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What you wanted to know about herpes but were afraid to ask (or couldn’t find anyone who knew the answers)
By gracefromhhp and auntiejessi
So you've just found out you have genital herpes or you think you might have genital herpes - what next?? Well, after you are done reading this - stop by the std community or the herpes community and post and we'll try to give you a hand with any questions you might have that this guide doesn't cover enough for you :) This is only a basic guide to help point you in the right direction .
Are my symptoms herpes?
You have some strange things going on, and want to know, “Is this herpes?” Well, that question isn’t so easy to answer, but we’ll try. Keep in mind that no one can diagnose you over the internet, and that you need a medical provider to examine and test you for an absolute diagnosis.
As you read this part, remember that 90% of those with genital herpes type 2 (ghsv2), don’t even know they have it because their symptoms are so mild (about 70%), or because they get no symptoms at all (about 20%). Genital herpes can cause different symptoms for different people. The most common symptoms are blisters that break, then heal. This can be a few big blisters, or a cluster of smaller ones. Typically, a herpes recurrence will last a week or two, but this does vary from person to person, or if you are taking antiviral medication. (More about a primary outbreak in a minute.)
Other common symptoms are ulcers, lesions, itching, raw, red patches, and pain. Its so important to remember that many other infections can cause these symptoms, including fungal infections, other stds, allergic reaction, etc., so don’t panic and think you have herpes just based on symptoms.
Primary outbreak vs recurrence:
A primary outbreak is when someone is newly infected with herpes simplex virus type 1 (hsv1) or herpes simplex virus type 2 (hsv2). A true primary is when a person is newly infected, and does not have an established hsv infection of any kind. Symptoms typically appear within 2-20 days, but this is not a hard and fast rule.
If a person gets either type 1 or type 2, and it’s a true primary, they might have more severe symptoms than someone who already had an hsv infection in another location (as in someone who has oral hsv1 and then gets genital hsv2). This person might have aches, a fever, tiredness, and flu-like symptoms. This can also happen with a non-primary new infection, but is more likely with a true primary. A recurrence is an outbreak that happens after the first outbreak does. These are almost always less severe than the first one, and typically heal faster.
Keep in mind that not everyone will get “classic” symptoms when they first get herpes, and some never get symptoms at all. About 20% of people with ghsv2 are truly asymptomatic, meaning they never get symptoms. Also, never make a self-diagnosis just based on your own symptoms. If doctors don’t always get it right by a visual exam, you probably won’t either.
What type of herpes do I have?
Many folks are diagnosed by a visual exam only which is a fine thing to start treatment based on but you also need diagnostic/laboratory testing to find out if indeed you do have herpes and if you do , what type you have. Traditionally herpes simplex type 1 ( hsv1 ) is oral but it can also be genital. In fact in the under 30 age group in the US - it's the cause of about 60% of all newly diagnosed genital herpes infections. In the US about 60% of folks have hsv1 orally so it's very common. In other countries the rate of hsv1 oral infection is even higher. Not many of us make it thru life without at least hsv1. Herpes simplex type 2 ( hsv2 ) is the most common cause of genital herpes infections but it too can infect the oral area. Statistically in the US, 1 out of every 4-5 adults has hsv2. It too is quite common but unfortunately most folks who have it aren't aware that they have it.
So finding out what type of herpes you have and where is the first step. You also will need to know what your partner's status is too and what type(s) they have too so that the two of you can make educated decisions about what precautions to take from here on out in your sex life.
For some people finding out if they have herpes or not and what type will come very quickly and be fairly easy to find out. Getting seen promptly by your provider as soon as you suspect that something is going on in the genital area is important. A lesion culture of active symptoms is most likely to be accurate if done within 24-48 hours of its appearance. Wait longer than that and the risk of having a false negative goes higher quickly. Discuss with your provider whether it's a good idea to get a blood test too at that time and then repeat it if need be in a few months. If you do get a blood test - make sure it's a type specific IgG herpes blood test. Do not waste your time or money on the IgM test for herpes. Why? Well, Dr Handsfield in the std expert forum has said it best in the past already so check out his post about it ( http://www.medhelp.org/posts/show/248394 ).
