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Frequently asked questions.

Last updated 13-11-14.

The Virus

  1. Do I have genital herpes?
  2. Do I have to see my GP before I can go to a clinic?
  3. Will details of my diagnosis be sent to my GP?
  4. What is herpes simplex?
  5. What are the other herpes viruses?
  6. How common is herpes simplex?
  7. What is the difference between the two herpes simplex types?
  8. How long after contact with a person with herpes simplex will it be, before I get symptoms?
  9. What symptoms may I have?

    Passing it on
  10. How is herpes simplex caught and passed on?
  11. Can I spread the infection around my body?
  12. Will my partner catch it again if he or she already has it?
  13. How can I have caught it if my partner hasn’t got it?
  14. Can I pass the virus to a partner if I have no symptoms?
  15. Can using a condom prevent transmission?
  16. Can I catch herpes simplex off towels, cups, or anything?
  17. Can genital herpes be caught from a cold sore?
  18. Risk of infection between recurrences (asymptomatic shedding)
  19. I’ve heard it can come back, why?
  20. How often might it come back?

    Treating it
  21. Do I need treatment for the first infection?
  22. What is the usual treatment?
  23. What can I do to stop discomfort and speed up healing?
  24. I sometimes get odd feelings/pains around my buttocks or down one or other leg. What does this mean?
  25. What are recurrences and how likely are they?
  26. What can I do to prevent frequent recurrences?

    Other questions
  27. Herpes simplex, pregnancy and childbirth
  28. Do I have a greater risk of cervical cancer?
  29. Can I give blood?
  30. Is herpes simplex ever serious?
  31. Where can I get answers to my other questions?

1 - Do I have genital herpes?
The only way to find out what is causing a genital problem is to go to a clinic or doctor. We recommend that you attend a sexual health clinic or department of genito-urinary medicine. There is probably one at your local hospital. There is sometimes no need to make an appointment, but if you do have to, tell them you think it is genital herpes – then they may see you sooner because it can only be diagnosed while you have symptoms. Ring the hospital for the address and clinic times – or search the list of clinics you can find here.

Don't wash your genitals immediately before going to the clinic. This could wash off traces of virus, bacteria, etc. and make it difficult for the doctor to find out what is causing your problem. It is only possible to diagnose herpes simplex when symptoms are present so don’t delay.

Often, an experienced medical professional will be able to say that it looks like genital herpes. This is called a 'clinical diagnosis' (that is 'a diagnosis made by a clinician'). A swab should be taken from the area of the infection and tested to confirm the diagnosis.

Sometimes, if the swab is negative but the symptoms suggest herpes simplex, a doctor may arrange a blood test to assist in reaching a diagnosis.

Urine tests are not used to diagnose genital herpes - even though these may be offered inappropriately by private testing services.

 [More info...]

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2 - Do I have to see my GP before I can go to a clinic?
No, you can arrange this yourself.

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3 - Will details of my diagnosis be sent to my GP?
No. Your visit to the clinic is confidential. The clinic may ask for your doctor’s details, but you do not have to supply them. You don’t even have to use your real name. This confidential system was set up to encourage everyone with a genital infection to get diagnosed, treated and helped not to pass it on.

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4 - What is herpes simplex?
Herpes simplex is the name given to two viruses in a family of herpes viruses all of which, once caught, remain in the body. The two viruses are:

  • Herpes simplex virus: type 1 and type 2. Both types can cause symptoms on the genitals (genital herpes), the face (facial cold sores), or the hand or finger (called a herpetic whitlow).

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5 - What are the other herpes viruses?

  • Varicella-zoster virus (also called herpes zoster).
    This causes chickenpox and shingles which are occasionally mistaken for herpes simplex. Shingles is a recurrence of chickenpox and in the elderly it may cause painful nerve damage.
  • Cytomegalovirus (CMV) and Epstein Barr virus, also called glandular fever. These viruses do not cause spots or blisters like herpes simplex. They may cause flu-like illnesses.
  • And four others: humanherpes viruses 6, 6a, 7 and 8.

