Some conditions are more widely misunderstood than others. Herpes is one such condition. For someone discovering that they have herpes for the first time, it can be tempting to assume the worst, and that the virus is going to have a significant and detrimental impact on their lives.
But this is often not the case at all.
The majority of the time, herpes outbreaks and cold sores are much more straightforward to manage than you might think. It’s just a case of knowing how to do so, and how to limit the risk of an outbreak.
Wherever possible, we like to get specialist input on the subject we’re tackling here on our blog at Treated.com. With this in mind, we approached two leading experts on sexual health, in order to find out more about how to reduce the likelihood of a flare-up, and what precautions someone with herpes or cold sores can take to protect themselves and their partner from experiencing symptoms.
Natika Halil is Chief Executive of the Family Planning Association (FPA) and Sue Burchill is Head of Nursing at sexual health charity Brook.
First of all, how common is herpes?
Answer: More common than you think.
‘There were 31,777 new cases of genital herpes diagnosed in 2014 in England.’ Natika tells us. ‘In 2013 it was over 32,000.’
And that’s just new diagnoses.
‘While we don’t know the overall number of people living with genital herpes we know that in England it is females who are most affected,’ explains Natika, ‘they accounted for 62.6% of all cases last year, and particularly those in their early 20s.’
It isn’t a condition which is exclusive to the younger generation, however.
‘Older people are also affected,’ Natika says, ‘there were 3,863 diagnoses in 2014 among people aged 45 and over.’
Furthermore, when you take into account the number of people living with cold sores, who may self-treat and not necessarily approach their doctor for a definite diagnosis, the total number of people living with the herpes simplex virus (HSV) is likely to be much higher.
What are the symptoms?
The symptom we most commonly associate with herpes is the development of small blisters on the genitals or around the anus, which will usually burst after a couple of days and go on to form painful sores. Similarly, with cold sores, these blisters will manifest on the lips and around the mouth, and develop in a similar way.
But few are aware of the numerous other symptoms that may also accompany these. As Natika Halil explains, herpes can also cause ‘a more general feeling of being unwell, with flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back and down the legs or in the groin; and in the case of genital herpes, pain when going to the toilet caused by urine flowing over sores.’
After these symptoms dissipate, the virus may appear to have gone away, but in actuality, it is simply lying dormant. Symptoms then reappear subsequently when someone experiences a ‘reactivation’ of the virus. These reactivations can occur frequently or infrequently for several years afterwards, but will usually appear less often and with less severity the older a person gets.
‘The outbreaks that follow the first one are usually less severe and heal more quickly,’ explains Sue Burchill, ‘because your body will have had an opportunity to produce antibodies that fight infection. Consequently, recurrences are self limiting and generally only cause minor symptoms.’
So what causes these reactivations?
It’s common knowledge that herpes and cold sores are passed on through direct contact with an open sore, and that these blisters may remain infectious for a few days afterwards. Upon contracting herpes, it’s likely that a person will go on to develop symptoms quite soon afterwards.
But once someone has the condition, what factors can trigger a reactivation?
Perhaps the most common offender is a weakened immune system. With the virus essentially lying in wait, it stands to reason that the less able your body is to keep the infection in check, the more likely the virus is to develop and cause a manifestation of blisters and sores.
As a result, Sue explains, a reactivation ‘will often be accompanied by tingling and flu-like symptoms.’
But, in addition to a compromised immune defence, there are several other triggers, and these aren’t always the same for everyone.
Natika illustrates that ‘different people may find different triggers bring on an outbreak,’ and cites the following as potential triggers:
- being ill, run down, tired or stressed
- friction from sex or masturbation
- ultraviolet light on the affected skin area (such as from sunbathing or using sunbeds)
- tight clothing such as spandex and nylon or lycra underwear
- drinking alcohol
Natika adds that women may be more susceptible to a reactivation at certain points throughout their menstrual cycle.
As herpes and cold sores are (at time of writing) not curable, the key to treating these conditions lies in reducing the likelihood of a recurrence and, in the event of an outbreak, taking measures to limit the extent of symptoms.
But, taking into account the demands of everyday life, how achievable is this?
‘Some triggers for herpes are avoidable to an extent,’ Sue explains, ‘but others are more difficult to avoid.’
‘Limiting the triggers above, or being aware of what is a potential trigger for you, will help to reduce the chance of a recurrent episode.’ says Natika. ‘If you notice a pattern, you may be able to do something about it by changing certain aspects of your life.’
‘As with any virus, ensuring that you are in good overall health will help your body to deal with it. If your overall health is poor, you may find that recurrent outbreaks will last longer.’
Many people with herpes turn to antiviral medication for help when a reactivation looks likely; while some only do so when symptoms are in full swing. But, as Sue illustrates, timing is an essential factor when using medicinal treatment:
‘You should only use antiviral drugs for treating herpes at the time of the outbreak. If you have recurrent herpes outbreaks, you can use suppression therapy under supervision from your doctor, which means taking an antiviral drug every day for a certain length of time. The earlier in an episode you can take treatment, the more likely it is to be effective.’
Treating a flare in progress
It can be easy, however, for someone with herpes to not realise that an outbreak is about to occur until it is too late; sometimes symptoms can develop quickly, and it isn’t possible to get access to the appropriate medication in time.
So are there other helpful steps someone can take, in cases where symptoms have already manifest?
