Herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus (HSV).

Genital herpes infection is very common and on the increase. It is more common in women (1 out of 4) than in men (1 out of 5) possibly because male to female transmission is more efficient than female to male transmission.  

HSV-2 infection is also more common in areas of high socio-economic disadvantage, facing fundamental issues of health such as:

  • access to quality health care

  • poverty

  • living in communities with a high prevalence of STDs

  • illicit drug use

The Herpes Virus

HSV-type 1

  • causes fever blisters on the mouth or face (oral herpes)

HSV-type 2

  • typically affects the genital area (genital herpes) 

Both viral types can:

  • be inactive or 'silent' causing no symptoms

  • cause either genital or oral infections

  • cause 'outbreaks' of blisters and ulcers  

People can remain infected for life after the first initial episode

Herpes is spread by direct contact including: 

Sexual contact

  • Anal sex

  • Oral sex

  • Vaginal sex

as well as

  • Kissing

  • Skin-to-skin contact which transmits HSV-1 and HSV-2

Genital herpes

  • Can be transmitted with or without the presence of sores or other symptoms

  • Is often transmitted by people who do not realize infection can be passed on even when there are no symptoms

  • Is often transmitted by people unaware they are infected


  • An estimated 40 million people have genital herpes which is a chronic viral infection

  • About 500,000 new people get symptomatic herpes each year 

  • There are even more people without symptoms

Genital herpes infection

  • has increased most dramatically among young white teens (12-19 years old)

  • among whites is 5 times higher than 20 years ago

  • is twice as likely to infect 20-29 year old adults

How serious is Herpes?

Mild symptoms can be experienced with HSV-2, but often no apparent symptoms are present.   

HSV-2  may cause recurrent painful genital ulcers and can be severe in people with suppressed immune systems.  Severe genital herpes frequently causes psychological and emotional  stress.

If a woman with HSV-2 is pregnant, potentially fatal infections  in infants can occur. A caesarean section delivery is usually carried out  if a woman has active genital herpes at time of giving birth.
People infected with herpes may be more susceptible to HIV infection, and  HIV-infected individuals may be more infectious.

How do you know if you are infected with genital herpes?

Many people with HSV-2 are sometimes not aware that they are infected.  

Some people infected with HSV-2 do not have lesions or may suffer only  very mild, almost unnoticeable, symptoms which are sometimes mistaken for insect bites or a rash.

Symptoms of  the primary episode can be quite pronounced. The primary episode usually occurs within two weeks after the virus is transmitted and lesions usually heal within 2-4 weeks of outbreak.  

Other symptoms may include a second crop of lesions, or flu-like symptoms including:

  • fever 
  • swollen glands

A primary episode of genital herpes can cause several symptomatic recurrences a year (average 4 or 5).  Most recurrences occur more often within the first year following the primary episode.

Herpes simplex, a recurrent viral infection, caused by Herpes Virus hominis (HVH), is a widespread infectious agent, which is very hard to control. As well there are  latent herpes associated  infections. 


Symptoms vary, but often most people have no noticeable symptoms. 

Early symptoms may include:

  • burning sensation in the genitals

  • flu-like symptoms

  • lower back pain

  • pain when urinating

Small red bumps may appear in the genital area after initial symptoms, which later develop into painful blisters.

The blisters usually:

  • crust over

  • form a scab

  • heal


The First Outbreak

Symptoms usually  develop within 2-20 days after contact, but could continue up to 2 weeks.

The first infection may be so mild it goes unnoticed. In other cases, the first attack causes visible sores. Subsequent recurrences of the virus may cause an outbreak of blisters.

The virus retreats into the nerves and lies dormant. Even when there are no symptoms of herpes, transmitting the virus is still possible (asymptomatic viral shedding). 

Healing of the skin does not normally  leave scarring. 

Typical Symptoms

When it  gets into skin cells the virus reproduces itself  and starts to multiply, making the skin red and sensitive.  

Blisters or bumps may appear on the genital area, the blisters first opening and then healing with the regeneration of new skin tissue.

During the outbreak the infected area may:

  • be painful

  • burn

  • itch

  • tingle

Other symptoms include:

  • fever  

  • headache

  • infection of the urethra causing a burning sensation when urinating

  • muscle ache

  • painful inflamed blisters which develop around the infected area

  • swollen lymph glands 

  • vaginal or penis discharge

The first episode is the most severe, with most episodes lasting 10-21 days.  A  warning sign (prodrome) such as tingling is experienced by many people in recurring outbreaks.