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6 - How common is herpes simplex?
About six out of ten people in the UK carry type 1 and about one in ten carries type 2, more in the sexually active population. Most facial cold sores are caused by type 1. Herpes simplex on the genitals may be type 1 or type 2.If this seems like a lot, it is because most people who have it don’t know, they have no symptoms or they get it so mildly, they do not notice.

Each year the number of new people diagnosed is recorded by Public Health England. It is over 30,000 - see the data here. And we know that a further 1.4 cases are diagnosed by each GP in the country (say about 75,000 cases) [research by Dr P Woolley].

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7 - What is the difference between the two herpes simplex types?
They are genetically different but cause similar symptoms. The only difference is that
- type 1 is more likely to reappear when it is caught on the face and is less likely to recur when it is caught on the genitals;
- type 2 is more likely to recur when affecting the genitals.
There is no difference in the visible symptoms caused by the two types, so it is only possible to establish which type you have caught through a laboratory test. Both viruses are called herpes simplex virus.

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8 - How long after contact with a person with herpes simplex will it be, before I get symptoms?
It usually takes two to fourteen days after contact for the first symptoms to appear, with 4 to 5 days being the most common incubation period. Some people never catch it. Others catch it but show no symptoms.

Occasionally it appears for the first time years after you caught it. This means that it can turn up unexpectedly in a long-term faithful relationship. This is why herpes simplex is not proof of infidelity. About four out of five people (80%) get no clear symptoms when first infected. There is more about transmission in our "Transmission" leaflet – available to members when they join.

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9 - What symptoms may I have?
Symptoms may start with itching, tingling, soreness and discomfort in the area affected. There can also be general flu-like symptoms with backache, headache, temperature, aching and mild swelling of the lymph glands in the groin, armpits and neck.

On ordinary skin (e.g. under pubic hair, or on the shaft of the penis or scrotum, on the fingers, hands or other parts of the body), you are likely to get blisters, spots or red bumps which may be quite painful. These burst and form sores, raw spots or ulcers which will crust over and new skin will form as they heal. On mucous membrane, (e.g. under the foreskin and on the inner side of vaginal lips), the virus causes ulcers which heal directly into new skin. You will not normally have any scarring, although the new skin may be paler for a while. This first episode may last from 2 to 3 weeks.

Some people get recurrences - these are not like the first illness. Because the body now has specific antibodies to fight this virus, repeat outbreaks usually heal much more quickly (often in only in a few days). They are usually mild and seldom involve the flu-like symptoms. A few people get frequent recurrences. If you are one of these people we suggest you look at antiviral treatment and self-help suggestions.

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10 - How is herpes simplex caught and passed on?
The virus is passed directly from the affected area of skin, by direct skin to skin contact, with friction, when the virus is present. It enters easily through mucous membranes, i.e. the moist skin inside the mouth and genital-anal area. Sometimes it gets into ordinary skin, on other parts of the body, if there is a cut or break in the skin. This can be the fingers/hands, knees, etc., if these come into direct contact with the affected area of another person. A finger sore is called a whitlow.

You can pass it on when the virus is present on the skin surface of the affected area: from the first warning signs that a recurrence is starting (tingles, burning skin sensations, aches, stabbing pains), through the time when there are sores or blisters, until they have healed and fresh skin has grown back. There is also a slight possibility that virus may be transmitted through asymptomatic shedding. See more about transmission in our "Transmission" leaflet – free to members – to get this you will need to join.

About six in ten adults carry herpes simplex virus type 1 and one in ten carries type 2. Only around one in five of those infected – with either type - is aware of this. [BASHH] It is rare for people to catch a virus that they already have a second time – even in different parts of the body.

The virus does not travel through the body. So a person with genital infection can kiss or perform oral sex - there is no risk of infecting a partner; the virus will not travel inside the body from the genitals to the mouth.

