What is a Herpes Infection?

‘Herpes’ is normally used to refer to one type of herpes infection – when we talk about ‘herpes’, most commonly we are referring to herpes affecting the mouth or the genital area – either oral or genital herpes. However, herpes can also affect other areas such as the hands and fingers.

Herpes is an extremely common infection – in one study, around two thirds of adults aged under 50 were found to have herpes simplex type 1 (HSV-1) antibodies. This implies that around 70% of the population by middle age, have been infected at some point in their lives, with this herpes simplex virus.

Herpes is a virus – it is important to understand that herpes is a virus and not a bacteria. This means herpes does not respond to treatment with an antibiotic. To treat herpes an antiviral medicine is needed.

There are two types of herpes simplex virus (HSV) – HSV1 and HSV2. Historically it was thought that HSV1 was the virus which caused cold sores on the mouth while HSV2 was the virus which caused sores and ulcers on the genitalia. However, it’s now recognised that either virus can affect these areas. HSV2 tends to be more aggressive, and slightly more likely to recur, but otherwise there is no difference in advice or treatment.

Herpes infections can’t be cured – there is no way to completely remove the infection, although you can treat the symptoms successfully.

The herpes virus can be passed from direct skin to skin contact – this includes:

• Mouth to mouth
• Mouth to genitals, for example during oral sex
• Genitals to genitals during sexual activity, even if it’s not penetrative sex

It isn’t passed on through objects – herpes does not live for long outside the body and is not passed on from towels or toilet seats. However it can be passed on during sexual activity, if sex toys are shared.

How does the infection happen? – the virus enters through tiny breaks in the skin and reproduces in the tissue, causing the initial symptoms. It can then travel to nerve cells, where the virus can lie dormant. Later on it can become active again causing a fresh outbreak of infection.

Passing it on to a sexual partner – You are most likely to be infectious and pass on the virus when you have blisters/ulcers. It is important to avoid any sexual contact from the moment you notice any tingling/soreness or blisters, until the blisters are dry and healed - usually about 10 days. This means not even sex with a condom. There may also be 1-2 days per year when you can shed virus and yet have no blisters or ulcers (asymptomatic shedding). It is not possible to know when these days are, so it is important between episodes to use a condom. Shedding is most common in the first year after an outbreak, and reduces over time if you don’t have any recurrences. After 2 years of not having any outbreaks it is very unlikely that shedding will occur.

A herpes outbreak doesn’t mean someone has been unfaithful – unlike with other STIs, a herpes outbreak doesn’t necessarily mean someone has had sex with a new partner recently. They could have had the virus for a long time without symptoms or come into non-sexual contact with someone who is shedding and infectious.

Passing it on to newborn babies – herpes can also be passed to a baby during delivery. Herpes is a very serious infection for a newborn baby, and if you get herpes for the first time in the last trimester of pregnancy, you may be offered a Caesarean Section. Sometimes you will be given antiviral medication to take towards the end of pregnancy to reduce the chance of spreading it to the baby. It is important to talk to your GP or midwife if you think you might have herpes and are pregnant.

Physical effects – physically, a herpes infection is usually more of a nuisance, as the symptoms are unpleasant and may be recurrent, but aren’t usually very serious. Many people are infected with the virus, but never have any symptoms. On it’s own it is rarely going to be life-threatening.

Very rare physical effects – herpes can very rarely have some serious outcomes. Herpes very occasionally affects the brain, eye and skin, in atopic eczema.

Effects in a newborn baby – herpes in newborn babies, ‘neonatal herpes’, is serious infection. A past history of herpes in pregnancy is not an issue and does not cause harm to the baby. The major risk is if you get herpes for the first time in the last trimester of your pregnancy. This should be discussed with your midwife as part of antenatal care.

Psychological effect – the psychological consequences of knowing you have tested positive to a herpes infection can be strong. Many people feel extremely anxious, and suffer with feeling of low self esteem, and mood disturbance. A diagnosis of herpes may also have psychosexual consequences.

Effect on your chance to get pregnant – herpes is not linked with infertility in women. There is also no evidence herpes causes early pregnancy loss/miscarriage. However, herpes has been associated with a lowered male sperm count.

Effect on sexual function – recurrent herpes can affect sexual function. Feelings of fear, low self esteem, loss of confidence, anxiety and embarrassment are common. Sometimes this may result in erectile dysfunction, vulvovaginal pain on sexual intercourse inability to orgasm.

How often does genital herpes happen in the UK? – there were approximately 38,000 new cases of herpes diagnosed in the UK in 2015. This figure does not include recurrent episodes of herpes.

Risk factors – although herpes is transmitted like other STIs, because it so common and difficult to detect it is possible for most people to contract the infection. As a result it’s not really worth considering risk factors the way you would for other STIs.

You are are more likely to get herpes if you currently have another STI – probably because the skin in the genital tract is inflamed and more likely to be susceptible to entry from the viral particles.

Avoiding sex with someone with genital herpes symptoms – we don’t recommend having sex with someone who is currently suffering from herpes. There is a very high risk you will become infected, even with a condom, because the virus can be present on areas of skin not covered by the condom.

General safe sex precautions help – the best advice to avoid getting genital herpes is the same as the advice for avoiding getting other STIs. This is listed below:

• Always use a condom before any sexual contact occurs – the virus spreads by mixing body secretions and by skin to skin contact
• Do not have oral or sexual contact with a partner who has a cold sore
• For oral sex with a new partner, always use a condom or dental dam – condoms and dental dams are available free of charge in sexual health clinics
• Avoid having more than one partner at the same time, i.e. overlapping partners
• Get tested for STIs regularly – either with a home STI test kit or going in to a clinic. Having one STI increases the risk of having others. If your genital skin is inflamed, it is more susceptible to infection by bacteria and viruses. You should also have a test for syphilis and an HIV test
• Try to discuss STIs with a new partner – this is not easy, but it is important to let them know if you have an STI and can help make sure you take the necessary precautions

You can only be tested for herpes while you have ulcers/blisters. The ulcers/blisters may take up to 10 days or more to appear. You can use a home test kit to find out if you have herpes. Or you could see your GP or visit a sexual health clinic. They may also test for other STIs at the same time.