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STDs (Expert Forum)
Can sex lead to a herpes outbreak? Or is it a UTI?
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
Can sex lead to a herpes outbreak? Or is it a UTI?
by sq181, Nov 28, 2007 11:26AM
30 year old female. I tested positive for HSV 1 & 2 about two years ago, but I'm not sure when I actually acquired it. I get outbreaks 2-3 times a year and they seem pretty minor compared to some people's. I used to get bad UTIs after sex a lot, but it doesn't happen much anymore, and when I do get them, they're more minor.
Recently I had (somewhat rough, protected and unprotected) sex with a partner (who has been tested recently and does not have any STIs). Now I have symptoms that I can't tell if they are a herpes outbreak or a UTI. Symptoms: pain during urination (but not as bad as it has been with some UTIs in the past), need to urinate, some uncontrollable urination, general pain in the genital area, anal itching, possibly some small sores/tears inside the opening of my vagina and on my labia. This sex was also at the tail end of my period and involved his finger in my anus, both of which has been connected to greater chance of a UTI for me.
I've been taking uristat to control the pain and drinking lots of water/cranberry juice to clear this thing out. That has usually worked with UTIs for me in the past.
My main questin is: What are the chances that I could infect a partner right now? How long do I need to wait to have sex again? Or if it is just a UTI, do I not need to avoid sex at all?
I have a prescription for acyclovir in case of outbreaks, but I haven't been using it suppressively. Is this a time when it would be worth it for me to start taking it, perhaps in a suppressive does of 400mg 2x day instead of the prescribed 400mg 3x day? Are there long term effects that I should make me worried about taking this drug too casually? Is there an important difference btw acyclovir and valacyclovir?
Recently I had (somewhat rough, protected and unprotected) sex with a partner (who has been tested recently and does not have any STIs). Now I have symptoms that I can't tell if they are a herpes outbreak or a UTI. Symptoms: pain during urination (but not as bad as it has been with some UTIs in the past), need to urinate, some uncontrollable urination, general pain in the genital area, anal itching, possibly some small sores/tears inside the opening of my vagina and on my labia. This sex was also at the tail end of my period and involved his finger in my anus, both of which has been connected to greater chance of a UTI for me.
I've been taking uristat to control the pain and drinking lots of water/cranberry juice to clear this thing out. That has usually worked with UTIs for me in the past.
My main questin is: What are the chances that I could infect a partner right now? How long do I need to wait to have sex again? Or if it is just a UTI, do I not need to avoid sex at all?
I have a prescription for acyclovir in case of outbreaks, but I haven't been using it suppressively. Is this a time when it would be worth it for me to start taking it, perhaps in a suppressive does of 400mg 2x day instead of the prescribed 400mg 3x day? Are there long term effects that I should make me worried about taking this drug too casually? Is there an important difference btw acyclovir and valacyclovir?
Doctor's Answer
by H. Hunter Handsfield, M.D., Nov 28, 2007 12:09PM
, Nov 28, 2007 12:09PM
Sex does not trigger genital herpes outbreaks. It can seem to do so, but many such instances are simply that a sympomatic outbreak was about to start anyway; or sometimes the massaging and rubbing with sex might irritate an otherwise asymptomatic outbreak.
Your symptoms indeed sound more like a UTI, a yeast infection, or perhaps other kinds of anal and gential irritation, and not a herpes outbreak. Probably you have read that UTI and herpes can be easily confused, but it's actually not often so. When someone, particularly a woman, doesn't know she has herpes, she might experience symptoms that involve irritation around the urethra; and sometimes the very first herpes infection causes painful urination and occasionally even urinary urgency. When herpes is eventually diagnosed, it then is understood that what was thought to be a UTI in fact was the first occurence of herpes.
