Herpes Simplex Virus (HSV) FAQ

There are two main types of herpes that we test for:

• HSV 1 most often causes infections of the mouth and lips (oral herpes). You may have heard of them referred to as “cold sores” or “fever blisters.” Symptoms are often milder than HSV 2, and you may get fewer outbreaks. It can spread to the genital area during oral sex and cause genital herpes. If HSV 1 spreads to the genital area, it is still HSV 1.
• HSV 2 is the most common cause of genital herpes. It is spread through vaginal, oral, or anal sex. HSV 2 can spread to the mouth during oral sex. If HSV 2 spreads to the mouth or lips during oral sex, it is still HSV 2.

Do I have genital herpes if I get cold sores around my mouth (oral herpes)? Was it sexually transmitted?

Not necessarily. A cold sore on your mouth usually means you have herpes simplex virus type 1 (HSV 1). Oral herpes is typically transmitted by kissing someone, or sharing utensils or lipstick—so not sexually transmitted. You can also get HSV 1 or 2 orally if you give oral sex to someone who has genital herpes.

Transmission of genital herpes

Herpes is transmitted through direct skin-to-skin contact with an infected partner. Most HSV 2 infections are acquired through vaginal or anal sex, but can be transmitted via genital-to-genital rubbing. Transmission is most common when you are symptomatic, but technically the virus can shed at any time, which is why we encourage safe sex and condom use. While condoms are an excellent tool to decrease the chance of transmission, they are not 100%.

What if I’ve never had an outbreak?

If you’ve tested positive for HSV 1 IgG or HSV2 IgG in your blood it means that you were exposed to that virus in the past. It does not tell us when or by whom you were exposed, what part of the body was exposed, and if you will ever have an outbreak. It may be helpful to compare previous HSV testing results, as if they were negative previously it will give you an idea of when you may have been exposed. Keep in mind that just because you or your partner were “tested for everything” in the past does not mean HSV testing was done, as many clinicians do not do routine testing for Herpes unless it is requested, or you have symptoms.

What if my HSV2 IgG is less than 3?

HSV2 bloodwork can result in false positives sometimes, and we may suspect that’s the case if your HSV2 IgG is less than 3 and you’ve never had an outbreak. For “equivocal” results (1.1 to 3) we can do HSV2 inhibition testing (confirmatory blood test) or repeat your HSV2 IgG in 2-3 months. You may also choose to decline more testing.

What are the symptoms of Herpes?

Typically, symptoms arise within a few days to weeks of exposure. Usually, an outbreak starts with a tingling, burning sensation followed by small red bumps that may turn into blisters, located where the virus entered your body, such as on your mouth or vulva. After a few days, sores become crusted and then heal. This process can be painful as herpes lesions are usually very tender when touched.

Symptoms during your first outbreak tend to be the most severe. In general, symptoms usually last 1-2 weeks but can last for up to 4 weeks. Other symptoms may occur before you have a genital outbreak, such as:

• Flu-like symptoms, including fever
• Itching or burning feeling in the genital or anal area
• Swollen glands
• Unusual vaginal discharge

When in doubt, we recommend you come into the office to have these issues evaluated.

What do I do if I have an outbreak?

While there is no cure for herpes, we do have antiviral medications like Valtrex (Valacyclovir) that can help shorten the course of your outbreak. There are also over the counter and prescription creams that may soothe the area. Call the office and we can discuss what the next best steps are!

If you believe you are having an outbreak:

• Keep sores clean and dry.
• Try not to touch the sores.
• Wash your hands after any contact with the sores.
• Avoid all sexual contact from the time you first notice symptoms until the sores have healed.

Does this mean I can’t have children?

No! If you test positive for HSV, even if you don’t have a history of outbreaks, you will be given antiviral medication towards the end of your pregnancy in hopes of preventing an outbreak. If you do have an outbreak of genital lesions at the time of delivery, a C-Section will be recommended to avoid transmission to the baby.

What about suppressive therapy if I’m not pregnant?

Valtrex can be given daily to decrease your chance of getting outbreaks. However, this is not usually recommended unless you have frequent outbreaks. Some patients whose partners do not have HSV may request to take suppressive Valtrex as it can decrease the risk of transmission, however it does not eliminate the risk 100%. We are happy to discuss this further with you if you desire.

What do I do now?

Learning that you have herpes can feel very overwhelming. We want to reassure you that you can still lead a very healthy and normal life, you may just experience times of discomfort due to outbreaks. We are here if you need further reassurance or have more questions.

If you have further questions, we recommend scheduling a follow-up appointment in the office or on Telehealth.