Journal

Living With Herpes

Many feel anxious when they hear the word “herpes.” As a society, we tend to make jokes about herpes, rather than take it seriously. Perhaps because of this attitude, a good deal of confusion exists about herpes and how it's different from other types of common sexually transmissible infections (STIs).

Herpes is a viral STI, which means it's caused by a virus rather than bacteria, as many other STIs are. As a result, herpes cannot be treated with antibiotics, and the virus remains in a person's immune system for life. Depending on which area of the body a person has acquired a herpes infection in, herpes may cause symptoms in, on or around the mouth, genitals and/or anus. Not all who contract the herpes virus develop symptoms, however—in fact, two-thirds of those with herpes carry the virus and never know it.

Nearly 50 million Americans, or 20 percent, carry the virus for genital herpes and anywhere from 50 to 80 percent carry the virus for oral herpes. As a result, just about all of us are going to deal with this common STI at one time or another. Whether it be a romantic partner, a friend, or ourselves, it's important to know the facts about herpes and how to have a healthy, safe and enjoyable sex life, while minimizing the risk of transmission.

Table of Contents

The difference between genital herpes and oral herpes.

Ever noticed how friends or coworkers will complain that they are getting a cold sore, but no one ever announces when they are suffering from a genital herpes outbreak? There is a stigma attached to genital herpes, while oral herpes is the subject of casual conversation and benignly referred to as “cold sores.”

The truth is, both types of herpes are caused by similar viruses, which can cause breakouts in, on or around the mouth, genitals and anus depending on where one is infected. Oral herpes is most often caused by the herpes simplex virus-1 (HSV1). Genital herpes is most often caused by the herpes simplex virus-2 (HSV2). Both viruses, however, can cause breakouts in both areas, if one is infected on that area. A partner with oral herpes may transmit the HSV1 to a partner's genitals while performing oral sex, and that partner may then develop symptoms as genital herpes, and vice versa. More commonly, neither partner gets any symptoms, or else they may mistake their symptoms for something else. Many who contract one or both herpes viruses never show any symptoms and, therefore, never know they have it.

Herpes is always transmitted through oral or genital contact with the virus. This may include, oral sex, vaginal sex, anal sex and skin-to-skin contact when the virus is active on a person's mouth or genitals. The herpes virus isn't always active, but it can be even when no symptoms are present—part of the reason that herpes is so common.

Ultimately, it's important to recognize the similarities between genital herpes and oral herpes, and focus on treatment and prevention.

How to talk about genital herpes with a new partner.

Many single people with genital herpes struggle with when and how to tell a new partner that they have this common sexually transmitted infection (STI). Some worry that they will lead a partner on by not being honest from the start, while others all but assume they will be rejected if a partner learns they have herpes and, as a result, may avoid the issue for some time. Perhaps unfairly, those with oral herpes do not struggle with the same concerns, even though there is little difference between the two forms of herpes except for location (see The Difference Between Genital Herpes and Oral Herpes [link]).

For many, the right time to talk about genital herpes with a new partner is when you both feel ready to start a sexual relationship, or earlier if you are more comfortable bringing up the conversation well before you may begin a sexual relationship. In most cases, however, there's no reason to share you have genital herpes, or any other particularly sensitive issue, too early in a relationship before you have had a chance to get to know each other and develop trust; it may be a moot point if a relationship doesn't develop.

When you do decide to bring up herpes, keep the conversation relatively brief, offer to answer any questions, and say you're willing to provide more information or go on the Web together to read about it. Reassure a partner that there are easy ways to reduce the chances of passing genital herpes to him or her—with medication, safer sex practices, and abstinence before and during outbreaks.

Also, it's important for those with genital herpes to take care of themselves, too. Make sure you feel safe and comfortable with someone, before you share that you have genital herpes and consider beginning a sexual relationship.

Genital herpes and oral sex.

Many believe they are safe from genital herpes if they abstain from intercourse. However, contact with the herpes virus during oral sex can infect a person with genital herpes, oral herpes or both.

Herpes is caused by two different viruses (see The Difference Between Genital Herpes and Oral Herpes [link]), which are active on a person's skin. Not everyone with oral herpes or genital herpes knows when they are contagious. The herpes virus may be spread even when there are no visible lesions, through a process known as shedding.

As a result, a person with oral herpes, or cold sores as they are commonly called, who performs oral sex on a partner may transmit the virus to them. Likewise, a person with genital herpes may transmit the virus to a partner who performs oral sex on them.

Using condoms and dental dams can minimize the risk of transmitting herpes, though not eliminate it, as can medication to manage herpes outbreaks, abstinence during outbreaks and healthy lifestyle choices to help the immune system fight the virus. (See also: Condoms offer some protection against genital herpes [link].) Remember, the majority of those with herpes never know they have it, because they've never have a noticeable outbreak.

Related reading: When herpes is contagious.

Genital herpes and dating.

Many worry about the future of their love life after a genital herpes diagnosis. They wonder how they'll share the information with new partners. Or they worry about passing herpes on to a partner.