‘There are a few simple things you can do to ease the discomfort caused by a flare-up and to speed up the healing process,’ as Sue explains:
- ‘Apply an ice pack or ice cubes in a plastic bag to the affected area (however, do not apply ice directly to the skin).’
- ‘Take a cool shower to soothe the blisters.’
- ‘Avoid washing too often and carefully pat the area dry.’
- ‘Gently bathe the area with warm salt water (dilute one teaspoon of salt in one pint of water).’
- ‘Wash your hands before and after touching the infected area to avoid introducing bacteria.’
- ‘Keep hydrated and drink extra fluids.’
- ‘Wear loose, cotton clothing.’
- ‘Apply a local, over-the-counter anaesthetic cream such as lidocaine, or use an over-the-counter painkiller to help with pain and discomfort.'
For many perhaps, the most anxiety-inducing aspect of herpes (and cold sores) is the prospect of passing it on to someone else. Although the condition is manageable and will tend to decrease in severity over time, symptoms can be a nuisance and a source of irritation; and the last thing a person living with herpes will want is to transmit it to their partner.
So what measures can someone take to reduce the likelihood of this happening?
‘The herpes simplex virus is most likely to be passed on just before, during or straight after an outbreak,’ says Natika, ‘including through vaginal or anal sex, or by sharing sex toys. It can also be passed on through close genital contact even if you don’t have penetrative sex, through oral sex, or through skin to skin contact if a person with herpes on their hand or finger touches a partner's vagina, genitals or anal area.’
Natika goes on to explain that it is the blisters associated with herpes which are highly infectious, so her advice for someone who has herpes (or whose partner has it) is to:
- avoid kissing when you, or a partner, have cold sores around the mouth
- avoid oral sex when you, or a partner, have mouth or genital sores
- avoid any genital or anal contact when you, or a partner, have genital sores or blisters, or if you feel an outbreak starting.
The use of barrier contraception can play a pivotal role in preventing the spread of herpes:
‘If you have oral sex,’ advises Natika, ‘use a condom to cover the penis, or a latex or polyurethane (soft plastic) square to cover the female genitals or male or female anus. If you are a woman and rub your vulva against your female partner’s vulva one of you should cover the genitals with a latex or polyurethane square. And avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.’
Another reason why practising safe sex and using barrier contraception is important, explains Sue, is because: ‘In some people the virus can be present without causing any symptoms and can be passed on. This is called asymptomatic shedding.’
This is obviously particularly pertinent for those who are sexually active but not in a monogamous relationship to know.
‘Many people will not have any visible signs or symptoms of genital herpes at all, or not be aware of them, but could still pass the virus on.’ Natika tells us. ‘Some people will get symptoms within 4–5 days of coming into contact with the virus. In other people the virus may be in the body for several weeks, months or possibly years before any signs or symptoms appear. Therefore, when you get symptoms it doesn’t necessarily mean you’ve only just come into contact with the virus.’
Having Sex After a Flare-Up Has Settled
As many people with herpes and cold sores will know, the window of infectiousness following an outbreak can be something of a grey area. Because shedding may still occur after symptoms have appeared to clear up, it can be difficult to know when it is safe to have sex again without posing a significant risk of transmission.
With this in mind, we thought we’d ask the experts for their advice on how long someone should wait, following a flare-up, before having sex again:
‘To help prevent passing the infection on to someone else, it is strongly advised that you do not have any sexual intercourse, including vaginal, anal or oral sex, if you know an outbreak is coming, while you have signs and symptoms, and for a week after the symptoms have gone.’ said Natika, who went on to add that: ‘For someone experiencing an outbreak, having sex while you have blisters or sores can also delay the healing process.’
And, after this period has passed and you are ready to have sex again, Sue advises that you should: ‘Use a water-based lube, to reduce the chance of irritation to your genitals.’
As noted above by Sue, it is common for someone who has herpes to notice symptoms becoming less severe as time goes on. ‘Recurrence rates do appear to decline over time in most individuals,’ Sue tells us, ‘although this is variable.’
Natika adds that these recurrences are likely to become easier to predict:
‘There is often an early warning, in the form of a tingling sensation, and you may get a flu-like illness before an outbreak. The blisters and sores are usually fewer, smaller, and less painful and heal more quickly. They normally appear in the same part of the body as in previous outbreaks but in some people they may appear nearby.’
But perhaps the burning question for someone living with herpes is: can these reactivations ever stop completely?
Yes, according to Natika:
‘Recurrences eventually stop altogether within 18–24 months for many people, although it may take much longer for others.’
Herpes and Pregnancy
Finally, we thought it might be useful to ask our experts about the impact of herpes on conception, and pregnancy. For those couples where one or both partners has the condition, it might not be clear whether certain precautions are necessary when either trying for a baby, or expecting.
On a positive note, Natika explains that: ‘Genital herpes does not affect fertility in men or women, and most women who have genital herpes give birth to healthy babies.’
She goes on to add that: ‘Genital herpes can also be safely treated during pregnancy. Furthermore, if you get genital herpes before you get pregnant the risk of passing it on to your baby at birth is very low and you do not usually need to have a caesarean delivery.’
‘Repeat outbreaks of genital herpes during pregnancy pose little risk to the baby at birth but you may be given some treatment to prevent an outbreak occurring when you are due to give birth.’
- To find out more about the Family Planning Association and the work they do, or to make a donation, visit their website.
- You can discover more about sexual health charity Brook, the work they do, and make a donation, by visiting their website.