Your Questions Answered

Frequently asked questions

The following are questions about genital herpes that many people often ask – whether they suspect they have genital herpes, are newly-diagnosed or they’ve been living with genital herpes for some time. It is hoped that the answers to their questions will also help answer questions you may have.

Some of the following are the expressed opinions of the experts and do not necessarily reflect the opinions or recommendations of GlaxoSmithKline.

About Genital Herpes

• What is genital herpes?

  Genital herpes is a common infection caused by a virus called herpes simplex virus (HSV). HSV-1 is the most common form of the virus, causing cold sores on or near the lips and mouth area. HSV-1 is also responsible for an increasing number of genital herpes infections because it can be transmitted to the genitals from a person with a cold sore during oral sex. HSV-2 has been the most common cause of genital herpes, causing sores and blisters on or near the genitals and surrounding areas. It is almost always transmitted through genital-to-genital contact.^1,2,3

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  Virus a small infectious organism that “invades” another living cell in order to multiply and survive

• How did I get genital herpes?

  HSV is passed from one person to another through skin-to-skin contact. In general, HSV cannot pass through the thicker skin on most parts of the body. HSV needs an easy place to enter and infect the skin cells. Mucous membranes and thinner skin, like the skin of the genital and anal areas and the mouth, provide an easy entry point.¹

  There are two types of HSV: HSV-1 and HSV-2. HSV-2 is the most common cause of genital herpes.² However, HSV-1 (which generally causes cold sores) can also cause genital herpes through oral-to-genital contact and is becoming a more frequent cause of genital herpes.^4,5

• What are the symptoms of genital herpes and what, specifically, does an outbreak look like (i.e., how can herpes simplex virus (HSV) be distinguished from something else)?

  The symptoms of genital herpes may include a prodome , with numbness, pain or tingling at the site of a recurrence prior to the outbreak. These symptoms may be followed by a red patch of small bumps or water-filled blisters, which may be itchy or painful. However, an outbreak may present as only a very small ulcer, especially if the outbreak occurs on mucous membranes or wet areas. Sometimes the diagnosis is not clear, since other conditions can be confused with genital herpes. The best way to confirm a diagnosis of genital herpes is to have your doctor examine the suspected outbreak and confirm the diagnosis using lab tests such as viral culture or type specific serology.

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  Prodrome early warning symptoms of virus activity – itching, tingling, numbness or burning. Headache or fever, swollen glands and pain in the groin, buttocks, thighs, genital area or down the back of the leg can also occur. Symptoms typically begin one to two days before blisters appear. Not everyone with genital herpes gets or can recognize prodrome

• Can genital herpes infect other parts of the body?

  In the past genital herpes was most often caused by HSV type 2 (HSV-2), but it is increasingly caused by HSV type 1 (HSV-1), the virus that causes common cold sores. ^3-5 For unknown reasons, HSV-2 prefers to infect the genital regions. There are people with HSV-2 on their face, but this is very rare.⁶ HSV infection usually occurs on mucous membranes and thinner skin (anal, genital and perianal regions, and areas around the mouth and nose). Herpes symptoms may occur, however, anywhere a nerve fibre supplies sensation. It is not uncommon for genital HSV sores to appear on the buttocks or thighs because the buttock nerves and the genital nerves are close to one another.

• Does genital herpes cause cancer?

  Genital herpes is not known to cause cancer.¹ Human papillomavirus (HPV), the virus that causes genital warts, has been linked to cancer of the cervix (cervical cancer) in women, not herpes simplex virus (HSV).

• Is the herpes virus present and active in the urine and semen?

  The herpes virus reactivates and travels from the spinal ganglia, where it was dormant, to the genital or anal mucosa via the sensory nerves. The virus multiplies in the mucous membranes, not in the urine or semen. Therefore, in order for the virus to be transmitted, direct contact must occur between two mucous membranes.

• Can genital herpes have an effect on menstruation?

  Genital herpes does not affect menstruation. However, menstruation can be a trigger of genital herpes outbreaks.

• I think I have genital herpes, but I am very shy about being examined by a doctor. Can I get a prescription from my doctor by describing my symptoms or is there an over-the-counter drug available?