The fact is, everyone has past complication that's going to come up with a new partner. Dating and mating with genital herpes simply requires a little more planning and a lot more education—for both partners. It's important for someone with herpes to learn about how to minimize the chance of passing herpes to a partner and put these practices to work in his or her sex life. And there's no reason to talk with a new partner about herpes until you think you may be heading for a sexual relationship.

Some are open-minded about dating someone with herpes, while others are not. Herpes simply becomes one more bit of information evaluated for compatibility and a shared willingness to move forward with the relationship. If you simply feel too uncomfortable with the thought of discussing herpes with an unaffected partner, consider online support groups where those with herpes meet each other, both for friendship and dating. These sites can be a good way to ease back into the world of dating.

When herpes is contagious.

The herpes virus is most contagious during and just before a person has an outbreak. Herpes outbreaks often appear as a rash, bumps or one or more sores around the genitals or the mouth, which can progress to blisters. Initial outbreaks are sometimes associated with fevers and flu-like symptoms. If you see anything appearing like that on yourself or a partner, avoid sexual contact, including kissing if the symptoms are on the face.

Even if there are no visible lesions, herpes can be spread through a process known as shedding. During shedding, the herpes virus is active on the skin, usually where the person has had symptoms before. As a result, any type of genital, oral or skin-to-skin contact with the virus may transmit it. There is no way to know when another person is shedding, but safer sex practices significantly minimize the risk of contracting herpes. (See also: Condoms offer some protection against genital herpes [link].)

The good news is many options exist for managing herpes and significantly eliminating the risk of transmitting it to a partner. Several prescription medications help minimize outbreaks. Abstinence during outbreaks and the use of condoms and dental dams every time you have sex are essential. Once in a committed, monogamous relationship, many with herpes transition to not using condoms, so long as both partners are otherwise STI-free.

The symptoms of herpes.

A herpes outbreak will often start as a rash, bumps or one or more sores on the mouth or the genitals, which can progress to blisters. Sometimes, fever and flu-like symptoms are present, too. Oral herpes may be visible on the lips, mouth or face, and genital herpes may appear on the penis, scrotum, vulva, vagina, anus, perineum, buttocks or inner thighs. A person is most likely to transmit herpes when they have an active breakout or just before a breakout.

Most people with herpes say they can feel when an outbreak is coming, but not all. Because symptoms may be mistaken for skin irritation or something else, a partner can't depend on the partner with herpes to always know when they are contagious.

The frequency and type of herpes symptoms experienced can vary widely. Some who contract herpes are symptom-free, others have just one breakout and still others have regular bouts of symptoms. For these reasons and more, safer sex practices are important—even when symptom-free—since the herpes virus may be spread through a process known as shedding, when the virus is active on a person's skin.

Condoms and dental dams offer some protection against herpes.

Using a latex or polyurethane condom or dental dam for oral, vaginal and anal sex may reduce the risk of transmitting herpes if a partner is infected, but it will not eliminate it. It is also important to keep in mind that lambskin condoms do not offer any protection, as they only protect against pregnancy.

Herpes is most contagious when there is a visible rash, bumps, one or more sores or blisters in, on or around the mouth, genitals or anus. It's important to realize that a condom and dental dam only protects the area it covers. Since herpes is transmitted from skin-to-skin contact, areas like the inner thighs, the vulva, the anus and the scrotum are vulnerable. Not to mention, having a herpes outbreak can make a person more susceptible to HIV infection if their partner is infected.

In addition, a person may transmit genital herpes in the absence of visible symptoms, via a process known as shedding. Unfortunately, those with herpes have no way of knowing when they are shedding, which is about 3 percent of the time—the equivalent of roughly 11 days a year.

Testing for herpes.

When something appears in, on or around a person's mouth, genitals or anus and they think it might herpes, it is important to get to the doctor when the symptoms are present. The reason is that herpes is best diagnosed upon visual examination and taking a culture of the area by swabbing the rash, bumps, sore or blister. Once the symptoms have healed or disappear it is not possible to diagnose in this way.

Another option is a blood test. If a person is infected with the virus the antibodies will appear in their blood sample. However, while the lab can detect if a person has HSV-1 or HSV-2, the results cannot decipher where future outbreaks may occur. The reason is that both viruses can infect either location. Since herpes is spread through skin-to-skin contact, it depends on the area that was exposed to the virus.

Managing herpes.

While herpes cannot be cured, it can be managed. Some treatments are available by prescription or over the counter to reduce the severity and speed healing of an outbreak. Another type of therapy is daily suppressive therapy in which a pill is taken to reduce the number of outbreaks, as well as possibly reducing the chances of spreading the virus to a sex partner. However, since transmission is still possible even if this medication is used, it's important to use protection.

A person that is infected with the virus may also find other ways to limit their outbreaks by exercising, changing their diet and lowering their stress level. However, it's important to note that while they may appear to be symptom-free, they may still spread the virus.

Anyone that thinks they may be infected should seek medical attention to receive a proper diagnosis and learn the best medical options available for their situation.

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