Should any of these symptoms occur, consult your doctor or other health care provider immediately. 

Genital herpes should be diagnosed and treated professionally. 


Diagnosis can be made by:

  • Blood Test

  • A blood test for herpes is available only in a few research centres. 

  • Microscopic Examination of Tissue Scrapings

In this process, scrapings from lesions are stained and then examined under a microscope. 

This test is less accurate than viral cultures, as it is difficult to ascertain which type of HSV infection is present. 

  • One common test is called a Tzanck smear.

  • Results of the tests take up to 2 weeks.

Viral Cell Culture Test

The test  is a specific virus culture or assay for herpes virus. 

The doctor or health consultant will obtain  fluid from the sores and send it to a laboratory to see if the herpes virus is present. 

A viral culture is a fluid sample taken from a lesion when it first appears.  Highly accurate results can be given from a culture taken while the lesion is still in the clear blister stage, but the process takes a few days.

The test will not work if the sores have healed.

Immune Response Tests

These tests detect the body's immune response to the herpes virus and are slightly less reliable than viral cultures, but  more reliable than tissue scrapings. 

  • Results can sometimes be provided in two hours. 

Other available tests:

  • Antigen test

  • Pap Smear

Identifying Your Type

Not everyone knows whether they have HSV-1 or 2 and in certain situations that information could be relevant.  

In a situation where both partners have HSV-2 both are already infected so precautions to prevent the spread of the disease are optional.

If one partner has genital HSV-1 and the other has HSV-2, each might get infected with a second type unless precautions are used.

HSV- 1

Diagnosing genital HSV- 1 is difficult because the infection seldom recurs.  Since many people have HSV-1 orally, a finding of HSV-1 by Western blot serology (blood test) would not positively identify genital infection.  

A Western blot confirms if you have HSV-2. If you are seronegative (negative by blood test) for type 2, but positive for type 1, that gives you a strong clue as to the cause of your outbreaks, i.e. seropositive for type 1 but not type 2, with infrequent recurring genital herpes is  probably  genital HSV1.

Seek immediate professional help if genital herpes is suspected.  Some of the available diagnostic procedures become less reliable the longer you wait.


Listed below are some other conditions sometimes mistaken for herpes: 

Bacterial or yeast infections

  • do not usually produce blistering

Canker sores (aphthous ulcers)

  • are grey with a distinct edge

  • usually occur inside the mouth

  • usually heal within 10-14 days without treatment


  • is a highly infectious bacterial disease

  • often produces crusty blisters

  • is more common among children 

Molluscum contagiosum (molluscum)

  • like herpes, molluscum is a viral infection of the skin

  • unlike herpes, molluscum produces lesions that are raised, with a central dimple


  • is a bacterial infection

  • causes chancres sometimes mistaken for blisters caused by genital herpes

Unlike genital herpes, Syphilis does not usually produce a cluster of blisters, and it usually responds well to antibiotics.


Herpes is spread through: 

  • anal sex

  • oral sex

  • vaginal sex

To help prevent the spread of herpes:  

  • avoid any sexual contact if you are infected

  • limit the number of sexual partners

  • use latex condoms

  • visit a local sexually transmitted disease (STD) clinic, hospital, or your doctor if you are infected 

Genital herpes infections can be spread by people with no noticeable symptoms. 

The herpes virus is also transmitted through: 

  • caressing infected areas

  • kissing

  • touching

Associated Herpes Viruses

Herpes is a disease posing great risk to the community and is of growing public health importance. Keeping yourself informed is your best protection. The Herpes family of viruses is large.

Human herpes viruses include:

  • Epstein-Barr Virus

  • Herpes simplex virus types 1 and 2

  • Human cytomegalovirus

  • Varicella-Zoster virus

These viruses cause or are associated with a whole spectrum of diseases ranging from infectious mononucleosis to malignancies and mental retardation and have the ability to cause more than one kind of disease.

Herpes Type I

  • affects the skin and mucous membranes

  • is transmitted by oral and respiratory secretions

  • produces cold sores or fever blisters

Herpes Type II

  • is transmitted by sexual contact, with  cross-infection possible from oral/genital sex

  • primarily affects the genital area 

Approximately  85% of all HV infections are sub-clinical, the others produce localized lesions and systemic reactions. 

