Herpes - American Sexual Health Association


Do you have a question about herpes that you’d like to ask our experts? Email us and then check back to see if your question has been chosen. Please note that not all questions will be selected.

I have had genital herpes since I was a teen-ager. I’m in my 30s now and pregnant with my first child; is my baby at risk? I’m terrified about giving my baby herpes!

Our expert says...
First, the risk of your baby getting herpes is almost certainly very, very low. Women with genital herpes most often have normal pregnancies and deliver healthy babies, especially if the infection is long-standing: the mother’s immune system responds to the virus and helps protect the baby. The risk of transmission is highest among women who are infected with genital HSV close to the time of delivery. The lack of an immune response to share with the baby—and the large amounts of virus shed during first outbreaks—combine to put the baby at risk.

The important thing is to make sure your healthcare provider(s) are aware that you have a history of genital herpes, so they can examine you closely when you deliver your baby, to see if any genital lesions are present.

Experts debate whether or not pregnant women should use medications for herpes. There’s no indication that using these medications during pregnancy causes problems or birth defects, but their safety in pregnant women isn’t really well understood. Women with severe outbreaks can be treated with the drug acyclovir. Ask your healthcare provider what he or she recommends.

One other note: experts recommend that if at all possible, it’s best not to use fetal scalp monitors with babies born to mothers with genital herpes. This is because the monitors can cause small cuts in the infant’s scalp, which might provide HSV a way to enter if the baby is exposed.

Visit the HRC online for a detailed discussion of herpes and pregnancy.

–The STI Resource Center Staff

Is it possible for the herpes simplex 1 to turn into the herpes simplex II? Is it possible to test negative for both types and then test positive a few months later, even without an outbreak? What about having a “false” positive test result?

Our expert says...
Herpes simplex virus-1 (HSV-1) is similar to herpes simplex virus-2 (HSV-2), with the main difference being that HSV-1 is most often experienced as an oral/facial infection while HSV-2 is more commonly related to genital herpes. The two types don’t somehow change into the other type. It is true that either type can infect genital or oral skin, which can cause confusion. HSV-2 rarely infects oral tissue, though, and a blood test positive for HSV-2 typically indicates that an individual has genital herpes, even if they’ve never experienced symptoms.

Blood tests also can be used when a person has no visible symptoms but has concerns about having herpes. Blood tests do not actually detect the virus; instead, they look for antibodies (the body’s immune response) in the blood.

The accurate herpes blood tests—known as type-specific blood tests or serology—detect IgG antibodies. Unlike IgM antibodies, IgG antibodies can be accurately broken down to either HSV-1 or HSV-2. Research (RA Morrow et al., 2002 and 2005) corroborates this finding: labs that used non-gG-based tests (“non-specific” tests) for herpes had high false-positive rates for HSV-2 antibodies. But 100% of the labs using gG-based tests (“type-specific” tests) accurately reported that the blood sample was negative for HSV-2.

The challenge here is that the time it takes for IgG antibodies to reach detectable levels after initial infection can vary from person to person. For one person, it could take just a few weeks, while it could take a few months for another. So even with the accurate tests, a person could receive a false negative if the test is taken too soon after contracting the virus. For the most accurate test result, it is recommended to wait 12 – 16 weeks from the last possible date of exposure before getting an accurate, type-specific blood test in order to allow enough time for antibodies to reach detectable levels. False positives are rare with type-specific blood tests when used in this manner.

–Gary A. Richwald, MD, MPH

I have been living with both genital herpes and genital warts for many years, but I only recently learned about asymptomatic shedding. I was originally told I could only pass the virus on when I had an active outbreak, and have never understood how someone can have herpes and not experience symptoms.

Our expert says...
First of all, it’s important to separate genital herpes from genital warts. Both are caused by viruses. However, the viruses are different, and they cause different kinds of symptoms.

Genital herpes is caused by two related but different herpes viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Infections with HSV-1 are very common (about 75% of adults, depending on age and where you live) and usually cause an infection with few symptoms: most people never know they have it. HSV-1 infections can be passed during sex from one person to another, but it can also be passed by other types of contact as well. If people do have symptoms of HSV-1 infection, it is often with recurrent sores around their lips and mouth, commonly known as “cold sores” or “fever blisters.”

