Herpes Questions and Answers / Telling Your Partner
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- What Is Herpes?
- What Causes Herpes?
- What Happens When You First Get Genital Herpes?
- How Long Does a ?First Episode? Last?
- What Are the Symptoms of Recurrent Genital Herpes?
- Does Everyone with Herpes Have Symptoms?
- Can Herpes Be Active Without Causing Symptoms
- How Often Is Herpes Active?
- What Causes Recurrences?
- How Is Herpes Transmitted?
- How Can One Reduce the Risk of Transmitting Herpes
to a Partner?
- How Can I Get Tested for Herpes?
- What About Treatment?
- Will Herpes Spread to Other Places on My Body?
- What About Pregnancy?
- Why Tell?
- How Do You Start?
What Is Herpes?
Herpes is a common and usually mild infection. It can cause "cold sores"
or "fever blisters" on the mouth or face (known as "oral herpes") and
similar symptoms in the genital area ("genital herpes").
What Causes Herpes?
Herpes is caused by one of two viruses: herpes simplex type 1 (HSV-1)
and herpes simplex type 2 (HSV-2). Herpes is different from many other
common viral infections in several ways. Most importantly, herpes sets
up a lifelong presence in the body, called "latency." The virus can travel
the nerve pathways in a particular part of the body and hide away--virtually
sleeping--in the nerve roots for long periods of time. This means that
even though HSV may not be causing "cold sores" or genital symptoms at
a given time, it can still cause symptoms later. What
Happens When You First Get Genital Herpes?
When a person is first infected with HSV-1 or HSV-2, the immune response
is not well developed. This means the virus is able to multiply more rapidly
and in more places than it can later. Symptoms during a first episode,
therefore, can be severe for some people. First episodes of herpes usually
occur within two weeks after the virus is transmitted.
On the other hand, some people have a first episode so mild they don't
even notice it. It may be a later episode, or "reactivation," that is
first noticed months or years later.
How Long Does a ?First Episode? Last?
Many people experience their most dramatic symptoms of HSV shortly after
becoming infected. This "first episode" frequently causes small pimples
or blisters that eventually crust over and scab like a small cut. But the
signs of herpes vary greatly. They may be obvious or hard to see, painful
or easily ignored.
First episodes may take from two to four weeks to heal fully. During
this time, some people will experience a second crop of lesions, and some
will have flu-like symptoms, including fever and swollen glands, particularly
in the lymph nodes near the groin.
Treatment with antiviral drugs during first episodes can speed healing
significantly.
What Are the Symptoms of Recurrent Genital Herpes?
Symptoms of genital herpes vary greatly from one episode to the next, and
from one person to the next. Some people will notice small sores; others
will have so-called "classic" blister-like lesions that crust over. In recurrent
herpes, this process usually takes less than half the time a first episode
does.
In addition, many people have very subtle forms of recurrent herpes that
can heal up in a matter of days. These can be mistaken for insect bites,
abrasions, yeast, "jock itch," hemorrhoids and other conditions. These
symptoms can be found not only on the penis and vulva, but near the anus,
on the thigh, on the buttocks--anywhere in or around the genital area.
Right before 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 precedes lesions
by a day or two. In some people, prodrome will involve pain in the buttocks,
the back of the legs, or even lower back.
Does Everyone with Herpes Have Symptoms?
Some people who have latent infection never experience herpes prodrome or
genital lesions. In addition, many people have such mild symptoms that they
may not recognize the infection for many years.
About one in five adults in the United States has genital herpes. Two-thirds
of these people have not been diagnosed and are unaware they have it.
Can Herpes Be Active Without Causing Symptoms?
It used to be thought that all of HSV's active times were marked by "outbreaks"--a
sore, a blister or some other kind of symptom, like an itch. Then researchers
learned that the virus could become active without causing symptoms. This
is often called "asymptomatic shedding." Another term for it might simply
be "unrecognized" herpes.
The term "unrecognized" is important for three reasons: 1) some lesions
are not seen because they occur in places we simply never look; 2) some
are mistaken for something else--an ingrown hair, for example; and 3)
some can't be seen at all with the naked eye.
Even if you're a person with recurring symptoms that you can usually
recognize as herpes, it is very likely there will be days when you won't
be aware that the virus has reactivated and traveled to the skin.
How Often Is Herpes Active?
Reactivation is influenced by HSV type and by how long one has been infected.
HSV-2
People with a marked first episode caused by HSV-2 can expect to
have several outbreaks a year. Most people have four or five outbreaks
a year, but these outbreaks are not as severe as the as the first
episode. In addition, people with HSV-2 can expect to have recurrences
that do not cause symptoms. These probably occur less often than
symptomatic outbreaks but account for about a third of all reactivation.
In most cases, the first year has the most viral activity.
HSV-1
HSV-1 behaves quite differently in the genital area. With type
1 infection, people may have a marked first episode, but they are
much less likely to have recurrent outbreaks. The average number
of outbreaks is about one per year. The rates of unrecognized reactivation
are lower as well.
What Causes Recurrences?
Herpes' triggers are not well understood but appear to be highly individual.