  You need to discuss how you feel with your doctor. A diagnosis of genital herpes must be confirmed by clinical examination and by lab test (viral culture or special blood test), both of which should be performed by an experienced medical professional. Unfortunately, no over-the-counter medications have been found to be effective in clinical trials. All antiviral medications used for the treatment of genital herpes require a prescription from your doctor.

• Can genital herpes cause chronic fatigue?

  Many viruses, including herpes viruses, were initially linked to chronic fatigue syndrome. However, more recent studies have not confirmed a causal link between any known virus and chronic fatigue syndrome. It is likely that certain viral infections, such as genital herpes, are associated with a temporary fatigue state, i.e., one lasting for a few days.

• Can one be a carrier of genital herpes without having any symptoms for a few years?

  A person infected with the herpes virus will be a carrier of this virus for the rest of their life. In some cases, symptomatic outbreaks are very sporadic (once a year or even less), but one can continue to have periods of shedding the virus without symptoms (asymptomatic viral shedding ) between outbreaks.

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  Asymptomatic viral shedding shedding of the active virus when there are no signs or symptoms

• I have herpes. Can I still give blood?

  The herpes virus is transmitted through direct contact between mucous membranes (e.g., during kissing and sexual contact) and not in the blood, so you should be able to donate blood.

• Does herpes have any effect on the liver?

  Herpes does not generally have any effect on the liver. In very rare cases, individuals with serious illnesses and/or weakened immune systems may develop herpes infection of the liver. However, this is not a concern in an otherwise healthy individual with genital herpes.

• Is there any connection between herpes and HIV or hepatitis A or B?

  People who have genital inflammation, such as lesions caused by genital herpes, are at higher risk of contracting HIV infection than those who do not have genital inflammation. There is no known connection between hepatitis A or B and herpes.

• Do genital herpes outbreaks leave scars?

  Most people with genital herpes do not develop permanent scars from the outbreaks. However, some people are susceptible to the development of scars. There are several factors that determine whether a scar will form, such as skin colour and having frequent outbreaks in the same location. Whenever a scar forms, it tends to disappear with time.

• What healthcare providers need to be informed that I have genital herpes?

  Individuals who need to know your diagnosis of genital herpes are those who may be affected by your disease – i.e., sexual partners and medical doctors. Since skin-to-skin contact is required for transmission of this infection, you do not need to inform chiropractors, dentists and other allied health workers. You do not need to disclose that you have genital herpes to health clubs and you should check with your health insurance company about disclosure requirements.

Transmission & Its Risks

• How can I reduce the risk of transmitting genital herpes to my partner?

  Genital herpes is transmitted through direct skin-to-skin contact with the affected area.⁴ Although the risk of transmission is highest during an outbreak, most cases of genital herpes are transmitted during asymptomatic viral shedding .⁵

  You can reduce the risk of transmitting genital herpes by telling your partner that you have genital herpes, avoiding sexual contact during outbreaks, and using condoms and other barrier methods at all times.

  One oral antiviral medication has been shown to reduce the risk of transmission of genital herpes among heterosexual monogamous partners when used in combination with safer sex practices, including condoms. Talk to your doctor about ways to reduce the risk of transmission.^3,7

• My partner has genital herpes and we would like to have sex. How can we make sure that I don’t get it from my partner?

  The only sure way to prevent getting genital herpes is by not having any sexual contact (abstinence). Since you both want to have sex that is not likely an option. Your partner has already reduced your risk by telling you that they have genital herpes. Now you can make safer sex decisions together to further reduce your risk. It is important to practice safer sex at all times, including the use of male or female condoms or dental dams for oral sex. You should also know that condoms may not cover all areas of skin where the herpes virus may be present and contagious. (See Transmission & Its Risks). And for this reason, condoms have been shown to be more protective against transmission for women than men.⁸ Your partner should consult a doctor about all ways to reduce your risk, one of which is an oral antiviral medication that when used in combination with safer sex practices has been shown to reduce the risk of transmission of genital herpes among heterosexual monogamous partners.⁷ You may also wish to get tested for herpes because some people have it and do not know it.