After the first infection, a patient is susceptible to recurrent infections brought on by:

  • fever

  • heat and/or cold

  • menses

  • stress

In recurrent infections there may be no constitutional signs and symptoms.  Herpes occurs equally in males and females.

Herpes Zoster

Herpes Zoster (Shingles) is an acute unilateral and segmental inflammation of the dorsal root ganglia caused by infection with the herpes virus, varicella-zoster, which also causes chicken pox.

Herpes Zoster usually occurs in adults  producing:

  • localized vesicular skin lesions confined to a dermatome

  • severe neuralgic pain in peripheral areas especially  the nerves arising in the inflamed root ganglia


Unless the infection spreads to the brain eventually most patients recover completely, except for possible scarring and, in corneal damage, visual impairment.  However, in some cases neuralgia may persist for months or years.

Herpes zoster results from reactivation of the varicella virus that has lain dormant in the cerebral ganglia or the ganglia of posterior nerve roots after infection from chicken pox. 

The virus is thought to multiply as it is reactivated and  is neutralized by antibodies remaining from the initial infection. However, the virus continues to multiply in the ganglia, destroys the host neuron, and spreads down the sensory nerves to the skin if effective antibodies are not present.

Herpes zoster is found primarily in adults over 50 and seldom recurs. 

Onset of herpes zoster is characterized by:

  • fever

  • malaise

Within 2-4 days, severe deep, continuous pain may develop

Other symptoms may include:

  • hyperesthesia (abnormally increased sensitivity to stimuli)

  • paresthesia (an abnormal or perverted sensation, such as burning or tingling due to disorder of the sensory nervous system)

  • pruritus (itching)

This usually occurs on the trunk and occasionally on the arms and legs lasting from 1-4 weeks. 

Small red nodular skin lesions can continue to erupt on the painful areas up to 2 weeks after the first symptoms. 


Infection by the cytomegalovirus (DNA, ether sensitive virus belonging to the herpes family) occurs worldwide and is transmitted by human contact. 

About 4 out of 5 people over the age of 35 have been infected with cytomegalovirus usually during childhood or early adulthood. In most of these people, the disease is so mild that it is sometimes overlooked. 

CMV infection during pregnancy can be hazardous to the fetus, possibly leading to:

  • brain damage

  • neonatal illness.

  • other birth defects

  • stillbirth

Cytomegalovirus has been found in:

  • blood

  • breast milk

  • cervical secretions

  • faeces

  • saliva

  • semen

  • urine

  • vaginal secretions

Transmission usually occurs through contact with the infected secretions, which harbor the virus for months or even years

Risk Groups

Immuno-deficient patients 

AIDS patients or those who have received transplanted organs are a high risk for contracting CMV infection.

Immuno-deficient patients and those receiving immuno-suppressives may develop pneumonia or other secondary infections

Recipients of blood transfusions

Recipients of blood transfusions from donors with positive CMV antibodies are at some risk

Cytomegalovirus is thought to be spread through the body in lymphocytes or mononuclear cells to the lungs, liver, and central nervous system where it often produces inflammatory reactions. 

The disease usually runs a self-limiting course. 

Infectious mononucleosis

Infectious mononucleosis is an acute infectious disease caused by the Epstein-Barr virus (EBV), a member of the herpes group which usually  affects young adults and children. 

Infectious mononucleosis produces:

  • an increase in  lymphocytes and monocytes

  • cervical lymphodenopathy

  • development of heterophil antibodies

  • fatigue

  • fever

  • headaches

  • hepatic dysfunction

  • malaise

  • sore throat

  • temperature fluctuations

Recovery prospects are excellent

Other infectious diseases with symptoms similar to mononucleosis include: 

  • Cervical lymphodenopathy

  • Hepatitis

  • Rubella

  • Toxoplasmosis 

Symptoms usually subside about 6-10 days after onset of the disease but may persist for weeks.

Over 80 known viruses exist within the Herpes family, 8 of which are known to cause disease in humans, the most common being Herpes simplex virus 1 and 2. 

HSV-1 and HSV-2 look identical under the microscope, and either type can infect the mouth or genitals.  HSV-1 usually  occurs above the waist, and HSV-2 below the waist.


