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Frequently asked questions.

Last checked 19-8-13.

The Virus

  1. Do I have genital herpes simplex?
  2. Do I have to ask my GP for a letter for the 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 take, before I get symptoms?
  9. What symptoms will 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 herpes simplex be caught from a cold sore?
  18. What is asymptomatic shedding?
  19. I’ve heard it can come back, why?
  20. How often does it come back?

    Treating it

  21. Do I need treatment?
  22. How can the doctor help?
  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 can I do to prevent frequent recurrences?

    Other questions

  26. Does herpes simplex cause sterility? Does it make any difference to getting pregnant?
  27. How may herpes simplex affect pregnancy?
  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 simplex?
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 herpes simplex – then they may see you sooner as 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 or pass water for at least three hours before going to the clinic. This could flush away 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.

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2 - Do I have to ask my GP for a letter for the clinic?
There is no need for a letter from your GP.

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3 - Will details of my diagnosis be sent to my GP?
No. Your visit to the clinic is confidential. (A court order is required before patient records can be released and this is very rare.) You don’t even have to use your real name. This is 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 virus is one of a family of herpes viruses all of which, once caught, remain in the body. There are two types:

  • 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.
Each year the number of new people diagnosed is recorded by the Health Protection Agency - 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?
Genital herpes can be caused by either type 1 or type 2. The only difference to you is that
type 1 is more likely to recur when it is caught on the face and does not often 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 take, before I get symptoms?
It usually takes between two and seven 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 could have caught it. This means that it can turn up unexpectedly in a long-term faithful relationship. Because of this, it is important to realise that herpes simplex appearing is not proof of infidelity. There is more about transmission in our "Transmission" leaflet – available to members – when they join.

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9 - What symptoms will I have?
Symptoms may start with itching, tingling, inflammation and discomfort in the area affected. There can also be general flu-like symptoms with backache, headache, temperature, soreness 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, fingers, hands or on 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. This does not normally result in scarring, although the new skin may be paler for a while. This first episode may last from 2 to 4 weeks.

If you get recurrences, they will not be like the first illness. The first one is worse as you do not have specific antibodies to fight this virus. If you get a recurrence, the antibodies to fight the virus will be available much faster.

Recurrent symptoms - if they occur - usually heal much more quickly (often in only in a few days). They are usually mild and seldom involve the flu-like symptoms. A small minority of 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 active. It enters easily through mucous membranes, i.e. the moist skin which lines the mouth and genital-anal area. It can also enter through a cut or break in the ordinary skin on other parts of the body: fingers/hands, knees, etc. if these come into direct contact with the affected area of another person. We call it a whitlow when it's on the fingers.

You can pass it on whenever the virus is present on the skin surface of the affected area: from the first warning signs that a recurrence is starting (tingles, aches, stabbing pains) until fresh skin has grown back. There is a 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.

Only people who do not already carry the virus can catch it. About seven in ten adults already carry herpes simplex virus type 1 and one in ten already carry type 2.

The virus does not travel through the body. So a person with genital infection can always kiss or perform oral sex, the virus will not travel inside the body from the genital 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. This is called a whitlow. If you have caught it in more than one place, you will notice the symptoms during your first outbreak. They will not appear in a second site long after first infection.

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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. So, if you have caught it on your genitals from your partner’s facial cold sores, he or she will not catch the virus back on the genitals. Or if you have caught it on your face from your partner's facial cold sores then he or she will not catch it on the genitals. There is more about transmission in our "Transmission" leaflet – available to – see members.

If the new partner has had facial cold sores in the past and they will either have the same virus as you and be unable to catch it from you, or will have the other type (there are only two types of herpes simplex). If they have the other type and then catch your type, their symptoms will probably be slight or non-existent. This is because the antibodies they already have for 'their type' will immediately start fighting this slightly different virus while their immune system prepares new antibodies to fight the new type of herpes simplex. It is called having 'partial protection'. This gives the partner who already has 'the other type of herpes simplex virus' an advantage over people who have no herpes simplex antibodies of either type. 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?
Three quarters 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 or an itchy bit of skin. 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.

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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 tingly or itchy feeling at the place where this is happening. We have produced two leaflets "Talking to your partner about herpes simplex" (four pages) and "For your partner" (two pages), with advice and information for people in new relationships. These can be ordered when you join.
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 - see Will my partner catch it again if he or she already has it? . 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?
The virus 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.

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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 if you have joined.

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17 - Can herpes simplex 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.

See the description of the two types.

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18 - What is asymptomatic shedding?
Asymptomatic shedding means that virus is present on the skin without causing any symptoms. If enough virus is being shed when direct skin contact occurs, a partner may become infected.