Prolonged exposure to strong sunlight can trigger oral herpes (as on a beach
trip, or skiing weekend). Known triggers for genital herpes include surgical
trauma and excessive friction in the genital area. With time, many people
come to recognize whatever physical or psychological stressor seems to trigger
HSV in their own bodies.
How Is Herpes Transmitted?
Herpes is spread by direct skin-to-skin contact. For example, if you have
a cold sore and kiss someone, you can transfer the virus from your mouth
to theirs. If you have active genital herpes and have vaginal or anal intercourse,
you can transfer the virus from your genitals to your partner's genitals.
Finally, if you have a cold sore and put your mouth on your partner's genitals
(oral sex), you can give your partner genital herpes.
Herpes also can be spread through sexual contact at times when there
are no obvious symptoms. Herpes is often transmitted by people who do
not know they are infected, or by people who simply don't recognize that
their herpes infection is in its active phase.
How Can One Reduce the Risk of Transmitting Herpes
to a Partner?
- Tell your partner: Ideally, both partners will understand the basics
of herpes prevention and make decisions together about which precautions
are right for them.
- Abstain from sex when symptoms are present: Having sex during an outbreak
puts an uninfected partner at risk.
- Use condoms between outbreaks: Condoms help protect against unrecognized
herpes (asymptomatic shedding) by covering the mucous membranes that
are the most likely sites of transmission. They can also help prevent
other sexually transmitted infections. Condoms do not provide 100 percent
protection because a lesion may be in a place the condom doesn't cover.
But, used consistently, they are the best available form of prevention.
- Medication? If taken daily, antiviral medication helps prevent outbreaks
and reduce the recurrence of virus on the skin. Early studies show that
suppressive therapy may reduce the risk of transmission. Further studies
are underway to find out for sure.
- Microbicides/Spermicides? The spermicides used in contraceptive foams,
films and gels kill HSV in lab tests. It is not known whether spermicides
can help prevent transmission of herpes. Don't use more than the recommended
dose. Spermicides should be used with condoms--not in place of them.
How Can I Get Tested for Herpes?
If you have symptoms, see a healthcare provider as soon as possible. Your
provider will look at the area, take a sample from the sore(s) and test
to see if the herpes virus is present. The test you should request is a
specific culture for HSV. This will tell you whether you have HSV-1 or HSV-2.
The test will not work if the sores have healed. It might not work if they're
more than a few days old.
If you don?t have symptoms, accurate, type-specific blood tests, like
POCkit(TM) or Premier(TM),
are available. It is important to know what kind of test to ask for because
many blood tests can easily mistake other herpes viruses (like chicken
pox) for herpes simplex virus. This can cause false-positive test results.
You can find out more information on how to obtain an accurate, type-specific
blood test by calling ASHA's National Herpes Hotline at (919) 361-8488.
What About Treatment?
No treatment can cure herpes, but medicines can help to keep the virus in
check. Three prescription medicines are currently approved for genital herpes.
Acyclovir, (Zovirax(R)), has been used for over a decade and is now available
in a generic form. Valacyclovir (Valtrex(R) uses acyclovir as its active
ingredient, but is better absorbed by the body and can be taken less often.
Famciclovir (Famvir(R)) works much the same way acyclovir does, but is
also better absorbed and can be taken less often. All three drugs are
similar in terms of how well they work. The major difference is how often
the drugs must be taken.
These drugs are safe and have virtually no side effects. Acyclovir and
famciclovir are available as a cream, but for genital herpes the capsules
or tablets work much better.
Episodic Therapy: This means taking medicine during an outbreak to speed
healing. A person begins taking medicine at the first sign of prodrome
and continues every day for three to five days. This can shorten a recurrent
outbreak by about two days. If you choose episodic therapy, ask your doctor
for a prescription and have it filled before an outbreak. Then you can
start taking medicine as soon as symptoms begin.
Suppressive Therapy: This means taking medicine every day to help prevent
symptoms. Suppressive therapy greatly reduces the number of outbreaks
for most people. It can prevent outbreaks altogether for some. It can
also greatly reduce asymptomatic shedding (the recurrence of virus on
the skin). Studies are under way to find out whether suppressive therapy
can help prevent transmission.
Antiviral medicine can help newly diagnosed people regain a feeling of
control over their lives. It can bring great relief to people who have
frequent or bothersome outbreaks. However, most people with herpes don?t
feel the need to take medicine because their outbreaks are mild. Talk
with you healthcare provider about what is right for you.
Will Herpes Spread to Other Places on My Body?
During a first episode, it's possible to move virus from the location
of an outbreak to other places on the body by touching the sore(s). The
fingers, eyes and other body areas can become infected in this way. Preventing
self-infection is simple: Do not touch the sores during an outbreak--especially
the first outbreak. If you do, wash your hands as soon as possible. The
herpes virus is easily killed with soap and water.
What About Pregnancy?
Transmission of herpes to newborns is rare, and most mothers with a history
of herpes have normal vaginal deliveries. However, an infant who gets
herpes can become very ill, so some precautions are advisable. When a
woman has an outbreak at the time of delivery, a cesarean section is usually
performed.
