Genital herpes is a Sexually Transmitted Infection (STI) caused by one of the two types of the herpes simplex virus (HSV): herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). Most Canadians will have at least one type of HSV in their lifetime. While herpes is very common, unfortunately for some, it can also carry a stigma that can lead to anxiety, fear and misinformation about herpes.
For many people, herpes is a minor skin condition that comes and goes without causing problems. As a result, many people may not be aware that they have the virus.
Herpes is passed from person to person by direct skin-to-skin contact with a person who has the virus. For example, kissing or sexual activity, including oral sex. It can be passed even when herpes sores are not visible.
It is also possible to pass herpes if a person touches the part of their body that has herpes and then immediately touches another person’s mouth or genitals. Sharing sex toys without changing condoms or washing toys may also pass the virus.
During a primary first outbreak, it’s possible to pass the virus to another area of that person’s own body. This can happen by touching the sores and then touching another part of their body (for example, rubbing a blister on their mouth and then touching their genitals).
The chance of passing herpes is highest when there is an active outbreak (when sores or blisters, or warning symptoms are present). You can still pass herpes when there are no symptoms (asymptomatic shedding), but this is less likely.
Pregnant people with an active outbreak in late pregnancy can pass the virus to their baby during a vaginal delivery.
Most people never have symptoms, or they are so mild that they do not know they have the virus. Sometimes, symptoms may not appear for months or years. Symptoms vary from person to person. Many people who do get symptoms may not realize that it’s caused by HSV.
Symptoms may include one or more sores that look like water blisters, cuts or broken skin on the genitals (external sex organs), rectum, anus, or the mouth, hands and eyes. Herpes can also cause blisters around the mouth (oral herpes) often called ‘cold sores’ or ‘fever blisters’.
Herpes infections have three different outbreak types:
A primary outbreak happens when someone first gets herpes symptoms; usually beginning 2 to 21 days (on average 6 days) after contact.
Some people experience warning signs, called ‘prodrome’ symptoms. This includes itching, burning and tingling of the skin at the site where the blisters or sores may appear, followed by painful herpes sores or tiny blisters. During a primary outbreak, symptoms of herpes may include:
When the blisters break, painful shallow ulcers appear. These ulcers crust over and usually heal in 7 to 14 days. A primary outbreak is generally worse than future outbreaks. A non-primary first outbreak is when someone who already has one type of herpes gets the second type. It's often milder and is unlikely to cause full-body symptoms.
After the first outbreak, HSV stays in the body and becomes inactive. There is no way of knowing if, or how often, a person will have future outbreaks (called recurrent outbreaks). When recurrent outbreaks happen, the symptoms usually show up in the same place where they first appeared.
Outbreaks are most common in the first year, and generally happen less over time, the symptoms are milder and will often go unnoticed. Genital herpes caused by HSV-1 recur infrequently.
Complications are rare, but some people, especially those with weakened immune systems such as people with unmanaged HIV, may have trouble fighting the virus and get a secondary infection in the eye, fingers, joints, throat, colon, liver, lungs or brain. They may also have a higher chance of passing HIV.
If you are pregnant and you or your partner have a history of herpes, it’s important to inform your health care provider. There are steps you can take to help prevent the virus from being passed to the baby, such as a C-section. This is most likely to happen if the mother has a primary first outbreak in the third trimester. Herpes can cause serious complications for the baby, including death. People who have genital herpes before they become pregnant are at very low risk of passing it to their infant.
Herpes testing is only generally done when there are sores present. Visit your health care provider as soon as possible after the sores develop. They will examine the area and may swab the sores (around the genitals, anus or mouth) or send you for a blood test, which is not routine.
If the sores have already started to heal, a swab test may not pick up the virus. In this case, the test can be negative, but you can still have herpes.
Antiviral medication can be prescribed when herpes first develops or if the blisters are painful or happen often. Antiviral treatments will not cure herpes but can help to reduce discomfort and how long it takes for a sore to heal. The medication works best if started as soon as possible. It can also decrease the chance of spreading herpes to others by preventing the virus from multiplying. To ease discomfort when you have symptoms, try the following:
It’s not well understood what reactivates (triggers) the herpes virus symptoms to recur. The triggers may include:
A healthy lifestyle, such as a good diet, getting enough sleep and rest, exercise and reducing stress may help limit the number of outbreaks. Using a water-based lubricant during sexual intercourse can help to reduce friction and skin irritation that may trigger an outbreak in some people.
Condoms provide good protection but do not completely prevent the spread of herpes because they do not cover the entire genital area. Use condoms on sex toys as well. Avoid sexual activity or skin-to-skin contact with herpes sores during an outbreak. Use a dental dam as a barrier during oral sex. Talk to your health care provider about suppressive therapy to reduce the risk of transmission. Wash your hands after touching the blisters. Talk to your partner(s) about herpes before engaging in sexual contact.
Call Sex Sense, a free, confidential sexual health referral and information service at 1-800-739-7367 throughout B.C. or 604-731-7803 in the Lower Mainland.
For tips on how to talk to your partner(s), visit the BC Centre for Disease Control (BCCDC) SmartSex Resource https://smartsexresource.com/resources/herpes-a-patients-guide.
For more information on how you can reduce your chance of getting an STI, visit HealthLinkBC File #08o Preventing sexually transmitted infections (STIs).
Call toll-free in B.C., 8-1-1, or 7-1-1 for the deaf and hard of hearing to get personalized assistance. Speak to a navigator who can guide you to reliable health information or connect you with a health professional. Translation services are available in over 130 languages.