However, most people with symptomatic recurrent genital herpes don't have typical UTI symptoms. Also, they usually experience pretty much the same symptoms every time, with typical blistes or sores in more or less the same spot, give or take a couple of inches. If you think back on your 3 times yearly outbreaks, you'll probably agree that describes your situation. (By the way, the mild nature of your outbreaks is very typical.) Thus, these new symptoms are not likely to be herpes. I cannot say for sure; that takes professional assessment. But your symptoms are more like UTI, yeast, etc.
As to whether you could infect a partner "right now", it is impossible to say. Most herpes transmissions do not occur during overt, symptomatic outbreaks, but during periods of asymptomatic viral shedding. Avoiding sex when you have a known outbreak reduces the transmission risk somewhat, but in the long run the odds are good you will infect a partner no matter how careful you are to avoid sex when you have symptoms. More effective strategies to prevent transmission are consistent condom use and suppressive antiviral therapy.
Which goes to your closing question. If you are having sex with an uninfected partner, or if you are dating and likely to be having sex with more than one person in the coming months or years, you should strongly consider suppressive therapy. Acyclovir in the dose you suggest probably is fine. Acyclovir and valacyclovir are equally effective in suppressing asymptomatic viral shedding, and therefore probably are equally effective in preventing transmission. But only valacyclovir has actually been studied to determine its effectiveness in preventing transmission. It also has the advantage of a single daily dose instead of two. On the other hand, it is more expensive than acyclovir. So it's your choice.
Bottom line: You need to seek personal health care to determine whether you have a UTI, yeast infection, or something else, and to be completely sure you're not having an atypical herpes outbreak. At the same time you can discuss the pros and cons of switching to suppressive antiviral therapy to both prevent transmission and reduce the already low frequency of your recurrent outbreaks.
I hope this helps. Best wishes-- HHH, MD
Your symptoms indeed sound more like a UTI, a yeast infection, or perhaps other kinds of anal and gential irritation, and not a herpes outbreak. Probably you have read that UTI and herpes can be easily confused, but it's actually not often so. When someone, particularly a woman, doesn't know she has herpes, she might experience symptoms that involve irritation around the urethra; and sometimes the very first herpes infection causes painful urination and occasionally even urinary urgency. When herpes is eventually diagnosed, it then is understood that what was thought to be a UTI in fact was the first occurence of herpes.
However, most people with symptomatic recurrent genital herpes don't have typical UTI symptoms. Also, they usually experience pretty much the same symptoms every time, with typical blistes or sores in more or less the same spot, give or take a couple of inches. If you think back on your 3 times yearly outbreaks, you'll probably agree that describes your situation. (By the way, the mild nature of your outbreaks is very typical.) Thus, these new symptoms are not likely to be herpes. I cannot say for sure; that takes professional assessment. But your symptoms are more like UTI, yeast, etc.
As to whether you could infect a partner "right now", it is impossible to say. Most herpes transmissions do not occur during overt, symptomatic outbreaks, but during periods of asymptomatic viral shedding. Avoiding sex when you have a known outbreak reduces the transmission risk somewhat, but in the long run the odds are good you will infect a partner no matter how careful you are to avoid sex when you have symptoms. More effective strategies to prevent transmission are consistent condom use and suppressive antiviral therapy.
Which goes to your closing question. If you are having sex with an uninfected partner, or if you are dating and likely to be having sex with more than one person in the coming months or years, you should strongly consider suppressive therapy. Acyclovir in the dose you suggest probably is fine. Acyclovir and valacyclovir are equally effective in suppressing asymptomatic viral shedding, and therefore probably are equally effective in preventing transmission. But only valacyclovir has actually been studied to determine its effectiveness in preventing transmission. It also has the advantage of a single daily dose instead of two. On the other hand, it is more expensive than acyclovir. So it's your choice.
Bottom line: You need to seek personal health care to determine whether you have a UTI, yeast infection, or something else, and to be completely sure you're not having an atypical herpes outbreak. At the same time you can discuss the pros and cons of switching to suppressive antiviral therapy to both prevent transmission and reduce the already low frequency of your recurrent outbreaks.
I hope this helps. Best wishes-- HHH, MD
