge of what it could possibly be. Long story short, he'd had herpes for years. He refused to use a condom, refused to take medication of any kind. I am now a carrier of both 1 and 2. I have never had an outbreak. Aside from the devastation of his lies and the devastation of being a carrier, I live in terror of having an outbreak. Can I get a straight answer -- can a carrier have an outbreak if she no longer has sex? Can I have an outbreak from additional sex with my husband or does being a carrier protect me from an outbreak? Also, since having sex with this man, I have begun to have severe sores in my mouth. They look like cancre sores. Could they have something to do with his herpes? I've also had an episode of shingles. Could that have had something to do with his herpes? What should I do to protect myself? I'm scared to have sex with him.

    - samantha

  • January 6, 2009 3:11 p.m.

    Deb: I apologize for taking some time to answer your question from a while back regarding whether or not I would have stayed with my ex-girlfriend if she had been upfront with me in the beginning regarding having herpes. It is difficult to objectively look back at a failed relationship and accurately and honestly answer your question. However, I feel that I can honestly say that, even if she told me before the first time we were intimate, that she had herpes, I still would have stayed in the relationship. Heck, I did stay in the relationship for nearly six months after she finally told me. Again, being honest, I can say that it never bothered me; obviously, I did not want to contract herpes, but I never thought less of my ex-girlfriend, was less attracted to her, or was never less interested in her, sexually. So, if I am any kind of an indicator - for women specifically, and, men, generally - your partner will love you regardless, no matter what. For those not in a relationship but still possessing apprehension about the future, DON'T. Herpes WON'T scare off someone who genuinely cares; look on the bright side, you might be able to scare off dead-end partners/go-no-where-relationships! Seriously though, just be honest, don't get discouraged, and above all else, just remember that you're just like everyone else (in a good way)!

    - LawSchoolStudent

  • January 5, 2009 11:37 a.m.

    It seems like there are quite a few posts about this disease being devastating and ruining your sex life, this does not have to be the case. I understand that feeling, even though my doctor has not officially diagnosed me. I believe that I have contracted HSV but have only had a couple of very mild outbreaks, which puts me in the precarious position of the doctors being unable to diagnose via culture or visual diagnosis. The doc told me to return with my next outbreak for diagnosis, but that outbreak hasn't happened yet. It would be very easy for me to continue to claim ignorance with future partners because I have not been diagnosed. But I have chosen to explain to my current partner that there is a possibility that I am carrying HSV-2 and that it is only fair for him to be able to make his own educated decision about our sexual relationship. Unfortunately, I wasn't given that opportunity by the man I contracted HSV from, and to this day he has still not been tested for it, his reasoning being that he has no symptoms. One must be reminded that between 20-25% of people have this disease, an estimated 70-80% of carriers DO NOT KNOW that they have it. It should not be devastating, the biggest problem is that we are taught at a young age that this is a symptomatic disease, but it is not. Don't be hard on yourself, try to change the way people discuss this disease, as the education system has a twisted way of keeping students and the public ignorant of the facts. Stay honest!!!!

    - ok

  • January 4, 2009 4:27 p.m.

    What Next, Did your wife's dr. give her Valtrex or acyclovir? I've been on suppressive acyclovir therapy and my boyfriend is still herpes negative. You will be able to have a sexual relationship again, just need to use suppressive therapy and condoms--unless you both test positive for HSV I and/or II. Usually the outbreaks decrease through time, the first outbreak is usually the worst. Good luck.

    - Deb

  • January 2, 2009 2:10 p.m.

    Two weeks ago, my wife of 16 months, suffered very severe swelling and extreme pain in her genital area. This issue went on for about 4 days (over a weekend where her Dr was unavailable) while we tried "anything and everything" to relieve the symptoms to no avail(she was a nurse for 17 years). By the time she saw her Dr, the dozens of lesions had appeared and as we thought- she was diagnosed with herpes, something that was not in her medical records previously. We were both shocked and stunned. I am 61 years of age (my wife is 54). I had a monogamous sexual relationship for 26 years with my previous wife, with no issues in my previous marriage and no issues in this marriage until 2 weeks ago. After probably 100 hours of internet research, I obviously have had HSV-1 since childhood as I remember having "cold sores" and "fever blisters" then. The virus has remained dormant all these years until, I assume, the recent physical and emotional stress of us being 24/7 caregivers to her dying, bed-ridden mother who lives with us. We have not had any sexual contact, not even a mouth kiss, for fear of the unknown. We do not want to live the rest of our lives like the past 2 weeks, but I do not want to inflict any additional pain and suffering upon her either. (physically or emotionally) We have both started taking daily 1000 mg L-Lysine, 2000 mg Vitamin C, 200 mg Alpha Lipoic Acid. What next?