For some people though the blood tests aren't going to be very clear cut. Visit the boards if you have any questions about your blood tests. Also check out gracefromhhp's journal entry on blood testing for herpes too ( http: www.medhelp.org/user_journals/show/12667 ). The website www.herpesdiagnosis.com is a terrific resource too, as well as the other resources we'll list here. Also if you get a negative lesion culture - that might not be the final answer as to if you have herpes or not. The false negative rate can be pretty high sometimes so additional testing might be necessary. We can help you sort things out on the boards if you have questions about your testing.
So let's say you've been to your provider and have been visually diagnosed as having genital herpes and properly tested. What next? It's appropriate to start treatment for genital herpes immediately based on the visual diagnosis only while waiting for test results to come back. The sooner you start treatment, the more it can do for you to help speed healing and make you feel more comfortable faster! No need to wait to find out if indeed you do have herpes and what type it is - you can be taking medication while waiting the couple of days it takes until that information comes back from the lab.
What medication is best? There are 3 different herpes antivirals that are commonly used: acyclovir, valtrex and famvir. Each of them have websites to read more about them and their side effects. Also there is a lot of info on them in the herpes handbook too ( see below for link ). You and your doctor can decide which one is best for you based on your insurance as well as how likely you are to remember to take pills ( also personal preference by some providers plays a part too ). Check out grace's journal entry for more info as well on how to make the decision of what medication to use and how to use it (http://www.medhelp.org/user_journals/show/8280 ).
So what's next? Well if you haven't already, talk to your partner if you have a regular partner ( for tips on this see auntiejess's journal entry on how to talk about herpes with a partner as well as the other resources below ( http://www.medhelp.org/user_journals/show/15788 ). Your partner will need to find out what type of herpes they have or don't have, too. Your partner should ask a medical provider for a type specific IgG herpes blood test. Once you know what type you have and what type your partner has - then decide if episodic therapy ( treating each outbreak ( ob ) as they occur to help speed healing ) or if suppressive therapy ( taking medication every single day whether you have an ob or not ) is the right choice for you and your lifestyle.
This will be a different choice for each person - if you need help trying to decide which choice is best for you - visit us on the boards and ask and we'll gladly try to give you a hand with this decision. Your medical provider can also help with this too.
How do you get herpes?
So what about those of you who are just worried about possibly having herpes? Perhaps you don't have "classic" symptoms or you are wondering about certain scenarios and if they are a risk for herpes or not? Perhaps you've already been doing some reading elsewhere and have seen that herpes presents differently in different people and can oftentimes be rather vague in its appearance so you are worried? Here is a list of prior posts from either the std community, the herpes community or the std experts community to make it easy for you to do some reading :
herpes from lap dance http://www.medhelp.org/posts/show/429938
herpes from oral sex http://www.medhelp.org/posts/show/317229
herpes from fingering http://www.medhelp.org/posts/show/247025
herpes from fooling around http://www.medhelp.org/posts/show/548122
herpes from toilets, gym etc http://www.medhelp.org/posts/show/248047
herpes from a partner who is on suppressive therapy http://www.medhelp.org/posts/show/369917
oral herpes transmission http://www.medhelp.org/posts/show/249411
genital herpes transmission to children http://www.medhelp.org/posts/show/249556
Performing oral sex with an active cold sore present - http://www.medhelp.org/posts/show/633510
Last but not least - where else can you do some reading for yourself or what other resources are out there that you can use for yourself, a friend or a partner? Here is a list of the ones we recommend :
www.westoverheights.com - the herpes handbook section
http://www.medhelp.org/health_videos/How-to-Deal-With-Herpes/show/1009 - this is a terrific video by Terri Warren - the herpes expert on medhelp
The IDEA of herpes is usually far scarier than actually living with it is. So many of us have it but yet no one ever takes the time to teach us about it. Visit us on the boards and ask any questions you have and we'll try to help you learn more about this awfully common virus!!!
grace and jess