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11 - Can I spread the infection around my body?
You will not spread the virus to other parts of your own body after the first episode. Even during this first outbreak, the infection is usually limited to one part of the body. Some people will catch it in two places, for instance they may get it on their hands, as well as on the genitals, since hands can be involved in sexual activity. If you have caught it in more than one place, you will notice during your first outbreak.

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12 - Will my partner catch it again if he or she already has it?
If you and your partner have the same virus you will not reinfect each other - even on a different part of the body. If you have caught it a genital infection from a partner’s facial cold sores, they will not catch the virus back on their genitals.

If you have caught it on your face from your partner's facial cold sores then they will not catch it on their genitals from you.

There is more about transmission in our "Transmission" leaflet available to members.

If your new partner has had facial cold sores in the past, this either means that they have the same virus as you, or will have the other type (there are only two types of herpes simplex). When you both have the same type, it is highly unlikely that either of you will reinfect the other. If you have different types and either of you catches a second type, symptoms will probably be slight or non-existent. This is because the antibodies for one type will have some immediate effect on the other type as well. This is called 'partial protection'. An antibody (blood test) might show that this is the case. Members can request our leaflet explaining what an antibody type test can do.

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13 - How can I have caught it if my partner hasn’t got it?
Your partner might have it and not know. Four out of five of the people with herpes simplex have it so mildly they do not realise they have it. So they may have sex when the virus is active. Mild symptoms can appear as a pimple, a little cut oa little cut or an itchy bit of skin and yet be very infectious, and are often more sensitive or painful than you would expect. When people with these mild symptoms learn to recognise them, then they can avoid sex at these times. They are often much more sensitive or painful than such small conditions should be. When people with these mild symptoms learn to recognise them, then they can avoid sex at these times.

Another possibility is that your partner does not have herpes simplex and you caught it from a previous partner. It is perfectly possible to have an outbreak a long time after first catching it.

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14 - Can I pass the virus to a partner if I have no symptoms?
When the virus is inactive (dormant) inside the nerve cells it cannot be caught by a partner. If there is virus on the place where you get your symptoms, it may be passed on – see What is asymptomatic shedding? There may be a tingly or itchy feeling at the place where this is happening.

An antibody (blood test) might show that your partner already has the virus. In this case your partner will have either total or partial protection. Members can request our leaflet explaining the antibody test in full.
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15 - Can using a condom prevent transmission of genital herpes?
Yes it can make a big difference.[ref BAHSS?] Herpes simplex cannot get through a condom, so using one is a good idea as long as it is put on the penis before genitals touch. If the virus is active on the skin outside the area protected by the condom, transmission may still happen. A Femidom (female condom) covers a wider area so may be more useful for some people. If you have obvious genital symptoms it is best for an uninfected partner to avoid contact with that area until they have healed.

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16 - Can I catch herpes simplex off towels, cups, or anything?
The virus is caught off the skin, not from objects. It is a delicate virus and dies quickly when away from the skin where the sore is. There is more about transmission in our "Transmission" leaflet -available to members.

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17 - Can genital herpes be caught from a cold sore?
Yes, if a person with a cold sore on the mouth does oral sex he or she can give his/her partner ‘cold sores on the genitals’ which is genital herpes.

Also, cold sores on the face may be caught from someone with genital herpes through oral sex.

Only the face is infectious in a person with cold sores - so they can have sex, but not kiss or do oral sex when they have a cold sore.

See the description of the two types.

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18 - Risk of infection between recurrences (asymptomatic shedding).
Studies have shown that virus may be found on an infected area, even when there are no visible symptoms. This is called asymptomatic shedding. If enough virus is present when direct skin contact (sexual contact) takes place, a partner may become infected.

Studies have shown that a majority of people catch it from someone who does not know that he or she is infected.

  • The fewer recurrences a person has, the less chance there is of asymptomatic shedding.
  • Asymptomatic shedding tends to decline with time. It is more likely to be happening in the first year and much less probable after that.

The virus is most often transmitted during the first four months of a new relationship; however partners are often together for years without the virus passing from one to the other.