• I was recently diagnosed with genital herpes and have never had sexual intercourse. My only sexual contact has been with one person who does not have genital herpes but does get cold sores. My partner gives me oral sex but we are careful not to kiss when my partner has cold sores. How did I get genital herpes?

  Cold sores are caused by type 1 of the herpes simplex virus (HSV-1). Genital herpes is most often caused by type 2 (HSV-2), but more and more cases of HSV-1 infecting the genital region are being identified.³ Since you have not had genital-to-genital sex, it is most likely that you got genital herpes when you received oral sex from your partner at a time when they had a cold sore. When someone has a cold sore, they should not let the sore come in contact with any mucous membranes or thinner skin, including genital areas and the area around the mouth and nose. HSV-1 can sometimes also be shed without symptoms and can be transmitted in the absence of sores.^5,9

• I have heard that the risk of transmission from male to female is greater than from female to male. I’d like to know why.

  Women are at increased risk of acquiring not only genital herpes, but all sexually transmitted infections (STIs). This is due to the relatively large area of mucous membranes that cover the labia minora, vagina and cervix. In contrast to the skin that protects the majority of the male genital area, the delicate mucous membranes of the female genitals are much more prone to cuts and abrasions which enable the herpes virus to enter the body. Condoms can reduce the risk of transmission and have been shown to be more protective for women than men.⁸

• I have genital herpes and my partner (who doesn’t) wants to have unprotected sex between outbreaks. Is my partner at risk of getting it from me this way?

  Yes, there is a risk of transmission between outbreaks. This is due to asymptomatic viral shedding .^10,11 The risk of transmission is highest during an outbreak, because the virus is most contagious and shedding from the surface of the skin.⁴ However, sometimes the virus reactivates and returns to the surface of the skin and sheds, but there are no signs or symptoms. Because there are no signs or symptoms, lab tests are the only way to tell that the virus is being shed from the skin. Always practicing safer sex is a good idea. Make sure that you and your partner are fully informed about genital herpes and all of the ways in which you can reduce the risk of transmission so that you can make educated choices.

• What is the difference, if any, between herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in term of transmission?

  Herpes simplex virus type 1 (HSV-1) infections are most commonly acquired during childhood and cause oral ulcers and cold sores. However, HSV-1 infection is an increasing cause of genital herpes due to oral-genital contact. HSV-2 is transmitted through sexual contact and is an infrequent cause of oral herpes. Asymptomatic viral shedding is twice as common in women infected with genital HSV-2 as in those with genital HSV-1. A similar difference may exist in men.

• My partner has HIV and I have genital herpes. Are there any special precautions we should take?

  Yes, it is highly recommended that you always practice safer sex. Studies have shown associations between genital herpes and the risk of getting HIV or giving it to someone. Specifically:

  • Having genital herpes, or any genital disease with open sores, increases a person’s risk of getting HIV from an HIV-positive sexual partner.¹²
  • Sexual contact with a partner who has both genital herpes and HIV increases a person’s risk of getting HIV and/or genital herpes.¹³
• Does a person with oral herpes have a degree of protection against genital herpes?

  Most studies have reported that having antibodies against herpes simplex virus type 1 (HSV-1) does not offer protection against genital herpes caused by HSV-2 infection. A person who has oral HSV infection should continue to protect themselves during sexual contact with a partner who has genital herpes.

• My boyfriend and I both have genital herpes. Can having more unprotected sex with each other make it worse?

  Since both you and your boyfriend now have genital herpes, you can no longer infect each other. However, having unprotected sex during outbreaks is not a good idea because it is painful, irritates the sores and can make them last longer.

• My roommate was just diagnosed with genital herpes. She leaves her bath towels lying around the bathroom. Is she putting me at risk?

  Transmission of genital herpes requires direct skin-to-skin contact involving the mucous membranes (e.g., sexual contact). Since herpes simplex virus (HSV) does not survive for very long outside of the human body, towels are not a source of HSV infection. (See How genital herpes is transmitted).

• My spouse and I have genital herpes. What is the risk of transmitting herpes to our children?

