Backgrounder

Herpes - your questions answered

What is herpes?
Herpes is a common, life-long infection generally transmitted through skin-to-skin contact. The symptoms of herpes can vary greatly, mainly depending on whether a person is experiencing their first or one of many episodes. A commonly recognised symptom is the appearance of small, painful blisters on the skin. Herpes can appear on the lips (oral herpes), genitals (genital herpes) or on other parts of the body (non genital herpes).

There are two types of the herpes simplex virus - herpes type I and herpes type 2. Herpes type 1 is the virus that most commonly causes cold sores on the lips or face. While often transmitted during childhood through kissing, this infection can be transmitted at any age. It can also be transmitted to the genitals through direct skin-to-skin contact, often via oral sex. The herpes type 2 virus is responsible for the majority of genital herpes and is commonly transmitted through sexual contact.

The primary difference between the two viral types is preference of location. Herpes type 1 is usually located in the trigeminal ganglion, a collection of nerve cells near the ear. From there, it tends to recur on the lips or face. The usual site of preference for herpes type 2 is in the sacral ganglion at the base of the spine. From there, it recurs in the genital area. The two types of the herpes simplex virus do behave somewhat differently depending on whether or not they are residing in their site of preference.

Either viral type can reside in either or both parts of the body and infect oral and/or genital areas.

The herpes simplex virus belongs to a larger family of viruses that cause chicken pox, shingles and glandular fever.

How many Australians have herpes?
Approximately eight in 10 Australians have herpes type 1 by the time they are 25. A much smaller number of people will show obvious symptoms, such as cold sores.

Approximately one in eight Australian adults has herpes type 2. Twenty per cent are aware of it, 60 per cent are unaware that they have it but have symptoms, while another 20 per cent are asymptomatic. Anyone who is sexually active can contract herpes type 2.

How do you know if you have genital herpes?
Many people have herpes but most do not show any symptoms. Most people will have no noticeable symptoms following infection and will not even realise that they have come into contact with the virus. They may only notice symptoms at a later date.

For others, the first symptoms of genital herpes may show up from two-to-21 days after coming into contact with the herpes virus. This first episode of genital herpes may be the most severe. When you first come into contact with the virus, your immune system has not had time to develop protective antibodies. This means that the virus can multiply rapidly, causing significant symptoms.

In a severe first episode of genital herpes, you may notice that:

• Your lymph glands are swollen (the glands under your arms, on your neck and in your groin).
  
• You may have flu-like symptoms eg. sore muscles, tiredness, headaches, fever and chills.
  
• You may have swelling, pain or itching around the genitals, possibly followed by painful red spots that can form blisters.
  
• Your blisters may burst to form open sores or ulcers, which will later crust over and heal.
  
• You may experience pain when urinating due to the tenderness in your genital area.
  

Herpes of the anus or rectum may also result in rectal and lower back pain, an urgent need to pass faeces, bloody or mucus discharge, constipation and blisters on the skin area around the anus.
Usually symptoms will heal within two-to-four weeks and cause no long-term damage. However, if you experience significant pain with any outbreak, you should ask your doctor about antiviral medication which can greatly reduce the length and severity of outbreaks.

How is a diagnosis of herpes made?
Accurate diagnosis of herpes is essential as people's experience of genital herpes varies so greatly and because the treatment of any sexually transmitted infection is distinctive and specific. People may also mistake their herpes outbreaks for insect bites, yeast infections, jock itch, ingrown hair follicles, hemorrhoids, abrasion or razor burn. Accurate diagnosis is made most easily and correctly at the time of an active herpes infection, preferably the initial symptomatic infection.

There are several diagnostic tests available for herpes, each with varying degrees of accuracy. These range from swabbing a herpes blister or sore, to a blood test. If you think you may have contracted the virus, see your doctor for testing.

What are some of the common emotions people with herpes experience?
Fear, shock and worry are common reactions of people after discovering they have herpes. This shock sometimes makes it hard to recall any advice given by a doctor or others when first learning about the infection. Doctors understand this, so it may be worthwhile revisiting your doctor to further discuss measures for managing your herpes. Your local sexual health clinic can also provide you with information about support groups and counsellors in your local area.

Do I need to tell my partner I have herpes?
It is important to discuss genital herpes with your current or potential partners before having sex. That way you can work together to reduce the chance of transmission. Talking about herpes may be difficult at first, but remember that open discussion is the best way to help you decide how to best minimise the risks for you and your partner. Let them know that you have a history of genital herpes and that there may be times when you cannot have sex. Discuss the place of condoms in your relationship. And don't forget to ask them about their sexual health.

A mature partner is likely to consider genital herpes as something that needs to be discussed and understood. Your partner may have many questions, so it is worthwhile trying to think of answers before telling your partner. Further discussion with a doctor may be useful. Once the topic is out in the open, your concerns can be aired, allowing you to build an open and honest relationship.

Sometimes a prospective partner may withdraw from a person with herpes because of their own concerns. However, most people respond well and appreciate the respect that you have shown them, although this may take time. Some partners may already have experienced herpes.

Will I get genital herpes again?
After a first episode of herpes, the virus stays in the body for life. Some people do not have any further episodes or symptoms of herpes. This is called inactive infection when the virus is hidden in the body and not infectious.

However, the symptoms of genital herpes do recur in some people, although a second or third episode is not usually as severe as the first. This is called an active infection and can occur when the immune system is at a low, during times of stress, illness or menstruation or from anything that causes skin irritation, such as friction from prolonged sexual intercourse and often for no obvious reason.

When a person has genital herpes, the virus sleeps in the bundle of nerves at the base of the spine. When the virus reactivates, it travels down nerve paths to the surface of the skin, sometimes causing an outbreak. A typical genital herpes outbreak starts off with an itching, burning or tingling sensation in the genital area and is followed by small blisters or sores that may be painful.

The nerves in the genitals, upper thighs and buttocks are connected. So a person can also experience outbreaks in any of the following areas:

* vagina	* vulva	* thighs
* penis	* scrotum or testicles
* anus	* buttocks

Further resources

Counselling
You may experience mixed emotions and confusion after discovering you have genital herpes. A counsellor may prove helpful. Counsellors experienced in genital herpes can often be contacted through sexual health clinics. They have an understanding of both the medical and emotional issues associated with genital herpes.

Support groups
Herpes support groups offer a confidential environment for discussing issues and information with others in a similar position. While some groups are facilitated by a counsellor, others have a more social focus. Contact your local sexual health clinic for information about support groups in your local area.

Internet
There are many sites on the Internet offering information, newslines, chatgroups and meeting services to people with genital herpes. Please note that anyone can set up a website, so the information may be of mixed quality. Verify the information you download from the Internet with your doctor. A new, Australian site offering information about genital herpes and sexual health centre contacts is located at www.herpes.com.au.

To obtain further information about genital herpes, see your doctor, or call the national Herpes Information Line on 1800 102 200.