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19 - I’ve heard it can come back, why?
Between recurrences the virus travels from the skin along the nerve to the nerve ganglion (a junction for several nerves supplying the same area). Here it rests in a dormant/inactive state. Once you have been infected, the virus remains in your body, just as chickenpox and some other viruses do.

Recurrent symptoms occur when the virus is reactivated or 'triggered.' It travels back to the skin surface where it enters skin cells causing another blister, sore or cut. Recurrent symptoms normally appear in the same area as the first time. But for some people they may shift a short distance, e.g. from genitals to buttocks within the same dermatome (nerve region).

Some people feel aching, tingling, burning or sharp pains in the area affected (leg, genitals or buttock) preceding a recurrence. These are called prodromal symptoms or prodromes. Sometimes they last for a few days then disappear without any symptoms appearing on the skin.

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20 - How often might it come back?
Some people get no further episodes, a few get frequent recurrences. A doctor may prescribe antiviral pills that you take for several months to prevent outbreaks - see antiviral treatment, or you can try self-help treatments. There are two pages of suggestions on our "Summary of Tips" leaflet. It is available to members. Outbreaks normally decline in frequency and severity over time.

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21 - Do I need treatment for the first infection?
Treatment can be helpful – particularly if there are severe symptoms. Some people are affected more than others. Herpes simplex infections clear up even if no treatment is given. See below for the rare occasions when it can be serious.

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22 - What is the usual treatment?
The doctor may prescribe antiviral tablets to speed up healing and reduce the severity of a first episode. Aciclovir is the most commonly used antiviral drug for this purpose. You don’t need the tablets if the first episode is mild, or if you have almost recovered before you see the doctor.

If you get more episodes later on, these are less likely to be treated with antiviral tablets as treatment has to start early on to have a useful effect. See below for self-help suggestions. Members can ask for our antiviral drug fact sheet – see subscription form.

Some people are unlucky and get frequent recurrences. In these cases the doctor may prescribe a longer course of tablets to keep the virus dormant – perhaps for six months at a time. For most people this is not necessary either because their body deals with the virus without help or because they find that adopting a healthier life style does the trick. See What can I do to prevent frequent recurrences?

Most antiviral pills are suitable for vegans and vegetarians. Click here to go the page with drug recommendations and click down to the information.

Advertisment:
There are now UK-based websites authorised by the Care Quality Commission to sell aciclovir to diagnosed patients such as DrThom and MedExpress .

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23 - What can I do to stop discomfort and speed up healing?
People with genital herpes have reported to us that these ideas have helped them:

  • If required, take a painkiller, e.g. ibuprofen, paracetamol or soluble aspirin – they reduce pain and inflammation. (Always follow manufacturers' instructions)
  • Wash your hands before touching blisters/sores (e.g. when applying medication) as this could introduce bacteria. This could cause an additional infection and delay healing.
  • Apply a local anaesthetic ointment, e.g. lidocaine 5% ointment. This can be used on genital or facial sores. Some people prefer a stronger anaesthetic such as Xylocaine 10% spray. Dab on (or spray on) as required to relieve pain, especially before urinating - see below. (These items are all available from a pharmacy without a prescription.) There is a low risk of a negative reaction from these topical anaesthetics. If you find that soreness increases, stop using them.
  • Keep the sores moist, you can apply Vaseline (petroleum jelly).
  • Keep the area clean: washing gently once a day is sufficient. Many people have found a warm salt water solution (1 teaspoon to 1 pint water) very soothing. Gently bathe the area using cotton wool.
  • Avoid scented soap and deodorants. It is best not to use wipes, gel or soap in this area, but if you do, use an unscented brand.
  • Avoid over-washing as this can increase irritation and delay healing.
  • Dab dry carefully with a tissue after washing or use a hair dryer set at 'cold'.
  • To reduce itching, keep the area as cool as is practical: : apply a well wrapped ice pack for up to (90 minutes). DO NOT put ice directly on the skin.
  • Women who experience pain when peeing during a first episode can try peeing while in the bath or shower, or sitting on the edge of the bath and pouring water over the area. This will dilute the urine and ease discomfort. Or try urinating through a tube or into a bottle to prevent urine coming into contact with the sores. You can put lidocaine ointment on the area about 15 minutes before urinating to anaesthetize the area, or use Vaseline (petroleum jelly) or Orabase on the sore as a barrier.
  • For further suggestions write to our office enclosing an SAE.