  The only way your children can contract genital herpes is if they come in direct contact with herpes lesions in the genital or mouth areas.

• I have genital herpes and my outbreaks occur on the buttocks, not on genital areas. Am I just as contagious?

  Outbreaks of genital herpes may involve the buttocks. In fact, the sores can move from side to side and from the genital area to the buttocks. You are just as contagious regardless of where the sores appear.

Living with Genital Herpes

• Since being diagnosed with genital herpes a year ago, I have been having outbreaks every month. Will I always have this many outbreaks?

  The frequency and severity of recurrent outbreaks are unpredictable, but in general:

  • HSV-2 outbreaks recur more often than HSV-1 outbreaks.¹
  • Outbreaks generally happen more frequently in those who have had genital herpes for less than 2 years.¹⁴
  • The number of outbreaks generally decreases over time.¹⁴
• Do I have to tell anyone that I have genital herpes?

  It is very important to tell your current sexual partner that you have herpes, and also to discuss herpes with any new sexual partners you may have in the future, before there is any sexual contact. If you went to a different doctor for your diagnosis (e.g., at an STI clinic), tell your family doctor about your diagnosis so that he or she can provide you with the best care should complications or new situations, such as pregnancy, arise. You may also wish to tell selected family members and/or friends who can offer you support.

• Ever since I was diagnosed with genital herpes, I have been sad most of the time. I just can’t seem to get out of this slump. Is this normal? Is there anything I can do to feel better?

  Talking about genital herpes can help. If you are not getting enough emotional support or time to discuss herpes with your doctor, you may wish to seek professional advice from a counsellor. There are people in Canada who specialize in sexually transmitted infection (STI) counselling. Your doctor can recommend a counsellor or a STI clinic will often have a counsellor on their team.

• Will genital herpes make me impotent?

  Medical conditions, medications and emotional and mental states are all reasons why a man cannot get or keep an erection. Genital herpes does not make men impotent, but the emotions associated with a diagnosis of herpes may influence sexual urges.¹ Finding out a partner has herpes could lead to worry about infection that decreases sexual urges and ability. Anger about being diagnosed with herpes or fear of giving it to a partner could also lead to impotence. Talking about these feelings with a doctor or other healthcare provider or counsellor will often help. There are reasons for impotence other than emotions, so consult your doctor.

• Will genital herpes make me sterile?

  Genital herpes does not lead to sterility, but some sexually transmitted infections (STIs) like gonorrhea and chlamydia can.^1,15 If you are being tested for the herpes virus you should also be tested for other STIs. Most STIs can be successfully treated and serious medical consequences can be prevented.

• I have had genital herpes for 10 years, and I do not get outbreaks anymore. Sometimes I have pain in my buttocks that moves down my leg, but my doctor can’t find anything wrong. Could it be related to herpes?

  Yes, it could be nerve pain related to genital herpes.¹ If so, this type of pain is actually an outbreak of genital herpes caused by reactivation of HSV. It happens because, after infection, HSV travels along nerve fibres to a bundle of nerves called the dorsal root ganglion . It stays there until reactivation. When it reactivates, it travels along the nerve fibres to the skin. The nerve fibres in the legs and buttocks stem from the same ganglia as the genital and anal regions. So the pain may be caused by reactivation of the virus traveling along the nerve fibres in the buttocks and legs. Very close examination of your genital and perianal region when this pain occurs may, or may not, identify small sores or areas of redness that are outbreaks of genital herpes. If your doctor thinks that your pain is caused by herpes, you may be prescribed antiviral therapy. Episodic antiviral therapy may help reduce the duration of these outbreaks, and suppressive therapy may help prevent or delay them from occurring.^7,16,17 Naturally, your doctor will need to rule out other potential causes of your pain before prescribing antiviral therapy.

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  Dorsal root ganglion a bundle of nerves located at the base of your spine where the herpes virus hibernates or lies dormant

• Since I’ve had genital herpes, I have not been able to have an orgasm with my partner. Is this all in my mind or is it because of herpes?