Herpes simplex virus 1 (HSV-1)

Herpes simplex virus 1 (HSV-1) commonly causes herpes labialis also called:

  • cold sores

  • fever blisters

  • oral herpes

The virus produces highly infectious open sores that crust over before healing. 

Although less probable, HSV-1 can also cause genital herpes.

Herpes simplex virus 2 (HSV-2)

Herpes simplex virus 2 (HSV-2) is a contagious viral infection primarily causing genital herpes in men and women. 

Symptoms of genital herpes include:

  • bumps  

  • rashes in the genital areas

  • recurrent clusters of blisters

HSV-1 and HSV-2

HSV-1 and HSV-2 can cause other diseases including:

Herpes simplex encephalitis

  • a rare but potentially fatal herpetic infection of the brain

Neonatal herpes

  • a rare but potentially severe HSV infection in a newborn

  • is caused by transmission of the virus from  mother to  baby during delivery

Herpetic whitlow

  • an HSV infection of the finger

  • caused from transfer of the infection from another part of the body or from direct contact with another

  • is more prevalent amongst health care workers  

Herpes keratitis

  • an HSV infection of the eye

  • can cause blindness

Herpes gladiatorum

  • an HSV infection, usually of the skin, acquired during wrestling

  • skin can become abraded or scraped, during a wrestling match, allowing a herpes virus to enter the body and establish an infection

Unlike viruses such as influenza which can be transmitted through the air, herpes simplex viruses require physical contact. 

They are frequently transmitted through:

  • mouth-to-mouth contact (HSV-1)

  • genital-to-genital contact (HSV-2)

  • hand-to-genital

  • mouth-to-genital 

Herpes Viral Infection

Some common herpes viruses and the diseases they cause are:

Varicella-zoster virus

  • chickenpox

  • shingles

Herpes simplex type 1 (HSV-1)

  • cold sores

  • fever blisters

Herpes simplex type 2 (HSV-2)

  • genital herpes

Epstein-Barr virus (EBV)

  • mononucleosis


Genital herpes is manageable. Over the years, a number of treatments offering effective relief from symptoms of genital herpes and cold sores have been developed

These include:

  • Prescription drugs
  • OTC "cold sore" treatments,
  • Herbal remedies
  • Vitamins
  • Nutritional changes
  • Psychotherapy
  • And more


The standard, effective and specific treatment for genital herpes is antiviral therapy, which is usually in tablet form.

Antiviral drugs stop HSV from replicating in the body. The treatment only works while you are taking the drug, and cannot prevent future outbreaks once you stop taking it.

Antiviral treatments can:

  • shorten the duration of a genital herpes outbreak and help speed healing
  • reduce the number of outbreaks suffered - or prevent them completely

Antiviral medications can be used in two ways:

1. To treat outbreaks as they happen ('episodic' treatment). With episodic treatment, the aim is to shorten the time each outbreak lasts and to relieve symptoms. If you are coping well and your outbreaks are not too frequent, you and your doctor may agree that episodic treatment is the most appropriate option.

2. To prevent or delay recurrent outbreaks  ('suppressive' therapy). If your recurrent outbreaks are frequent or severe your doctor may recommend that you take oral antiviral medication every day to help prevent outbreaks happening. Suppressive therapy is taken continuously, e.g. daily, for months or even years.

Simple SELF-HELP remedies for the relief of discomfort.

The following non-specific treatments can help alleviate the pain and discomfort:

SALT BATHS: used to wash the genital area, can clean, soothe and dry the sores. Use 1 teaspoon of salt in 600 ml of water or a handful in a shallow bath.

PAIN RELIEVERS: Include simple analgesics such as

  • Aspirin and paracetamol
  • Ice can be soothing if applied directly to the sores
  • Creams with an anaesthetic component

Creams, however, can slow down drying and should therefore be used sparingly and only for pain relief. In addition, topical creams have limited value on moist mucosal surfaces, particularly in women.

LOOSE UNDERCLOTHES: preferably cotton (not nylon), can help minimize discomfort and allow healing.

For anyone experiencing extreme pain when urinating, the process can be less painful when done in a cool bath. And it is important to remember to drink plenty of fluids as this dilutes the urine.

Bach Flower Remedies may be prescribed to ease the emotional stress of herpes, particularly Rescue Remedy 

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