Genital herpes and cold sores: What you need to know

As a physician, I have treated and written about many sexually transmitted diseases (STDs) including chlamydia, trichomoniasis and pelvic inflammatory disease. Herpes is one of the most common. There’s a lot to say about it. Here’s what you need to know:

Herpes simplex is a virus. There are more than 100 known types of herpes viruses, but only two are usually sexually transmitted: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both types can cause genital herpes. HSV-1 can also cause sores on the mouth or lips called fever blisters or cold sores.

How does someone get genital herpes? Genital herpes can be spread by having sex, either vaginal, oral, or anal with someone who already has it. Genital herpes can also be spread if someone’s genitals touch the infected skin or secretions (such as saliva through oral sex).

Genital herpes is common. Genital herpes may be common, but it’s not the most common STD. Human papilloma virus (HPV) has that distinction. But unlike herpes, HPV infection can be prevented by a vaccination. Worldwide, 3.7 billion people younger than 50 (67 percent) get HSV-1 and 417 million people (11 percent) get HSV-2, according to the World Health Organization (WHO). One in six Americans between ages 14 and 49 has HSV-2, and there is an increasing number of genital herpes infections caused by HSV-1, according to the Centers for Disease Control and Prevention (CDC).

Most people who have genital herpes don’t know they have it, yet they can pass it on. That’s why a person can get genital herpes from someone who has no signs of infection. The symptoms of genital herpes may include pain and itching, small red bumps, blisters, ulcers, and scabs on and around the vagina, penis and rectum. During the first outbreak, symptoms may begin about two to 12 days after exposure — during which someone who is infected may unknowingly spread the infection to others. If an individual has symptoms with their primary infection, they may have swollen lymph nodes in the groin and flu-like symptoms such as headache, muscle aches, and fever — which could easily be mistaken for another type of infection. Early in the reactivation phase (outbreak), many people experience a prodrome (warning symptom) such as an itching, tingling, or painful feeling in the area where their recurrent lesions will develop. The prodrome often comes a day or two before lesions appear.

Can herpes be cured? Unfortunately, no. Both HSV-1 and HSV-2 infections are lifelong. After the initial infection, the virus remains in the body — often without causing symptoms. Antiviral medicines such as acyclovir, famciclovir, and valacyclovir can make the sores go away faster, but they cannot cure the infection. If a person has several outbreaks in a year, the antiviral medication can be prescribed daily to reduce outbreaks and reduce the chance of spreading to sex partners.

A pregnant woman with genital herpes needs to need discuss it with her doctor. If she has sores when labor starts, the doctor may do a C-section to prevent the infection from being transmitted from the mother’s vagina to the baby. Neonatal herpes is a rare condition, but it can lead to neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires an HSV infection for the first time in late pregnancy.

Diagnosing genital herpes. Generally the CDC doesn’t recommend routine testing unless someone or their sexual partner has symptoms. And if someone does experience an outbreak, a skin swab might be used for confirmation. Blood tests are also sometimes done. If you have genital herpes, you should be tested for other STDs. Be sure to tell current and recent sex partners, so they can get tested too.

There are ways to lower the risk for genital herpes. The surest way to prevent genital herpes is to not have sex. Both male and female condoms, when properly used, can help reduce transmission, but herpes can be spread through skin-to-skin contact in areas that aren’t covered.

Other prevention tips: People with active cold sores in their mouths should avoid sharing saliva and having oral sex, and individuals with symptoms of genital herpes should abstain from sexual activity while experiencing any of the symptoms. Also keep in mind that people who already have HSV-1 infection are still at risk of acquiring HSV-2 genital infection and vice-versa.

Advice for parents: Don’t wait for the herpes lesson that teens may (or may not) get in their schools’ health education classes. If you are a parent, initiate this important discussion early — even before puberty — and often! Not talking about it can be a mistake.

Rima Himelstein, MD, is a pediatrician and adolescent medicine specialist at Crozer-Keystone Health System.