  Genital herpes can psychologically interfere with sexual activity and performance. However, you should be reassured by the fact that the infection does not physically affect any organs associated with sexual activity. If you continue to have difficulty achieving an orgasm, you should consult your doctor.

• Is it possible to suffer from long-term nerve damage after 30 years of herpes outbreaks? It feels exactly like pre-blister pain.

  Herpes simplex virus (HSV) infection is not associated with nerve damage. If you continue to have prodromal symptoms or pre-blister nerve pain, you may want to consider talking to your doctor about an adequate trial of daily oral antiviral therapy, as this treatment can prevent the recurrence of outbreaks. If you do not experience any relief, you should consult your doctor, as your symptoms may be caused by something other than herpes.

• I am having a hard time accepting that I have genital herpes. I am also afraid of relationships because I do not want to pass this disease to anyone.

  One of the ways to prevent the transmission of genital herpes is to always practice safer sex. Feeling depressed and afraid are common reactions in individuals diagnosed with genital herpes. It is a difficult diagnosis to accept because of its long-term nature and physical effects. However, there are oral antiviral medications available that can help prevent future outbreaks and one oral antiviral medication that can reduce the risk of transmission. Talk to your doctor. Also see Transmission & Its Risks for more information.

• I find informing potential partners that I have herpes the hardest thing to do. Please help, as I’ve struggled with this for a long time.

  Individuals with genital herpes find disclosure to sexual partners one of the most difficult aspects of this infection. You are to be commended for consistently informing your partners before any sexual contact occurs. The right time to disclose will depend on the relationship, but generally it is best to share the information after the relationship is established but before it becomes sexual. Since you appear to have difficulties in telling potential partners that you have genital herpes, seek help from your doctor or a counsellor at the Sexual Health Centre or STI Clinic nearest you. Healthcare providers are experienced in counselling on sensitive issues such as this and they can help increase your comfort in telling a potential sexual partner. (See Talking to your Partner).

• Is it possible for there to be no pauses between recurrences, even if I am taking suppressive therapy?

  Recurrences of herpes generally last 5 to 7 days. It is rare for recurrences to last longer, except in people with highly weakened immune systems (e.g., those with HIV infection or who have had a transplant). You should see your doctor to make sure that your symptoms are not caused by something other than herpes.

Pregnancy

• Can I get pregnant and have a healthy baby if I have genital herpes?

  Yes. However, there is a risk of transmitting genital herpes from a pregnant mother to her baby, but it does not happen very often. (See Pregnancy for more information). In general, the risk of transmitting herpes to the baby is highest for those mothers who become infected with genital herpes for the first time while pregnant, especially during the third trimester. Women who have genital herpes before becoming pregnant are not at high risk of transmitting herpes to their baby. If the mother has sores or symptoms during labour or delivery, the doctor may recommend a Caesarian section .¹ If you are pregnant and have genital herpes or your partner has genital herpes, you should speak with your doctor.

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  Caesarian Section an incision in the abdomen that allows for the delivery of a baby directly from the womb

• Is it safe to try to conceive during an outbreak?

  You should not have unprotected intercourse if you, or your partner, are experiencing an outbreak. The effects of an outbreak of genital herpes on conception are not known.

• Will taking antiviral medication while trying to conceive lower my chances of becoming pregnant?

  Antiviral medication is not recommended when you are trying to become pregnant, so you should talk to your doctor before trying to conceive.

• My partner and I are trying to have a baby. I don’t have genital herpes but he does. Any suggestions for ways of conceiving without unprotected intercourse?

  First, you should have a blood test called type specific herpes serology to confirm that you are, in fact, not infected with genital herpes. If you do not have herpes, your partner should be counselled by his doctor on taking daily oral antiviral medication to decrease the risk of recurrences as well as the risk of transmission. Conception could then be attempted when he is free of lesions and has no prodromal or warning signs of genital herpes. When you are pregnant, you should continue to practice safer sex so that you do not acquire the infection during your pregnancy. It is especially critical that you do not acquire infection during your third trimester and it is recommended that you abstain from all sexual contact during this time. You and your partner should discuss these options with a doctor who has expertise in this area.

• Is it possible to transmit herpes to the baby if I choose to breastfeed?