HSV-1 often causes genital herpes outbreaks. When it does, it is often only once. Then, the person never has another outbreak even though they still have the herpes infection. Their sex partners don’t get this infection because HSV-1 infections are already so common. This may explain your story because weve only known how to do specific tests for HSV-1 and HSV-2 for the past few years.

HSV-2 is different. HSV-2 infections are less common than HSV-1. However, about 25% – 30% of adults in the United States have an HSV-2 infection. HSV-2 infections are what people are usually thinking about when they talk about genital herpes. It is usually passed between people by sexual contact. However, most people with HSV-2 don’t know they have it either. Some people, however, get genital herpes outbreaks, often several times each year.

Genital warts are usually caused by human papilloma viruses (HPV). There are more than 100 types of these viruses, but only two of these types cause most cases of genital warts. Other HPV types cause several different types of genital and head/neck cancer. Although we are still learning more about HPV infections, most people with genital warts get over them without any complications. It’s important to know, however, that a vaccine is now recommended for almost all young women between ages 9 and 26 years that will prevent HPV infections by the two types that cause most genital warts, as well as the two types that cause most cancers.

–J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

I contracted HSV-2 some 30 years ago. Now as a female of 54 I have unfortunately given it to my dating partner of one year. He is very concerned about several things: 1. We think I gave it to him because after four years of my being daily medication, my new doctor told me to quit taking it and just take it in the event of an outbreak. A month later my partner contracted it from me and had a herpes outbreak 2. Do we always have to use condoms or can we re-infect each other and cause outbreaks? 3. How about oral sex? Can we never have oral sex without the worry of transmitting it to one another?

Our expert says...
The use of medication to prevent transmission of genital herpes to an uninfected partner works well (reduction of transmission by about 50% or more). But the medication must be taken every day. If it is stopped and used only instead to shorten outbreaks (“episodic therapy”), the protective effect goes away. Although you may have given him genital herpes, it is possible that he was asymptomatically infected before he met you or even while you were having sex with him a while ago, and only now has he become symptomatic and had his first outbreak.
Once you are both infected with the same type of the virus (HSV-2 presumably in your situation), there is no need to use condoms or any other protection from herpes transmission since you cannot give someone “more” herpes infection.

If you are both infected with genital HSV-2 it is very unlikely that you can acquire HSV-1 genitally from someone else’s mouth during oral sex. Also, it is difficult to acquire HSV-2 in your mouth from someone else’s genital area that is infected with HSV-2.

–Gary A. Richwald, MD, MPH

I’m only 15. I was in a serious relationship for two years with this guy but out of anger I let another guy perform oral sex on me. I haven’t had sexual intercourse for over 5 months but now am starting to think I have herpes because my vagina has been very irritated and red and maybe a little swollen. I have looked at pictures of herpes but what I see doesn’t look the same. Do I have an STD? Does this sound like herpes?

Our expert says...
Trying to figure out what symptoms mean can really make people nervous, because some of the symptoms of herpes and other STDs seem the same. This makes it all the more important that you visit a health care provider if you think you have an STD. What you described doesn’t necessarily sound like typical herpes symptoms, but it is still important to go see your health care provider. It’s okay to tell your health care provider that you’re really worried about herpes. You may want to ask for a herpes culture test if you have any open sores or bumps on your genitalia. Some providers may be able to do a blood test to see if you have herpes. Other tests for chlamydia, gonorrhea, or even a yeast infection, could help you understand your symptoms, get the right treatment, and help put your mind at ease. While it is possible to get genital herpes from oral, vaginal, and anal sex, the only way to know for sure is to get tested for herpes and other STDs. Getting everything checked out can also be a good time to plan how to be safe and healthy the next time you have any kind of sex.

–J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

When should you tell your partner that you have herpes? Is it a law to tell him or just a moral issue? If he wears a condom is it necessary to tell him that you have herpes, or is it ok to discuss before unprotected sex?