Asymptomatic shedding is often associated with herpes simplex because so many people carry this virus without knowing - they do not see or feel any symptoms - hence they are ‘asymptomatic carriers’.

As many as 2 out of 3 people who contract the virus, catch it from someone who does not know that he or she has the virus. This could be from the lips of someone who is unaware of a cold sore during oral sex, from the fingers of someone who does not know that he or she has a herpetic whitlow, or from direct genital contact.

People who experience recurrent symptoms may also occasionally shed virus asymptomatically between recurrences. This is more likely in the week before and the week after a recurrence.

  • In people who get recurrences, asymptomatic shedding occurs on average for 2 per cent of the time for people with type 2 infection and 0.7per cent of the time for those with type 1.
  • The fewer recurrences a person has, the less chance there is of asymptomatic shedding.
  • Asymptomatic shedding tends to diminish over the years. 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 while then disappear without any symptoms appearing on the skin.

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20 - How often does 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.

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21 - Do I need treatment?
Like flu, herpes simplex will get better by itself. Some people are affected more than others. Primary herpes simplex infections clear up even if no treatment is given in almost all cases. See below for the rare occasions when it can be serious.

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22 - How can the doctor help?
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.

Aciclovir is also put into a cream (e.g. Herpetad, Soothelip, Virasorb, Zovirax) but tests have shown that these creams are no better than a placebo (a dummy cream). Manufacturers do not recommend them for use on mucous membrane (inner ‘wet’ skin) as it may irritate this sensitive skin.

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 any significant effect. See below for self-help suggestions. Members can ask for our Anti-viral 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:
We have links to two websites which will sell you genital herpes antiviral treatments. These are UK-based sites which have the approval of the Care Quality Commission to sell on-line.

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23 - What can I do to stop discomfort and speed up healing?

  • If required, take a painkiller, e.g. ibuprofen, paracetamol or soluble aspirin. This reduces pain and inflammation. (Always follow manufacturers' instructions - and don't take aspirin if you have been told not to by a doctor.)
  • Wash your hands before touching blisters/sores (e.g. when applying medication) as you could introduce bacteria. This could cause an additional infection and delay the healing process.
  • Apply a local anaesthetic ointment, e.g. Lignagel 2 % or lidocaine 5% ointment (this used to be called lignocaine). These may be used on genital or facial sores. If you need a stronger anaesthetic try Xylocaine 10% spray. Dab on (or spray on) as required to relieve pain, especially before urinating - see below. (These are all available from a pharmacy without a prescription.) Occasionally lignocaine/xylocaine can cause hypersensitivity. If it makes your skin more sore, stop using it and your skin will return to normal.
  • Keep the sores moist, e.g. apply petroleum jelly/Vaseline.
  • 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: try an ice pack well-wrapped in cloth for as long as you like (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 pee through a tube or into a bottle to prevent urine coming into contact with the sores. You can put lignocaine/lidocaine BP ointment on the area about 15 minutes before urinating to anaesthetize the area, or use petroleum jelly/Vaseline 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 can I do to prevent frequent recurrences?
Try some of these suggestions from other people with herpes simplex:

  • Try not to worry: worrying is known to affect the immune system and lower our ability to fight infections. The more you know about simplex, the less concerned you will be and since your immune system works best when you are not stressed, by worrying less you will be healthier. (Stress can also be a trigger factor for many other skin conditions, e.g. eczema, psoriasis.)
  • Get enough sleep and avoid getting overtired. Have an early night every week and pamper yourself a little.
  • Eat a well balanced, healthy diet with plenty of fruit and vegetables every day.
  • If in doubt about your diet, take a multivitamin and mineral pill.
  • Taking 200 i.u. of vitamin E every day has been shown to boost the immune response.
  • Cut down on smoking and excessive alcohol.
  • Take regular exercise: 20 minutes brisk walk each day is a good start.
  • Try taking one soluble aspirin each day with food: this has been reported effective by many people. It is not suitable if your stomach is delicate, for children, or if you have been told not to by a doctor.
  • If the skin gets sore, this may trigger a recurrence. This may be the result of horse riding, bike riding or wearing tight trousers or underwear e.g. thongs.
  • Sometimes having sex will trigger an outbreak. If this happens, use extra lubrication (ones with silicon, sold to enhance sexual pleasure, are better than KY jelly) during sex and cool the area after sex with cold water or a cool damp flannel.
  • Wear loose fitting cotton or silk underpants rather than those made with synthetic material.
  • Women: try stockings or bare legs rather than tights.
  • 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.
  • If you prefer the idea of allopathic medicine (that means pills from the doctor) you can take aciclovir. It works in a way 'like a contraceptive pill for the virus' so while you are taking it, the virus cannot multiply properly and form blisters. It can be taken short-term to prevent an outbreak during a special weekend or holiday. It can be taken long-term if you are someone who gets lots of outbreaks. It is now a generic pill (which means any manufacturer can make it and the price has come right down) so the old problem of doctors not wanting to prescribe it long-term because of the price is no longer applicable. You can even buy it yourself: DrThom is a site where you can This is a UK-based website and has the approval of the Health Commission. However at £21.99 for 25 tablets (that would last 6 days at the 'suppressive dose' of four pills a day) this is an expensive option.
  • Talking to someone who has had personal experience of herpes simplex can be very helpful. Join us, come to meetings and/or call our helpline volunteer’s number. Experience, advice, understanding and accurate information are just a call away.
  • Come and talk to a helpliner at the London meetings open to all - see What's New page.
  • Generally we find that indifference to your herpes simplex is the most effective treatment and the less you think about it the less you see of it.