  Transmission of herpes simplex virus to a baby requires direct contact with the virus. Neonatal herpes occurs when the baby is exposed to the virus during delivery. If your herpes infection is confined to the genital area or your face, it is safe for you to breastfeed. However, you should ensure that the baby does not come into direct contact with your lesions and you should diligently wash your hands after touching any infected area.

• I am pregnant. Can I have unprotected sex with my boyfriend who has genital herpes?

  To decrease the risk of transmitting genital herpes to you, your boyfriend should always use a condom and you should never have sex when he is having an outbreak. It is also advised that you abstain from sexual contact during the last trimester of your pregnancy. Speak to your physician for more information. (See If your partner has herpes).

• I have had genital herpes for 5 years and am pregnant. Is my baby at risk?

  The risk to your baby is very low. There are ways to minimize the risk and decrease the need for a Caesarian section . You should discuss your concerns with your doctor. (See Pregnancy for more information.)

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  Caesarian section an incision in the abdomen that allows for the delivery of a baby directly from the womb

Cold Sores

• What is oral herpes?

  Oral herpes is more generally referred to as cold sores. Cold sores are most commonly caused by infection of the area around the mouth or nose with herpes simplex virus type 1(HSV-1).

• I have herpes on my lip and in the corner of my mouth. Can I spread it to other parts of my mouth or face?

  There is a small chance that you could get herpes in other parts of your body. When you have a cold sore avoid touching the affected area. If you do touch the affected area it is recommended that you immediately wash your hands to decrease the chances of infecting another area of your face with herpes.

• Is the herpes on my lip and inside my mouth caused by HSV-1 or HSV-2? Can it travel internally to cause herpes in the genital area?

  Virtually all herpes lesions around the mouth are caused by HSV-1. Oral herpes can be transmitted to your partner’s genitals through direct oral-genital contact. Conversely, if your partner has oral herpes, the virus can be transmitted to your genital area through oral sex. The oral herpes you have can only be spread to other parts of your body by directly transferring it (for example, by scratching the cold sore around your mouth and then touching another area of your body where the skin is broken).

Genital Herpes Treatment

• How can I get rid of genital herpes?

  There is currently no cure for genital herpes. After infection, the herpes simplex virus that causes genital herpes “hides” in the dorsal root ganglion, where it remains dormant or in a resting state. From time to time, the virus may reactivate. Treatment with oral antiviral medications are available to help decrease symptoms, reduce the number of outbreaks and the severity of outbreaks.^{7,16, 17} One oral antiviral medication has also been proven to reduce the risk of transmission.⁷ Talk to your doctor or another healthcare provider about your treatment options if you have genital herpes.

• My doctor suggested that I take antiviral therapy every day. I’m worried about taking medication every day.

  Antiviral therapy can work well when taken on a daily basis, since these drugs affect mostly cells that are infected with a virus when the virus is reproducing inside the cell.^{7,16, 17} Antiviral medications are generally well tolerated in otherwise healthy individuals. In research studies, the most common side effects experienced with antiviral agents were headache, nausea and diarrhea.^7,16,17 Other side effects have been associated with individual antiviral agents. You should discuss this with your doctor as appropriate.  There are special considerations for the use of antiviral medications in certain populations. Their use is cautioned in pregnant females (especially during the first trimester) unless a doctor determines that the potential benefits outweigh the potential risks. Other precautions apply to some of the antiviral agents in people with HIV and in children. People with kidney disease may be prescribed lower doses of antiviral agents, or antiviral therapy may not be prescribed at all. Your doctor will know your health status and will know what is safe for you to use.

• Are there any concerns regarding drug interactions with other medications when taking an antiviral?

  Whenever an individual is taking another drug, whether a prescription drug or over-the-counter medication, drug interactions are possible. Check with your pharmacist or doctor before taking any medication in combination with another.

• I have had a kidney removed. Is it safe to take an oral antiviral medication to minimize my outbreaks?

  You need to discuss the use of antiviral medications or any other medication with your doctor. Whether or not you can take antiviral medication may depend on your remaining kidney function and other medications that you are taking.