Our expert says...
You should discuss herpes with a new sex partner. Doing so not only shows them respect, it gives you both the chance to talk about sexual health and ways to protect yourselves. And depending on your state’s laws, there may be legal obligation to discuss a herpes diagnosis. Telling a partner can be difficult, I understand. First, have you come to terms yourself with having herpes? If you haven’t, then it’s unrealistic to expect another person to understand. How well informed are you? Know the basic steps to reduce the risk to your partner. Know the facts about herpes? You want to feel confident and knowledgeable before you can explain the infection to someone else.

Keep these points in mind:

  • No sex during outbreaks.
  • Herpes can be transmitted without any noticeable symptoms, though, so it’s a good idea to use condoms at all times. Condom use can reduce, but not 100% eliminate, the risks of transmitting herpes and other STIs.
  • Daily therapy with an antiviral medication, Valtrex, has shown to reduce transmission rates by about half. Discuss this with your health care provider to see what they might recommend for you.
  • Many couples (where one partner has herpes and the other doesn’t) manage the virus with minimal impact on their relationship. The two big keys in this are education and communication, and you’ve taken great first steps with both.

I suggest you say to your new sex partner the following “I care about you. That’s why I want to let you know that I have herpes. My healthcare provider is __________ and he/she will be happy to talk with you if you would like.”

–Versie Johnson-Mallard, PhD, RN, APRN, WHNP-BC

I have recently been diagnosed with genital herpes. My doctor has advised me to monitor how often I get outbreaks before determining if I should go on a daily medication (or just take it when I feel an outbreak coming on). Although I trust my doctor, I keep reading different things on line. Should I or shouldn’t I take a daily medication? My partner is a little uncertain and nervous and I am trying to reassure him, but I need some reassurance myself!

Our expert says...
The specific course of herpes treatment depends on the individual. For those with few or very mild outbreaks, treatment may not be needed at all. For others, taking an antiviral medication during an outbreak can shorten the duration of symptoms and speed healing. It can also be useful to know if your genital herpes is caused by HSV-1 or HSV-2. Your doctor could test a sample from a sore during an outbreak, or could obtain a blood test for HSV-2 between outbreaks.

In some cases, usually with a person experiencing frequent episodes of symptoms, it’s often desirable to take medication daily. This approach, known as suppressive therapy, has shown to stop approximately 75% of outbreaks for most. It’s important to discuss your feelings and experiences about these outbreaks with your doctor because some people experience a great deal of distress and discomfort with even a few outbreaks in a year. Others would find it very difficult to take a medication every day unless the outbreaks were quite frequent.

If your partner has not yet been tested for HSV-2, a blood test can be done to better understand your partner’s risk for developing genital herpes. If you’re both positive for HSV-2, there’s little reason to worry about issues of transmission or reinfection. Both you and your partner should remember that most people with HSV-2 don’t even know it. Discussing the results can help both you and your partner have a better understanding of your choices for treatment and prevention.

While HSV is most contagious during outbreaks, the virus can be transmitted even with no symptoms present. If your partner doesn’t have HSV-2, there are ways you can reduce his risk of acquiring the virus from you. The first is obvious, simply not having sex while you’re experiencing any symptoms of herpes (including itching or tingling that can precede an outbreak).

Condoms and dental dams can also reduce the risk, but aren’t fully protective here, as HSV can be present on skin a condom or dental dam won’t cover.

In addition to reducing the number of outbreaks, daily suppressive therapy with an HSV antiviral drug can reduce the risk of transmission to a partner significantly. Studies with one medication, Valtrex®, showed a daily use can reduce the likelihood of transmitting HSV-2 to a partner by about half. This approach can be especially valuable to couples in long-term relationships who don’t want to use condoms and dental dams.

–J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

I’m a very well educated professional woman, with a successful career and 2 great kids. I’ve been seeing a man who I thought was a great guy. We’ve known each other for about 2 years and our relationship recently became sexual. Five days later, I was sick in a way I’d never been before—with a high fever, painful urination, and then a rash that covered most of my genital area. My doctor said it could been a few different things, but the test for herpes came back positive for HSV-2. I asked my partner if he had ever had symptoms. He said no. I suggested he visit his doctor to be tested. He hasn’t spoken to me since. When I asked about the test results, he texted me that his results came back negative, but his doctor put him on antibiotics (which doesn’t make any sense to me). I’m not sure if he’s telling the truth. I remain unsure how I contracted the disease.

