Genital herpes – herpes simplex virus (HSV1 and HSV2)

Herpes simplex virus (HSV) II, a.k.a. genital herpes, is a virus passed on via sexual and close-quarters contact, including saliva.

Herpes typically appears as genital blisters 3-7 days after contact with an infected person, but can appear sooner or later, up to 3 weeks after contact. Importantly, however, symptoms may not appear for weeks, or years, or ever, in you or the person you caught it from.

Outbreaks may appear repeatedly in the same place, which is a clue if you have had more than one outbreak.

Strains of herpes – HSV-1 (mostly mouth) and HSV-2 (mostly genitals)

There are two strains of the herpes virus (HSV-1 and HSV-2), both of which can cause genital symptoms. HSV-1 is also often found in the mouth as cold sores, though HSV-2 is less commonly found there.

HSV2 is so common that one in eight people is thought to have it, yet most are unaware.

HSV-1 causes urinary symptoms more often than HSV-2. The first outbreak is almost always the worst by far. It can be crippling pain in your genitals. Then, the first year may be bad too, but after that, it tends to calm down as your immune system kicks in.

Some people may only ever get one outbreak. Condoms don’t stop the spread of herpes, but they definitely help.

Dead skin cells can shed the virus onto another person’s skin, infecting them. This means playing the blame game gets tricky: you could have caught it off someone a decade or more ago. ^​1​

Before you despair, therapies can reduce the outbreaks significantly (and sometimes they never come back by themselves), and reduce the severity of symptoms.

Herpes isn’t a life sentence, even though it is with you for life.

Symptoms of genital herpes

• Small, painful sores or blisters on the genital area that pop into blisters
• Blisters can take days or weeks to heal and scab over
• Flu-like symptoms – fever, headache, malaise
• No symptoms at all
• Itching
• Burning
• Swollen lymph nodes
• Body aches

Atypical herpes symptoms:

• A prolonged yeast infection
• A cut that appears for no reason
• A negative HSV2 test

WARNING: Many standard STI tests in some areas, for some unknown reason, do not test for HSV-1 or HSV-2 as part of their usual assay. Make sure you are tested for everything possible in your STI test.

The first episode of herpes

This is usually the most painful and the most anxiety-ridden. You may feel sick, as if you have the flu, with headaches, pains, and enlarged groin glands.

You may present with small blisters on or around your genitals, which pop open into ulcers, then scab over and heal after a week or two. You may see small red cracks in the skin, with or without itching or tingling, along with redness, rash, pain, and swelling in the genitals, with pain when you pee.

You may get some, all, or none of these symptoms. Avoid touching your vulva and vagina for as long as you need, including sex and masturbation – it will be sensitive.

Herpes outbreak triggers

Over time, episodes come on less often, are less painful, and are shorter. Things that can trigger outbreaks are stress, your period, sexual activity, and being otherwise unwell. ^​2​

Pregnancy and HSV

If you are pregnant, the chances of you passing the infection to your baby during delivery are small, but real. Herpes can make your baby very sick indeed. Discuss this with your healthcare professional and they will be able to advise you further. ^{​6​ ​7​}

How herpes is spread

Herpes is passed on by skin contact, so you don’t even have to have had sex for this to happen. A dirty finger, toy or mouth can pass it on. If you get oral sex by someone with a cold sore, it can be passed on that way to those who don’t have the mouth version of herpes already. ^​8​

Anyone with an active infection should not engage in kissing, sexual contact, or other activities that involve the infected area until the outbreak is resolved. It can be passed on even when the person is not showing signs of sores, so always use condoms or a barrier.

Testing and treatment for herpes

You need to be swabbed by your doctor to test for herpes to confirm the diagnosis. Antibody tests may be run.

Symptom relief during an outbreak

• Salt baths
• Ice packs
• Pain killers
• Antiviral drugs
• Antiviral herbal medicine

Don’t use mouth medication on your genitals.

Antivirals for prevention and treatment

Antiviral medication can now be taken daily or weekly to keep outbreaks at bay, or to treat an outbreak as it occurs and shorten symptom duration. Talk to your doctor.

There are immune-related herbs that can support your immune system, though what works best for you will need to be discovered through trial and error.^​3,4​

There are some antiviral-resistant strains of HSV, in which case your treatment will change. Topical antiviral treatments of any kind are not very effective, and their use is discouraged.

Treatment during pregnancy and breastfeeding

If you are pregnant or will be pregnant, the risk of transmission to your baby is high. If you have an active outbreak when you are due to give birth, a caesarean section is almost inevitable.

Drugs can be used to safely treat you during pregnancy and breastfeeding. Acyclovir and valacyclovir are the drugs of choice during pregnancy. There is no added risk of cancer with HSV infection.

Don’t spread it

Use condoms and dental dams during sex to protect yourself or your partner to reduce (not eliminate) the risk. There is always a risk. Lube also helps because it reduces trauma to the skin during sex caused by friction. This addition has been shown in research to be very effective when used with a new partner in reducing transmission, particularly in the first six months.

If you have many outbreaks, taking daily antiviral medication or herbs will help. If you are freaking out and need to talk to someone, call your local sexual health centre and go online to talk to others just like you who have been there, done that, and get some ideas on how to cope.

And don’t worry: out of every eight people you see walking down the street, one of them has it. You are in good company.

Dealing with your diagnosis emotionally

This virus causes probably the most distress outside of HIV, because it affects the way you feel about yourself, your body, and your relationships with your partners. This is understandable. There is a lot of stigma surrounding herpes.

It can feel really lonely and isolating, so try to remember that these feelings are normal, even though they’re incredibly unpleasant. You are allowed to grieve for all the bareback sex you may never have freely again, bemoan the conversations you never wanted to have with potential lovers, and curse your body for betraying you, your lover for infecting you, and the universe for giving you herpes. Do it! It’s ok.

If you’re lucky, you may never have another outbreak. Work on strategies to keep your immune system really strong. See a doctor, naturopath, and whoever else you need to keep your system functioning optimally to try to avoid outbreaks.

Lowered resistance is really what kicks off HSV2 (and HSV1), and you can control that to a greater or lesser degree. Your stress response is mainly in your hands, so get some tools in the toolkit.

That could include counselling, a case of wine and your best mates, a long run, sitting down by yourself, or herbs to calm your system. Figure out what works for you, learn about your stress systems, and how you can interrupt them. It’s worth doing. ^​5​

The blame game – stop it

It’s really tempting to blame the person whose genitals passed herpes on to you. It seems fair, right? They gave it to you. But remember, unless you have only had sex with one person, it could have just as easily been you who gave it to them.

And maybe someone in your past has turned up recently with herpes, and is busy blaming someone else close to them. This is the risk we all take when we have sex with other humans.

We are all smothered in all manner of bacteria, fungi and viruses. We pass them back and forth all the time. Every cold, flu or stomach bug you get, you catch from someone else.

Getting regular STI tests and making sure your partners do too is really important for this very reason. Don’t let someone else be in charge of your sexual health, and then blame them when it goes wrong.

Take responsibility for your choices, throw a tantrum about it (you’re allowed), but at the end of the day, you had sex with someone, and you now have an STI. Be kind to yourself.

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