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". Members can order these ­ when they join.

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26 - Does herpes simplex cause sterility? Does it make any difference to getting pregnant?
No. Having herpes simplex will make no difference to getting pregnant – except that you may have to avoid having sex at certain times.

Men: If you have genital herpes and are concerned about infecting your partner while making babies, she could have a blood test to see if she already has herpes simplex antibodies (serology test). If she does, you don't have to worry about her catching it. Since 7 out of 10 people have the virus and only one in five has had recognised symptoms, there is a good chance that the blood test will be reassuring.

Women: If you have genital herpes and are concerned about infecting your partner when making babies, he could have the blood test (see paragraph above) or else you can take aciclovir pills every day to prevent outbreaks; this is suppressive therapy - see "Guidelines" on this page. It has now been proved these pills are not a risk to the foetus. Or just take aciclovir pills for half the month: you take it from your period for two weeks (till ovulation) and then stop. If you have a period, it means you didn't get pregnant, start taking the aciclovir pills again. If you don't have a period - you are pregnant! And because you stopped taking the pills when you ovulated, you weren't taking them once you were pregnant.

If you have a problem finding somewhere that will do the blood test, send us an email info@herpes.org.uk

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27 - How may herpes simplex affect pregnancy and childbirth?
If you have caught herpes simplex before becoming pregnant you can give birth normally. You can see this recommendation in NICE's document about Caesarean sections.
This is because during the last few months 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 these viruses during childbirth and for 3 to 6 months afterwards; longer when breastfed because the antibodies are in breast-milk, but the virus is not.

During pregnancy, herpes simplex normally 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 the second and third cases, there is a danger that the baby could contract herpes simplex so a Caesarean-section is usually performed.

We used to say 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 four page, 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 another virus (papilloma virus - warts) is likely to be a cause of cervical cancer, and if a woman with papilloma virus also has herpes simplex genitally then she is more likely to develop cervical cancer. NHS guidelines recommend the normal smear test every three years even when a woman has herpes simplex.

Sometimes a smear test needs to be followed up because signs of herpes simplex (which does not lead to cervical cancer) and signs of pre-cancerous cells (which can lead on to cervical cancer) can be confused. If pre-cancerous cells are present - for whatever reason - treatment can be given.

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29 - Can I give blood?
Yes. There is no risk of transmitting herpes simplex virus in blood. The virus itself remains in nerve cells; only antibodies are found in the blood. But if you are having a recurrence, it is better to wait before you give blood. As with any illness, you need all your resources to get better.

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30 - Is herpes simplex ever serious?
Sometimes. Any infection can be serious if you have it at the wrong time – if you have other health problems. If you have just had an organ transplant, catching a cold can be dangerous. In other words, anyone whose immune system is compromised is at greater risk.

So herpes simplex can be serious if it is caught by people in any of the following categories:

  • People who have had an organ transplant
  • People on immune lowering cancer treatment
  • People with AIDS
  • People with extensive areas of broken skin, e.g. eczema

Babies whose mothers have not had herpes simplex can be infected. Small babies have immature immune systems so this can be serious. To be on the safe side, anyone with cold sores on the face should not kiss young babies. Having genital sores is no problem, as your affected part will not be in direct contact with the baby. See section on pregnancy.

Rare complications of facial cold sores are:

  • Bell’s palsy may occur in face if the seventh nerves 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. This is characterised by an ‘altered or lowered consciousness’ which sets it apart from other illnesses. The signs may be so subtle that only people close to the sufferer detect them, and they may have to be very persistent to be taken seriously by health professionals. If untreated, encephalitis may leave damage. www.encephalitis.info is a specialist charity for people with encephalitis.

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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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