• Is there a right time to start daily antiviral therapy?

  The recommended dose of antiviral medication for the treatment of a symptomatic outbreak is different from that used for daily therapy. It is best to complete the treatment of a symptomatic outbreak (3 to 5 days) before starting daily therapy or to start daily therapy between recurrences. You should use antiviral therapy as recommended by your doctor.

• What happens if I don’t treat my genital herpes?

  There are no long-term medical complications associated with untreated genital herpes. Over time, the frequency of your outbreaks may decrease. Taking medications when you feel an outbreak starting can reduce the number of painful blisters that develop and help them heal more quickly. You may also prevent blisters from developing. However, without daily treatment you may have significant periods of asymptomatic viral shedding and your sexual partner may therefore be at higher risk of contracting genital herpes.

• Is there a vaccine against genital herpes?

  Although various vaccines against herpes have been studied, we have no indication of when they will be available. Some of the vaccines have demonstrated positive effects in certain groups of people (e.g., women without herpes infection); however, research in this area is ongoing.

• Is it true that the more you take antiviral agents, the less frequent your outbreaks will be in the future?

  Antiviral agents significantly reduce the number of genital herpes outbreaks when taken daily for a prolonged period of time (suppressive therapy). However, if you stop taking antiviral medication, outbreaks can resume. For the majority of individuals with genital herpes, the number of recurrences generally decreases over time, but this is not because of a lasting effect of antiviral agents.

• What natural treatments are available to treat genital herpes?

  There are no data showing that alternative treatments to oral antiviral medications are effective in treating or preventing genital herpes. You should therefore carefully consider whether it is in your best interest to use an alternative therapy or natural treatment.

• Will taking antiviral medication for treatment during an outbreak affect the birth control pill I’m also taking?

  There is no known interaction between antiviral medications and the birth control pill.

• Is it expensive to treat herpes on a daily basis?

  The cost of daily antiviral therapy depends on several factors, including the medication and dose prescribed by the doctor and any coverage provided by provincial or private healthcare plans. Please check with your doctor or pharmacist to determine how much daily therapy would cost you and if it is covered by the province in which you live or by the healthcare insurance you may have.

Consulting a Doctor

• I have genital herpes. How often should I visit my doctor?

  You should visit your doctor as frequently as they recommend or at least 6 months after your diagnosis of genital herpes, sooner if you experience any complications or are having emotional or physical difficulties dealing with your diagnosis. Schedule an appointment any time there is a change in your health or life situation that may impact your management of genital herpes, such as pregnancy or a new sexual relationship. You may even want to schedule an appointment for you and your current partner or a new sexual partner. If a situation arises that your doctor cannot help you with, he or she will likely refer you to another healthcare provider.

• How do I know which type of herpes I have?

  The only way to find out for sure which type of the herpes simplex virus (HSV) you have is through a lab test. If you are concerned that you might have genital herpes, see your doctor and ask to be tested.