Do not over-treat the sores - let the skin heal. Symptoms will heal with or without treatment.

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24 - I sometimes get odd feelings/pains around my buttocks or down one leg. What does this mean?
Occasionally, herpes simplex virus can cause ‘burning skin’ sensations, deep aches or sudden twinges in the genital area. When they occur in the thighs or buttocks, they are sometimes compared to ‘sciatica’. These symptoms are called prodromes – or prodromal symptoms. They are a sign that the virus is trying to reactivate. Sometimes sores will follow, but very often your immune response overcomes the virus before visible signs appear. For information on treatment, select "tips to prevent recurrences" on the subscription form.

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25 - What are recurrences and how likely are they?
Recurrences (also called outbreaks) are repeat symptoms (sores, blisters, patches of red skin or tiny cuts) at or close to the place where the infection first appeared. They are often fairly minor and may be no more than a small spot that heals in a few days. They may be accompanied by sensations – itches or nerve twinges. They are unlikely to be as severe as first symptoms and may be almost unnoticed.

Around 50% (half) of people diagnosed only get symptoms once so do not expect to get recurrences – wait to see what happens. Recurrences may occur several times a year or can be much less frequent. They usually get milder, heal faster and happen less often as time goes by.

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26 - What can I do to prevent frequent recurrences?
There is no need to change your lifestyle or take steps to prevent recurrences until you know whether or not you are going to get any.
Other people with genital herpes have made the following suggestions, based on their own experiences after diagnosis. The HVA cannot confirm that any of them will work for you, but we believe they are worth considering:

  • Try not to worry: worry or stress is known to affect the immune system and lower our ability to fight infections. As you learn more about herpes simplex, you will be able to put it in perspective and worry less. Your immune system will benefit from this and you may get fewer outbreaks. (Stress can also be a trigger factor for many other skin conditions, e.g. eczema, psoriasis.)
  • Get enough sleep and avoid getting too tired.
  • Eat a well balanced, healthy diet with plenty of fruit and vegetables.
  • A modest vitamin E supplement (200 i.u. per day) has been shown to boost immune response.
  • Give up smoking and cut down on excessive drinking.
  • Take regular exercise: 20 minutes brisk walk each day is a good start.
  • Try taking one soluble low dose aspirin each day with food. (For adults only. This is not recommended for people with stomach problems. Talk to your doctor first.)
  • Try to avoid causing soreness to genital skin. ‘Skin trauma’ caused by waxing, shaving, thongs, tight trousers, horse or bike riding or even sexual activity may trigger outbreaks.
  • If sex is a trigger try using silicone based lubricant (sold to enhance pleasure).
  • Avoid direct sunlight or ultraviolet rays from sunbeds on the site of infection, i.e. no nude sunbathing! If you have cold sores (facial herpes simplex), use a sunblock to protect your skin.
  • Join SPHERE and ask for the ‘Tips to Prevent Recurrences’ - two sides of A4.
  • Talking to someone else who has personal experience of herpes simplex can be helpful. Join the HVA, come to meetings and/or call our helpline volunteer’s number. Experience, advice, understanding and useful information are just a call away.
  • Come to a London meeting hosted by one of our volunteers – they are informal and open to all - see What's New page.

You will see plenty of internet sites offering dubious ‘treatments’ that are unnecessary and probably have no effect.

Our "Summary of tips to prevent recurrences" is a two page list of self help suggestions. We also produce leaflets on "Diet", "Stress", "Boosting Immunity", and reports of our trials on "Olive Leaf Extract" and "Eleutherococcus senticosus" (Elagen). Members can order these ­ when they join.

