It starts as an itch or a burn. Maybe your skin feels raw. Some people feel run down, feverish or even flu-like. Painful lymph nodes may swell up in your groin or neck. You might keep looking to see what is there and you just don’t find anything. After a few days, you may notice some redness or small ulcerated lesion. These lesions can occur on or around your genitals, lips, mouth, throat or anus.
People often ask me. “How do I know if I have herpes?” My answer: “Herpes hurts like hell!” At least the first episode anyways. Unfortunately, herpes usually comes back. I tell people the first episode is always the worst. After that, it can be mores subtle. In other words, if the first episode feels like being hit by a truck, recurrent episodes are more like being gently trodden on by your overgrown Golden Retriever. Herpes typically looks like tiny little blisters over reddened skin. Over time it scabs over and then gradually heals. Type 1 herpes or HSV1, usually affects the mouth and causes cold sores. It is spread through shared oral secretions or contact with an active lesion. Type 2 herpes or HSV2 usually occurs below the belt. It is spread through sexual contact. (Although this does not have to be actual penetration.)
Here is where the picture gets slightly confusing. HSV1 can actually occur on your genitals and HSV2 can actually ocurr on your lips. However, HSV1 “prefers” the lips and HSV2 “prefers”the genitals. Because of this an HSV1 lesion on the genitals is often a less severe infection with less chance of recurrence and less risk of transmission to others. This is why it is a good idea to have lesions cultured to check which type it is. Unfortunately, once you have herpes, you have it for life and there is always some risk of recurrence. In addition (and here is the worst part), even without an active lesion, you can shed the virus and transmit it to your sexual partners.
Now for the good news…
- Both herpes 1 and herpes 2 are treatable. There are numerous prescription antivirals like acyclovir, valacyclovir and famciclovir that can decrease the duration of your outbreaks if started early in the outbreak. Make sure to see your healthcare provider at the first sign of an outbreak.
- There are ways to decrease your risk of shedding the virus and passing on the infection to your partners. Consider asking your provider about a daily suppressive dose of antiviral.
- If you get diagnosed with herpes, you are not alone. Some estimates say 90% of the adult population has HSV1 and 16% has HSV2.
If you already have genital herpes, know that you are more likely to shed the virus:
… within in the first year of being infected.
… if you are HIV+.
… if you have an active outbreak or feel one coming on.
…. if you are not on daily suppressive therapy.
…if you are not using a condom.
So does herpes hurt like hell? Unfortunately, it kinda does, at least the first outbreak anyway. So bottom line be smart! Talk to your partner. If you have herpes, you are not alone. Many people just like you have normal, healthy dating lives.