If you have herpes, it is important to talk with your healthcare provider
about it during a prenatal visit. This is important even if you've never
had symptoms or haven't had a recurrence in a long time. You should be
examined to see if you have herpes symptoms at labor and should tell the
doctor if you think you have active symptoms at that time.
If a woman has no history of herpes but has a sexual partner who does,
it's important that she avoid contracting herpes during pregnancy. A first
episode during pregnancy creates the most serious risk to the baby.
Telling Your Partner about Herpes
Telling a partner about herpes--especially the first time--can be one
of the most difficult aspects of having the infection. Telling can involve
risking rejection, facing social stigma and revealing a very personal
part of yourself. But it can also be a key step toward creating a relationship
built on honesty and acceptance.
How your partner responds to information about herpes is basically up
to him or her. But there are things you can do to shape your message and
how it is heard. Once you know what to say and how you want to say it,
you'll be able to tell your partner in your own way and at the right time.
Why Tell?
Some people don't--or don?t tell every partner. But there are many reasons
why it's important that herpes doesn't become a secret locked away from
your partner.
The first reason is that telling your partner allows him or her to make
an informed choice. By telling, you are showing respect for your partner
and concern for his or her well being. Your honesty may increase intimacy
and trust.
Telling also makes it much easier for you to avoid transmitting herpes.
If you keep herpes a secret, you may find yourself inventing lies and
half-truths to postpone sex during outbreaks. Ideally, you and your partner
will make decisions together about how to prevent transmission.
Equally important, talking about herpes can be the start of an important
discussion about sexual health. Herpes is one of more than 20 sexually
transmitted infections, and others have more far-reaching health consequences.
Your honesty encourages your partner to share information about his or
her sexual history with you.
Finally, telling your partner can prevent future misunderstandings or
the threat of legal action.
Before You Start
Before you can tell a partner you have herpes, you must begin with yourself.
Decide if you have come to terms with having herpes. If you haven't, it?s
unrealistic to expect this of another person. Also, do you know enough
about herpes? Do you know how to lower your partner?s risk? You need to
be sure about the facts before you can explain them to a partner. If you
need help with any of these questions, call the National Herpes Hotline
at (919) 361-8488 or visit the American Social Health Association's Web
site at www.ashastd.org.
Getting Ready
Knowing when and where to discuss the subject may make the difference
in communicating successfully with your partner.
- Get to know your partner. Decide if he or she is open-minded enough
for you to confide in.
- Let your partner get to know the real you.
- Don?t wait until you are sexually intimate to tell your partner. If
you wait until after sex, the issue of herpes may become tangled in
feelings of anger and mistrust.
- Practice what you will say to a close friend or relative, or maybe
to yourself in front of a mirror.
- Pick a neutral setting and a time when you won't be interrupted.
- Try to remember you are not lecturing or confessing, but simply sharing
personal information.
- Try to remain natural and confident. If you are upset, your partner
might think herpes is worse than it is.
- Expect that your partner will be accepting and supportive. People
tend to behave the way you expect them to behave.
How Do You Start?
You may wonder how to start such a personal conversation. Everyone is
different, but you may want to think about these suggestions and mold
them to fit you and what you want to say.
- "I really enjoy being with you, and I want to get closer to you. Let's
talk about safer sex."
- "I really feel I can trust you, and I'd like to tell you something
very personal. Last year, I found out that I have genital herpes."
- "I have something I'd like to talk to you about. Have you ever had
a cold sore or fever blister? The reason I ask is that cold sores are
caused by a type of virus. I have this virus. Only instead of getting
sores near my mouth, I get them in my genital area."
What to Expect
What happens when you tell your partner? Everyone is different. Some people
will not bat an eye. Others will overreact no matter what you say or how
you say it. Whatever happens, give your partner time to think about what
you have said. Remember that it took you time to adjust when you first
found out you had herpes.
In the end, most people will react well. Most will respect and appreciate
the fact that you trusted them enough to share such a confidence with
them. With the proper approach and information, herpes can be put into
perspective: an annoying, recurrent skin condition that is treatable and
manageable--no more, no less.
The Herpes Resource Center (HRC) provides up-to-date, sensitive and accurate
information about all aspects of herpes. The HRC, a service of the American
Social Health Association (ASHA), offers practical, nonjudgmental information
for the general public, media and medical community.
Source © 2000 American Social Health Association
May not be reproduced without written permission
For More Information
For Additional Information or to order brochures containing the previous
information:
E-mail: info@diagnology.com
or visit Diagnology.
American Social Health Association,
a not for profit organization, is America?s leading authority on STD patient
education and advocacy since 1914. Its National Herpes Resource Center,
established over 20 years ago, offers support through a hotline, newsletter,
books, tapes, pamphlets and Web sites.
For Teens
National Herpes Hotline
(919) 361-8488 Monday-Friday, 9 a.m. to 7 p.m. (EST)
National STD Hotline
(800) 227-8922 Monday-Friday, 8 a.m. to 11 p.m. (EST)
This brochure was made possible by an unrestricted educational grant
from Diagnology Inc.
