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Author: Sarah Sentz, Nurse Practictoner at the Arlene Cooper Community Health Center

There are more than 100 herpesviruses, but we will focus on Herpes Simplex Virus (HSV). HSV is broken down into HSV-1 and HSV-2. In the past, HSV-1 was also known as “cold sores” while HSV-2 was known as “genital herpes”. However, we now know that HSV-1 can also cause genital outbreaks although HSV-2 rarely causes oral outbreaks. Neither type 1 nor type 2 is “worse” than the other. Both cause similar symptoms, are diagnosed similarly, and have the same treatment.

Herpes is highly stigmatized, although not dangerous. Still today patients can feel devastated and confused by a herpes diagnosis. Much of this can be attributed to the herpes “hysteria” & stigmatization, which was perpetuated by the media as early as the 70s and 80s.

That said, herpes is incredibly common. We don’t exactly know how common herpes is because it is not reportable to the health department like some other STIs. Some people may not seek care for herpes, and others may carry herpes but have no symptoms.

Prevalence & Impact of Herpes

According to the World Health Organization (WHO), approximately 491 million people worldwide have HSV-2, and 3.7 billion people have HSV-1. 3.7 billion is 67% of the population!

Oral and genital herpes can be preceded by a tingling sensation in the area. “Outbreaks” are often precipitated by stress, sunlight, menses, illness, or other triggers. Triggers are dependent on the person. People who are immunocompromised, for example people living with HIV who are not taking medications, may have more severe outbreaks.

Oral and genital herpes cause similar symptoms. For the initial outbreak, some people can experience fever, body aches, and swollen lymph nodes. Oral herpes usually causes a painful sore or blisters on the outside of the lip while genital herpes causes similar painful sores or blisters in the genitalia or buttocks. The first “outbreak” is generally the most painful. Depending on the severity, it may take a couple weeks for the lesions to fully scab over and heal.

Demystifying HSV-1 and HSV-2

If you suspect you have herpes, a medical provider can make a diagnosis through a physical exam. The provider can perform a herpes swab, if available, to provide lab confirmation although this is not always necessary. If the lesion has already started the healing process, the swab test may be less accurate. Your medical provider should also recommend HIV, syphilis, and other STI testing at that time. Active outbreaks of genital herpes can increase the risk of transmission of HIV and other STIs due to open lesions.

Folks often ask about “herpes screening.” The CDC does not recommend routine blood screening tests for HSV. The tests only show if you have antibodies or have been exposed to herpes. It cannot definitively determine if you have herpes. There is also a high rate of false positives, up to 50%. So, there is a 50% chance the test isn’t even accurate. Herpes blood testing is rarely indicated. When performed, it is usually in specific cases and determined by your medical provider. We do not perform “routine” screening for herpes!

It is best to avoid sexual activity when you have or suspect a herpes outbreak. Herpes is transmitted through skin-to-skin contact, so condoms are helpful but not a guaranteed barrier for herpes. If there is an outbreak on the lips or genitalia, oral sex can also be a means of transmission.

Patients often ask if herpes can be transmitted when there are no lesions and no outbreak. The answer is that it is possible. If you have herpes, that does not mean you can’t have sex! If your partner has herpes, that doesn’t mean you can’t have sex with them! As always, it is important to have an open conversation with your partner/s.

Whew. That’s a lot. What about treatment?

Navigating Diagnosis & Treatment

Treatment is tailored to the individual. Some people have mild or rare outbreaks and manage supportively with over-the-counter anti-inflammatories. Over-the-counter creams have not been shown to be effective, however, they can provide pain relief for some. Taking a warm bath (aka “sitz bath”) for genital lesions can also be helpful.

Prescription medication options include anti-virals. Some folks take medications every day for suppressive therapy, which means to “suppress” the virus. There is some data to support that suppression can help decrease the chance of transmission. But most folks do not need to stay on daily therapy forever.

If there are symptoms of an outbreak, the dosage can be increased as needed. Other folks only take the anti-virals as needed or when they suspect an outbreak. Talk to your medical provider for more specific options. Data on herbal remedies is limited, although some patients find lysine to be beneficial. Talk to your medical provider regarding safety of supplements.

If you have never had an outbreak, you do not need anti-viral medication!

Medications are generally safe. They should be used with caution, however, in people with some medical conditions. Caution with alcohol is also advised.

The point is that herpes is not a big, bad, scary STI. It is just a nuisance virus that can cause uncomfortable symptoms. Herpes is very common & manageable. You can have herpes & still have good sex!

Make an appointment today at the Arlene Cooper Community Health Center to get tested and discuss your options.

About the Author

Sarah Sentz, Nurse Practitioner at the Arlene Cooper Community Health Center, brings a wealth of experience to our team, with over twenty years in the healthcare sector. Since earning her graduate degree as a Family Nurse Practitioner (FNP) in 2017, she has honed her skills in various clinical environments, building upon a solid foundation as a Registered Nurse (RN).

Her professional journey reflects a deep-seated expertise in family practice, with a particular emphasis on reproductive and sexual health medicine. She is passionately committed to community health, offering a spectrum of services that includes primary HIV treatment and prevention, comprehensive reproductive/gynecologic care, and the administration of long-acting reversible contraceptives like IUDs and implants. Additionally, Sarah provides gender-affirming and hormone therapy care, approaching each patient with a holistic mindset that focuses on treating the whole individual, not just the symptoms.

When she’s not at the clinic, Sarah's adventurous spirit leads her on hiking escapades with her husband, often recounted as joyful misadventures. She finds solace in the pages of science fiction novels while swaying in a hammock, and at home, she enjoys the delightful chaos of caring for her quirky felines, Artemis and Andromeda.