Herpes
What is herpes?
Herpes is a group of infectious diseases caused by the herpes simplex viruses (HSV). These infections affect the skin, often causing small blisters. There are two types of herpes viruses which are:
Herpes simplex virus type 1 (HSV-1) — causes most cases of cold sores on the lips or face
Herpes simplex virus type 2 (HSV-2) — causes most cases of genital herpes
While the different strains of the virus are usually linked to one type of infection, both viruses can cause either cold sores or genital herpes.
It’s estimated that in Australia, 75% of Australian adults have been infected with HSV-1, and 10% of adults have been infected with HSV-2, with women more likely to be infected with HSV-2 than men. Once you have been infected, you have the virus for life but it may lay dormant for many years.
How is herpes transmitted?
You can contract HSV through the skin on the mouth, genitals, anus or small cuts in your skin.
Transmission of HSV-1 is usually via direct physical contact such as kissing, skin-to-skin contact, sharing drink containers or utensils, or towels and toothbrushes with someone who already has a cold sore. Most people are infected with this virus when they are young.
HSV-2 is spread via skin-to-skin contact with someone who already has the virus, usually during vaginal, anal or oral sex. It can also be spread through kissing, foreplay and non-penetrative sex.
The risk of transmitting HSV infections is greatest when there are active sores and blisters, although it’s still possible to transmit the virus when there are no present symptoms.
Herpes symptoms
Sometimes HSV infections have no symptoms or only mild symptoms that go unrecognised. However, when there is an outbreak, there are usually obvious symptoms.
Cold sores
Noticeable symptoms of cold sores may include:
localised itching and tingling a day or two before the cold sore appears
small blisters
pain and tenderness at the site
heat or burning sensation
burst blisters after a couple of days
a crust that forms once blisters burst
dried crusts that eventually fall off after 10 days or so
As well as the symptoms above, people with a cold sore may also experience:
fever and headaches
nausea
pain or swelling in the mouth
sore throat and swollen glands
dehydration
Genital herpes
The first occurrence of genital herpes can be painful and distressing. Symptoms may include:
flu-like symptoms:
feeling unwell
headache
pain in the back and legs
enlarged glands in the groin
small blisters in the genital area, which will eventually burst to form shallow, painful ulcers that will form a scab and heal within one to two weeks
small cracks in the skin with or without tingling
redness or rash
pain and swelling in the genital area
pain and difficulty passing urine
Recurrent episodes of genital herpes are usually shorter in duration and less painful than the first episode.
What triggers a herpes outbreak?
Once you have the herpes virus, it lives in the nerves below the skin and can remain dormant for many years. During this time, you won’t notice any symptoms. When the virus activates, you are likely to notice symptoms.
It’s not clear as to what causes the virus to activate, however factors that may trigger symptoms include:
the common cold
sunburn or sunlight
hormonal changes associated with menstruation
stress or emotional upset
sexual activity
surgery
weakened immune system
How is herpes diagnosed?
Your doctor or pharmacist can usually diagnose a cold sore just by their appearance. However, your doctor may take a swab from the lesion for testing to confirm the diagnosis.
If you think you have genital herpes, you should visit your doctor immediately. They will take a swab from the affected area which will be used to confirm the diagnosis. Your doctor may also request blood tests, although this is rare.
How is herpes treated?
As there is no cure for herpes, treatment for an outbreak aims to reduce symptoms and prevent further outbreaks. In addition, practicing safe sex is an important to help stop the spread of genital herpes.
Treating cold sores
The most common treatment for cold sores is antiviral cream available from your local MediADVICE pharmacy. This should be used in the first few days when you notice a tingling sensation or a raised sore or blister. Antiviral tablets are also available so speak to your pharmacist about which product is best for you.
Other measures you can take to relieve pain and other symptoms include:
applying ice to blisters
applying povidone-iodine ointment (i.e. Betadine) to blisters
using over-the-counter (OTC) pain relief medication
avoid picking scabs or breaking blisters
If you experience frequent severe cold sores, your doctor may prescribe an oral antiviral medication to prevent the virus from reactivating.
Treating genital herpes
Treatment for genital herpes usually involves antiviral medication which may reduce the risk of passing the virus onto a sexual partner, as well as reduce the symptoms of an outbreak. This is most effective if started within 72 hours of symptoms beginning.16
You can also relieve symptoms by:
using local anaesthetic cream or ointment (your pharmacist can provide advice)
using ice packs on the affected area
using OTC pain relief medication
sitting in a salt bath (1 teaspoon salt to 2 cups of water, or 1 cup of salt in the bath)
Complications of herpes
Cold sores
Cold sores aren’t usually serious and don’t cause any permanent damage to the skin. However, if blisters become infected it’s possible to develop a bacterial infection that will require antibiotic treatment. Some people may also experience other complications such as:
herpes whitlow — when the infection is transferred from the mouth to the fingers
eye infection — sometimes the virus can spread to the eyes causing severe complications
widespread infection — people with atopic dermatitis (eczema) may be at risk of sores spreading across their body, which is considered a medical emergency
Genital herpes
Genital herpes can lead to potential complications which may include:
contracting other sexually transmitted infections (STIs) including HIV/AIDS
infection in newborns that poses a risk for brain damage, blindness or death in babies
bladder problems
meningitis, although this is rare
rectal inflammation (proctitis) — inflammation of the lining of the rectum
When should you see your doctor?
If you suspect you have genital herpes or any other STI you should see your doctor for a diagnosis in order to receive the correct treatment.
Most of the time, you won’t need to see a doctor for a cold sore. However, you should seek medical attention if:
you have a weakened immune system
you have severe symptoms
the cold sore becomes infected
the cold sore doesn’t heal or spreads to other parts of your body
your cold sore has spread to your eyes
you get lots of cold sores
Can you prevent herpes?
It may not always be possible to prevent the spread of the herpes virus. However, you can take the following precautions to reduce the risk of transmission:
wash your hands after touching any blisters
avoid touching your eyes after touching blisters
avoid sharing personal items such as toothbrushes, drinking containers, cutlery, or towels
avoid kissing others if you or they have a cold sore
use condoms or dental dams during sex, even if there are no blisters present
avoid sex when you have blisters as this is when you are most infectious
avoid sex with others who have blisters, sores or any other symptoms of genital herpes
avoid oral sex when cold sores are present
Your local MediADVICE Pharmacist is available to help you treat and relieve any symptoms of oral or genital herpes breakouts. We can speak to you about a range of medication and products available that may bring relief.
Find a store