Herpes (HSV-1 & HSV-2)

Herpes Simplex Virus exists in two types: HSV-1 (primarily associated with oral herpes — cold sores) and HSV-2 (primarily associated with genital herpes). Both types can infect either location. Herpes is one of the most common infections in the world — an estimated 67% of people under 50 carry HSV-1, and roughly 11% carry HSV-2.

Herpes is a lifelong infection — the virus retreats to nerve ganglia and remains latent, periodically reactivating. It is NOT curable, but it is highly manageable with antiviral medication. Many people with herpes live normal lives and have healthy sexual relationships with appropriate precautions.

Most people with herpes either have no symptoms or symptoms so mild they are never recognised:

• ORAL HERPES (HSV-1): Cold sores or fever blisters — clusters of small blisters on or around the lips, that crust over and heal in 7–10 days. A tingling or burning sensation often precedes the outbreak.
• GENITAL HERPES (HSV-1 or HSV-2): First outbreak is typically the most severe — painful blisters or sores on the genitals, inner thighs, or buttocks; flu-like symptoms (fever, body aches, swollen glands) during the first episode.
• RECURRENT OUTBREAKS: Usually milder than the first, lasting 3–5 days. Many people experience a 'prodrome' — tingling, itching, or nerve pain — before sores appear.
• ASYMPTOMATIC SHEDDING: The virus can be shed from the skin without any visible sores, which is how most transmission occurs.

• Skin-to-skin contact with an infected area — kissing (HSV-1), genital or anal sexual contact (HSV-1 and HSV-2)
• Virus shed from skin even when no sores are present (asymptomatic shedding)
• Mother-to-baby during vaginal birth — neonatal herpes is serious but rare; C-section may be recommended if active outbreak at delivery

Herpes is NOT spread through toilet seats, towels, swimming pools, or casual contact.

• Swab from an active sore — the most accurate test. Identifies the virus type (HSV-1 vs. HSV-2). Best taken within 48 hours of outbreak.
• HSV IgG antibody blood test — detects past infection even without active sores. Window period: 12–16 weeks for reliable results. Note: HSV-1 IgG may be positive due to oral herpes contracted in childhood.
• PCR (polymerase chain reaction) — highly sensitive detection of viral DNA from swabs or blood.

There is no cure, but antiviral medications are highly effective:

• Acyclovir 400mg three times daily — standard treatment; reduces outbreak severity and duration
• Valacyclovir 500mg–1g once or twice daily — more convenient dosing; converts to acyclovir in the body
• Famciclovir — an alternative option
• SUPPRESSIVE THERAPY: Taken daily, antivirals reduce outbreak frequency by 70–80% and transmission risk to partners by approximately 50%

• Any unexplained genital sores, blisters, or recurring skin irritation
• Before starting a sexual relationship with a new partner
• If a partner has disclosed herpes
• If you have had multiple sexual partners