1. Whitley RJ, Kimberlin DW and Roizman B. Herpes Simplex Viruses. Clinical Infectious Diseases 1998;26:541-55. 2. Gupta R and Wald A. Genital Herpes: antiviral therapy for symptom relief and prevention of transmission. Expert Opin Pharmacother 2006;7(6):665-675. 3. Aoki FY. Canadian Guidelines on Sexually Transmitted Infections 2006 Edition, Health Canada. 4. Sacks SL. The Truth About Herpes. 4th ed. West Vancouver, BC: Gordon Soules Book Publishers Lt.;1997. 5. Ebel C, Wald A. Managing Herpes: How to Live and Love With a Chronic STD. Research Triangle Park, NC: American Social Health Association;2002. 6. Ribes JA, Steele AD, Seabolt JP et al. Six-Year Study of the Incidence of Herpes in Genital and Nongenital Cultures in a Central Kentucky Medical Center Patient Population. J Clin Micro 2001;39(9):3321-3325. 7. Patrick DM, Dawar M, Cook DA et al. Antenatal seroprevalence of herpes simplex virus type 2 9HSV-2) in Canadian women. Sex Transm Dis 2001;28(7):424-428. 8. Mertz GJ, Benedetti J, Ashley R et al. Risk Factors for the Sexual Transmission of Genital Herpes. Annals of Internal Medicine 1992;116:197-202. 9. Wald A, Zeh J, Selke S et al. Virologic Characteristics of Subclinical and Symptomatic Genital Herpes Infections. NEJM 1995;333(12):770-775. 10. Wald A, Zeh J,Selke S et al. Genital Shedding of Herpes Simplex Virus among Men. Journal of Infectious Diseases 2002;186(Suppl 1):S34-S39. 11. Corey L, Wald A, Patel R et al. Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes. NEJM 2004;350(1):11-20. 12. Cuisini M and Ghislanzoni M. The importance of diagnosing genital herpes. J Antimicro Chemo 2001;47(Topic T1):9-16. 13. Steben M, Sacks SL. Genital herpes: The epidemiology and control of a common sexually transmitted disease. Can J Hum Sex 1997;6(2):127-134. 14. Wald A, Langenberg AGM, Link K et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 2001;285(24):3100-3106.     15. van der Laar MJ, Termorshuizen F, Slomka MJ et al. Prevalence and correlates of herpes simplex virus type 2 infection: Evaluation of behavioural risk factors. Int J Epidemiol 1998;27(1):127-134.

1. Sacks SL. The Truth About Herpes. 4th ed. West Vancouver, BC: Gordon Soules Book Publishers Ltd.;1997. 2. Patrick DM, Dawar M, Cook DA, et al. Antenatal seroprevalence of herpes simplex virus type 2 (HSV-2) in Canadian women. Sex Transm Dis. 2001;28(7):424-8. 3. Aoki FY. Canadian Guidelines on Sexually Transmitted Infections 2006 Edition: Genital Herpes Simplex Virus (HSV) Infections. Public Health Agency of Canada http://phac-aspc.gc.ca/std-mts/sti_2006/pdf/sti2006_e.pdf. Accessed May 15, 2006. 4. Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses. Clin Infect Dis. 1998;26(3):541-53. 5. Mertz GJ, Benedetti J, Ashley R, et al. Risk factors for the sexual transmission of genital herpes. Ann Intern Med 1992;116(3):197-202. 6. Boon RJ, Bacon TH, Robey HL, et al. Antiviral susceptibilities of herpes simplex virus from immunocompetent subjects with recurrent herpes labialie [sic]: A UK-based survey. J Antimicrob Chemother 2000;46(2):324-325. 7. Valtrex® (valacyclovir hydrochloride) Product Monograph. GlaxoSmithKline Inc., May 2006. 8. Wald A, Langenbrerg AGM, Link K et al. Effect of condoms on reducting the transmission of herpes simplex virus type 2 from men to women. JAMA 2001:285(24):3100-3106. 9. Ribes JA, Steele AD, Seabolt JP et al. Six-Year Study of the Incidence of Herpes in Genital and Nongenital Cultures in a Central Kentucky Medical Center Patient Population. J Clin Microbiol 2001;39(9):3321-3325. 10. Wald A, Zeh J, Selke S, et al. Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med 1995;333(12):770-5. 11 Wald A, Zeh J, Selke S, et al. Genital shedding of herpes simplex virus among men. J Infect Dis 2002;186:S34-9. 12. Wald A, Link K. Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: A meta-analysis. J Infect Dis 2002;185(1):45-52. 13. McFarland W, Gwanzura L, Bassett MT, et al. Prevalence and incidence of herpes simplex virus type 2 infection among male Zimbabwean factory workers. J Infect Dis 1999;180(5):1459-1465. 14. Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med 1999;131(1):14-20. 15. Health Canada. What You Need to Know About Sexually Transmitted Infections. Ottawa, ON: Health Canada. 2002. Available at http://www.phac-aspc.gc.ca/std-mts/sti_2006/pdf/sti2006_e.pdf. 16. Famvir® (famciclovir) Product Monograph. Novartis Pharmaceuticals Canada Inc.; January 2004. 17. Zovirax® Oral (acyclovir) Product Monograph. GlaxoSmithKline Inc.; March 2007.