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27 - Genital herpes, pregnancy and childbirth
Having herpes simplex does not affect fertility or the ability to conceive. Talk to your doctor about taking antiviral tablets if you need to prevent outbreaks when you want to conceive. This is safe.

If you have caught herpes simplex before becoming pregnant you can give birth normally. This is confirmed by the RCOG/BASHHguidelines for herpes simplex and childbirth.
Having outbreaks during pregnancy is normal. These will not harm the baby. Some women have more outbreaks during pregnancy.

Towards the end of pregnancy, babies in the womb develop antibodies to all the infections (‘childhood illnesses’) that their mothers have previously caught (and have antibodies for). These protect the baby from catching these viruses during childbirth afterwards; longer when the mother breastfeeds. After that, this protection fades away.

During pregnancy, herpes simplex only causes concern:

  • if the mother has it for the first time during the last few months of pregnancy. There will be no time for antibodies to have formed before birth.
  • if baby is being born before 32 weeks (very premature). These babies do not have full antibody protection so they could be infected during the birth if the mother has sores at the time.

In these cases, there is a danger that the baby could contract herpes simplex so a Caesarean-section is usually performed.

Women who do not have genital herpes should be careful not to catch it in the last two months of pregnancy – as explained above. This means that if their partners are already infected (facially or genitally) they should avoid contact that might transmit the virus to the mother.

Small babies can be susceptible to viruses. Anybody with cold sores on the face should not kiss young babies.

It used to be thought that there was a risk of miscarriage if the mother caught it in the first three months of pregnancy. Now we know there is no evidence for this at all. A primary infection will not cause miscarriage.

A referenced "Pregnancy and Childbirth" leaflet is available to members.

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28 - Do I have a greater risk of cervical cancer?
There is no greater risk of cervical cancer if you have genital herpes simplex. It was thought for a time that herpes simplex could be one of the causes of cervical cancer. Further research has shown that this is not so.

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29 - Can I give blood?
Yes. The virus is not found in blood.

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30 - Is herpes simplex ever serious?
Genital herpes can cause severe discomfort and a flu like illness. In rare cases there may be urinary retention during a first outbreak and a catheter may be needed but this does not mean that it is considered to be medically serious.

Some people with weakened immune systems or on certain medications may have many outbreaks and will be prescribed antiviral medication to prevent them.

People with widespread eczema (or some other skin conditions) can have a more severe infection if a large area of skin is infected.

Although genital herpes is not serious, facial herpes simplex can sometimes have serious complications – see links below. They cannot happen to people who only have genital herpes.

Rare complications of facial cold sores are:

  • Bell’s palsy is a temporary partial paralysis of one side of the face that usually gets better in a few weeks. It can happen when the nerve in the face is affected by cold sores. This causes loss of taste, drooping features and unresponsive facial muscles – typically in only one side of the face. Bell’s palsy usually resolves in a few weeks though it can last longer. www.bellspalsy.org.uk can give you more information.
  • Very rarely, when the virus has been caught on the face, it can reactivate inside the eye. This is called ophthalmic herpes simplex or herpes keratitis, dentritis or uveititis. It should be referred to a specialist eye doctor: if left untreated it may damage sight. The Eye Care Trust offers more details.
  • Extremely rarely, when the virus has been caught on the face, it can reactivate in the brain. This is called encephalitis; if untreated, it may leave damage. www.encephalitis.info is a specialist charity for people with encephalitis.

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31 - Where can I get answers to my other questions?
We run a helpline answered by trained volunteers who have herpes simplex themselves. Phone 0845 123 2305 with a pen and paper handy, to jot down the times when the next volunteer is available (it tends to be weekday afternoons and evenings). You can come and talk informally and personally to the patient representative for the medical Herpes Simplex Virus Panel, at the London meetings open to all - see What's New page.

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This page was last revised 2-6-13 and will be reviewed 2-6-16