    - What next

  • December 28, 2008 10:37 p.m.

    I believe I have had the virus for well over 10 years and I now have chronic prostititus; Has any other men out there been experiencing problems w/ their prostate, urine flow or ejaculation stregnth?

    - Jee Jee

  • December 19, 2008 8:18 p.m.

    When I was pregnant my husband had an affair, and two days afer childbirth I had the first outbreak. It was very uncomfortable and I showed it to the doctor, it was on the buttock. He didn't know what it was-this was 44 years ago, and I have been in misery since with frequent outbreaks, usually only one lesion. Now they are more frequent. I tried lysine and it seems to work pretty well, but I did some exercises and got another lesion. I am past due for a colonoscopy due to strong family history of colon Ca but cannot make an appointment as I never know when I will have an outbreak. I cannot face a doctor with this, I will literally die first. I think I need to be on continuous therapy but don't know if it is safe to take so much lysine. I take the 500 mg tabs and take about 2000 mg when I feel an outbreak coming on. My life would take on some meaning if I felt there was some option. I have not been sexually active in 35 years so no problem there. Acylovir did nothing and I cannot afford Valtrex.

    - Devastated

  • December 19, 2008 5:04 p.m.

    Linda, Are you using suppressive therapy?

    - Lois McGuire

  • December 19, 2008 5:03 p.m.

    Beth-Latex and polyurethane condoms are protective. Please do not buy "Natural or Lamb skins condoms". These are porous and viruses can pass through the membrane. I have not heard of silicone condoms. Do you have a brand and I will do some research?

    - Lois McGuire

  • December 19, 2008 4:56 p.m.

    I am going to answer a few more questions. Confused-Acyclovir 200 mg once daily is not an acceptalbe dosing. Acyclovir should be taked twice a day at 400mg. I would encourage you to take it as directed or do not take it at all. You are not currently taking a theraputic dose for suppression. It is important to take it correctly. I am not sure how to answer your question of whether to suppress or not. If you are not sexually active, you do not need to take a suppressive dose. If you are sexually active, you should take a suppressive dose to oprotect your partner. If you decide not to take a suppressive dose, you may have an increase in outbreaks as your immune system is weakened due to your MS. If your outbreaks increase, you may want you to stay on the suppressive therapy. I don't believe there are any contraindications to being on suppression with MS

    - Lois McGuire

  • December 19, 2008 1:17 p.m.

    I get outbreaks from just wearing jeans and they aren't even that tight. Any suggestions other than to not wear jeans or slacks?

    - Linda

  • December 18, 2008 12:31 p.m.

    If both partners have HSV2, they don't need to use precautions. I don't want to infect my partner as he is negative so I use suppressive therapy and we use condoms. Some people have a lot of pain and very frequent outbreaks--the virus affects each person a bit differently. My outbreaks are mild and have never been a problem until my husband died and I went through the grief process and then my immune system was down and I had a lot of outbreaks, but since I wasn't with anyone I didn't treat them. Gradually I got back to small outbreaks, but then I met someone who is not infected. For me herpes isn't too much of a problem and I feel fortunate that I don't have HIV or AIDS. The pictures of herpes outbreaks that I have seen are not at all like my outbreaks, which are hardly noticeable, but I do get the prodromal tingling before an outbreak. My lesions usually heal in 2-3 days. Now with suppressive therapy I hope to not have any at all. The problem with herpes is that each person has a different experience with it. We must always let new partners know of our herpes before we have a sexual relationship with them.

    - Deb

  • December 17, 2008 3:14 p.m.

    Furthermore: if the uninfected partner subsequently contracts HSV-2 and their symptons prove mild, now both partners have HSV-2. Why then is it necessary for them to take any precaustions when practicing monogamous sex?

    - uncertain

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