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

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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

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  • December 17, 2008 3:04 p.m.

    I have a simple, but possibly complex question. It is: if one contracts HSV-2, what harm does it do to me? I'm aware of the periodic outbreaks but these can be viewed as a nuisance. I've heard of the possible link to cervical cancer, and if true, this is significant - however, I believe there is much debate about this link. It is not life-threatening, right? So, if one's outbreaks are mild/tolerable, and it is not life-threatening, and the link with cervical cancer proves untrue, then what is the downside and why is this condition perceived as so terrible? If one partner has the virus and the other does not, and they are monogamous and committed to staying that way, what does it matter?

    - uncertain

  • December 17, 2008 7:20 a.m.

    I have had meningitis 4 times. First case being severe, the rest not as bad, but all needing hospitalization. This last time the Dr. tested and confirmed that it is herpes simplex virus meningitis. It sits dormant and rears up very unexpectedly. It has been an ugly experience, but be strong and alert to your body. Watch situations of extreme heat, tanning beds, hot baths, as they have always triggered an outbreak for me. I contracted this from my boyfriend, who had told me he had it..We were careful, but I eventually contracted it, after we were Married! I'm still with him today and yes, i love him. It isn't the end of the world, but it is a tough road.

    - be strong

  • December 17, 2008 6:50 a.m.

    Perhaps this can help others. though still not sure if it is herpes, never having been tested, I'm fairly sure the symptoms fit herpes. Buttocks: blisters that can be painful that seem to come in times of stress or fatigue. The've minimized in frequency over the years but come mysteriously, now limited to one or two. I've learned to 'treat' them by opening the blister almost as soon as I sense it is a blister. I do this with a sterilzed needle. This process quickly dries up the beginning blister/sore whereupon it heals quickly, the pain never develops and the whole dries up.

    - faith

  • December 16, 2008 9:36 p.m.

    Still in Shock, You will kiss and love again. You need time to educate yourself and to absorb this change in the way your sex life will change--using protection and suppression therapy. Also, being honest with all sexual partners before the relationship becomes sexual. I have been with my boyfriend for over a year and he is still negative. Herpes shedding can occur at any time and there is no way to know. With the percentage of infected people, you may have been with others who had herpes and didn't even know. You are not alone. The cervical cancer link may not be true. Anyway, an annual pap will screen for that. Please don't be so hard on yourself.

    - Deb

  • December 16, 2008 7:31 p.m.

    Just got off the phone with my doc. Had my annual physical and was tested for STD's. I tested positive for Herpes 1 & 2. I'm angry with myself for having unprotected sex with a partner I KNEW had Herpes, even tho' it wasn't active. Since I have BOTH kinds of Herpes, does this mean I can't even kiss a guy anymore? I've resigned myself to never having sex or kissing anyone again. Since Herpes is a virus, even if I didn't have a cold sore and gave someone oral sex without a condom, I could pass it, right? And, no kissing on the mouth either? And of course, Herpes also makes women more susceptible to cervical cancer! I'm screwed and not in a good way!! Trying not to be bitter...

    - still in shock

  • December 16, 2008 6:37 p.m.

    Disturbed, Please don't let herpes change who you are and don't waste time on negative thoughts. Herpes won't kill you like HIV and AIDS might and there are so many people infected who don't even know they have herpes. It is possible to have a loving and sexually fulfilling life while living with herpes. Of course, condoms are necessary and maybe suppressive therapy. There are herpes dating sites too. I think all of us in the course of our lives have trusted people who maybe didn't deserve that trust. Please quit beating yourself up. I never thought I'd find someone to love again after my husband died, and now am in a loving relationship. We always have hope--for a new love, a cure for herpes, or just someone who understands. Also, did your boyfriend know he had herpes--a lot of infected people don't know as the symptoms are so mild. Good luck.

    - Deb

  • December 16, 2008 6:15 p.m.

    Hi, I was in a similar situation as the first lady, Julie, who expressed her anger with herself for contracting Herpes. The difference between you and I is that this boyfriend of mine did not tell me he had it. I think that it is a malicious act on these people's behalf to have done such a horrific act. Don't let the hate consume you Julie, as painful as it is, there is a Karma that always gets back to people who do ill to others. I can totally relate to you being angry with yourself. I am in the same situation. "How could I have been so trusting?" Thanks to this life changing experience I can no longer trust any man, it is devastating to feel this way. I reach out to this blog for emotional support. Is there anything you can do to help?

    - Disturbed

  • December 16, 2008 4:57 p.m.

    I decided to be tested for STD. I was in a reationship with a man who told me he had herpes AFTER we had unprotected sex. I had just gotten out of a long time relationship where we both would get tested often. I just paid off a $10,000 debt the man that I now learned I contracted herpes from, will always be on my 10 most hated list. I am middle-aged and was not with too many partners over the years. I am very, very angry with myself.

    - Julie

  • December 16, 2008 4:33 p.m.

    I work in NICU & have seen babies born to positve moms who didn't know they were infected. Could you give more information on this?

    - No name given

  • December 12, 2008 9:02 p.m.

    Try lLysine. It has worked for me for years. It shuts down an attack. Without it I have an attack.

    - Old Lady

  • December 10, 2008 7:48 a.m.

    I have been on Acyclovir 200, once daily for about 10 years. In that time I have only had 3 outbreaks. I was diagnosed with MS in 2006. My GYN has suggested, with so few outbreaks, I should only take the Acyclovir when I have an outbreak. Is this a good idea?

    - confused

  • December 9, 2008 8:12 p.m.

    This is important information. I am HSV-2 positive. Yet, three doctors said that it was just a rash. I got a blood test which confirmed my suspisions. Males can get the rash anywhere, including the buttock and leg. My outbreaks occur about 8 times a year on my buttock and go away in about 2 weeks, but may leave a red mark which eventually fades away.

    - Frank

  • December 9, 2008 6:17 p.m.

    Ive never had an outbreak. Do I shed the virus less due to that fact?

    - michelle

  • December 9, 2008 2:36 p.m.

    Do condoms have to be latex to prevent the spread of HSV or other STDs? What about the new silicone-type or others?

    - Beth

  • December 9, 2008 10:55 a.m.

    Hello! I want to respond to many of your comments. New Mom-please have your son tested! Unless you have already had a blood test that confirms he has herpes, I am not convinced that he has it. Many people,including providers, are confused, thinking sores inside the mouth with a flu or cold are herpes. Usually they are not! You may have been given some bad information. MILW-You still need to protect your partners. Even though you have not had an outbreak for many years, this virus can be activated at any time. Also, you may not have obvious outbreaks but you could still be shedding the virus without symptoms. Vanessa-we have not discussed that the virus can appear in unusual places on the body. I would suppress as you don't know if you are shedding without symptoms from your genital area. Elaine-you and your husband should have a blood test. If you both have HSV 1, he could have exposed you during sex. Jennifer and Deb-your questions about treatment are addressed on the next blog. It should be available soon.

    - Lois McGuire

  • December 8, 2008 9:05 a.m.

    I hope you will discuss the longterm effects on non treatment. Pregnant mothers and the effects on children. And my a reason why its so hard to find a cure!

    - -Very Careful

  • December 5, 2008 7:01 p.m.

    Thank you for your excellent blogs and responses on this topic. There's so much misinformation out there. And with the number of infected people, it's clearly something everyone should understand. I am glad you'll be discussing prevention next. I'm curious what the rates/risk of transmission are depending on active outbreak vs in-between outbreaks, whether you're less likely to transmit the disease if you've had it for a very long time, and whether there's any difference in rates/risks of transmission during oral sex vs intercourse.

    - Careful

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