I’m devastated and have been mourning the loss of my sexuality. I can’t visualize myself trusting anyone enough to tell them I have herpes. Am I leading someone on if I accept a date without telling them about my condition?

Our expert says...
The emotional response when one is first diagnosed with genital HSV can be difficult, but in most cases the impact is fairly short-lived. A key to this is getting good information and seeking the support you need, so we’re glad you found ASHA.

A diagnosis of genital herpes is in no way the end of sex and romance, and don’t let anyone tell you otherwise! There are options couples can take –including condom use and medication- that can reduce the risk of transmission to a partner who doesn’t have the virus. Keep in mind that genital HSV-2 is very common (about 1 in 5 Americans are estimated to have the virus) but 80% or more of these infections are undiagnosed and not recognized, so a new partner may have genital herpes and not even know.

You have no obligation at all to inform someone of your diagnosis before the first date, but it’s a good idea to talk about herpes within the context of sexual health before becoming sexually active with someone. Click here for tips on how to talk about sexual health (including herpes) with a new partner. Keep in mind that you haven’t done anything wrong.

–The Herpes Resource Center Staff

I read on your website that the herpes virus does not last very long outside the body. I’m sending you two studies I found online that suggest HSV can live for two hours at room temperature. Which information is correct? It seems to me bathrooms might be a real risk.

Our expert says...
Research suggests HSV outside the body begins to degrade fairly quickly. The real issue is whether or not herpes virus on objects poses a risk for transmission: let us assure you there is no documentation that HSV has ever been contracted through inanimate objects. In the book ASHA publishes, Managing Herpes, the authors write:

Can you get herpes from a toilet seat, for example, or a dirty towel? The basic answer on the risk of getting herpes from inanimate objects like these is something along the lines of “generally impossible.” The main reason for this goes back to our earlier discussion about transmission, about skin to skin contact, and about the likely places where herpes can take hold. If you rubbed a herpes sore against a towel, for instance, some of the herpes simplex virus could be deposited onto the towel. The virus may persist outside the body for several hours, but soon it begins to lose its ability to invade and colonize new cells.

While the possibility of HSV transmission through objects cannot be discounted, experts do believe the risks are slight. A common sense approach will suffice: with the example mentioned above, it might be smart not to dry you face with a towel immediately after using it to dry an area that has herpes lesions. Again, let us stress the risk here is minimal at best, and don’t lose sleep over “what if…” scenarios. It’s also a good idea not to use or share sex toys during outbreaks, and to clean them thoroughly after each use.

–The Herpes Resource Center Staff

Excerpt taken from: C Ebel, A Wald. Managing Herpes, pp. 62-63. (c) American Social Health Association, 2009. Available for purchase online.

I was just diagnosed with genital herpes. I take care of my toddler and am worried about giving him the virus. Everything I have read says that you get herpes by ‘skin to skin’ contact. However I’m not sure exactly what types of contact this might involve. Can I shake people’s hands, hold my daughter, play pat-a-cake? Or am I a walking virus infecting everything I touch? Can I actually get herpes on my hands? Help!

Our expert says...
Herpes is transmitted through direct skin-to-skin contact. This occurs when a contagious area comes into contact with a tiny break in the skin or mucous membrane tissue, primarily the mouth and genitals

Herpes simplex virus (HSV) has evolved in a way that makes the virus more likely to become established in certain skin areas, primarily the soft, moist skin of the genitals, cervix, anus, and mouth. Other skin areas (like the arms and hands) are typically too tough for the virus to penetrate and establish itself in the nerve pathways. It’s not impossible for skin other than the anogenital and oral areas to become infected, but when this happens it most likely the result of damage to the skin that provided an opening for the virus; such infections are not common.

Transmission via hands is very unlikely but use common sense; if you touch an active blister, simply wash your hands before, say, rubbing your eye or touching your daughter. Do not worry excessively about this manner of transmission.

–The STI Resource Center Staff

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