Genital Herpes: Useful info for those looking for answers like me!

Sexual health
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Ever since I suspected genital herpes (GH) and was recently confirmed to be going through a primary outbreak of HSV-2 (ugh, the "bad" one), I have been researching the topic like crazy! Guess that's a pretty normal thing to do, lol, and I'm sure many others here have done the same.

Anyway, I thought it would be helpful to share everything that I have learnt thus far, and I will continue to add to this thread as I come across more useful, interesting and/or relevant info.

Genital HSV symptoms

Testing for HSV

Does having one HSV type protect you against the other?

Autoinnoculation (self-contagion to other areas)

When is genital HSV most contagious?

Genital HSV transmission risk

Antiviral meds for genital HSV

Natural treatments for genital HSV

Genital HSV and increased risk of HIV

Transmission risk via inanimate objects, swimming and blood

Genital herpes and menstruation

Genital herpes and BV and yeast infections

Is there a vaccine for HSV-1/2?

Possible complications of genital herpes

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Genital HSV symptoms

Everyone knows what the "classic" symptoms are supposed to look and feel like. The problem with genital HSV, however, is that the symptoms often do not look or feel like textbook cases!

Lesions can range from the classic blitster cluster, scattered blisters (not clustered) to a single blister, which ulcerate and scab over (if on normal skin, like the penis or buttocks).

Lesions may also bypass the blister phase entirely and produce instant ulcers (especially inside a woman's labia where the skin is moist), resemble a regular pimple or ingrown hair, or appear as a small fissure/tear. They can also be pinhead-sized.

As a result, if you have anything suspicious and are concerned or freaking out - especially if accompanied by flu-like symptoms, swollen/tender lymph nodes in the groin area and/or burning urination within 2-20 days of possible exposure (incubation period) - the best thing to do is to get yourself tested.

https://www.ashasexualhealth.org/signs-symptoms/

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Testing for HSV

In the presence of symptoms, a lesion swab should be taken. DNA testing is more accurate than a viral culture. First outbreak lesions and new lesions are better than recurrent lesions or those that have already started to heal (may result in a false negative).

In the absence of symptoms, an IgG antibody blood test can be performed. This can also establish which HSV type you have, but NOT when you acquired HSV (unless you test regularly) or which part of your body is infected (the exception being HSV-2, which is nearly always genital). False negatives are possible if testing is done too soon after a new infection (should wait at least 6-12 weeks after exposure, even 12-16 weeks) or if antiviral meds are being taken.

The IgM blood test is NOT recommended in the case of HSV due to the recurrent nature of the virus. Some providers do not understand this and falsely believe it can establish when an infection was acquired, but this is NOT the case and is a waste of time and money.

https://www.ashasexualhealth.org/herpes-testing/

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Does having one HSV type protect you against the other?

Those with genital HSV-1, followed by those with oral HSV-1, are somewhat "protected" against genital HSV-2, but this is NOT a sure thing. It is still very possible to get HSV-2 on top of an existing HSV-1 infection, and in such cases syptoms are more likely to be greatly reduced or non-existent, resulting in asymptomatic HSV-2 carriers.

Those with genital HSV-2, on the other hand, do not tend to contract genital HSV-1, although oral HSV-1 may still remain a possibility (not been able to find anything on the latter).

Also, oral HSV-1 largely protects against genital HSV-1, but again this is NOT a sure thing (exceptions exist), while HSV-2 rarely ever results in an oral infection in anyone (nearly *all* HSV-2 infections are genital).

http://www.medscape.com/viewarticle/820140_5

http://www.herpes.com/hsv1-2.html

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Autoinnoculation (self-contagion to other areas)

Autoinnoculation is most likely to occur during a primary outbreak and until sufficient antibodies have been established, which is usually within 3-6 months of infection.

HSV-1 seems more capable of spreading to other parts of the body than HSV-2.

See - https://www.herpes.org.nz/about-herpes/myths-vs-facts

Occurence of HSV-1 vs HSV-2 elsewhere on the body - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88338/

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When is genital HSV most contagious?

Genital HSV-2 is more contagious than genital HSV-1, since it is associated with more outbreaks and more asymptomatic shedding in between outbreaks.

New infections are more contagious, and newly infected individuals would appear to be more contagious during the first year, which is why suppresive therapy may be advisable in some cases.

An individual is also most contagious just before and during an outbreak, so during the prodrome period (usually one day before the appearance of lesions) until the lesions have fully healed. Sex should be avoided during this time.

Even if a full-blown outbreak can be avoided by taking antiviral meds, I have read that it is advisable to wait 3-4 days before sex.

https://www.plannedparenthoodaction.org/planned-parenthood-advocates-arizona/blog/std-awareness-asymptomatic-shedding-of-herpes/

HSV-2 shedding in symptomatic vs asymptomatic individuals -http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144252/

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Genital HSV transmission risk

You cannot pass genital HSV back and forth if both partners are infected with the same type.

In discordant couples (where one partner has it and the other doesn't), steps can be taken to reduce transmission to the non-infected partner. These include avoiding sex during periods of prodrome/outbreak, daily suppressive therapy (starting *at least* five days before commencing sex), and condom usage.

Suppresive therapy (1 x 500mg valacyclovir daily) has been shown to reduce HSV-2 transmission in discordant couples by around 50%. Proper condom usage reduces general HSV transmission by another 30-50%.

It is also worth noting that compared to men, women are generally more likely to acquire genital HSV, to suffer worse symptoms (though supposedly fewer outbreaks) as well as possible complications, due to the greater (mucous) surface area women possess, etc.

Daily valacyclovir in discordant couples - http://www.ncbi.nlm.nih.gov/pubmed/14702423

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Antiviral meds for genital HSV

There are three main antiviral meds for genital HSV at present: acyclovir, valacyclovir and famciclovir. Acyclovir is the most established and cheapest of the three, but valacyclovir is fast becoming the antiviral med of choice with both doctors and patients, being just as effective (if not more so) and involving fewer tablets.

All three meds can be taken for primary outbreaks and as episodic therapy (for recurrent outbreaks), although only acyclovir and valacyclovir are recommended for long-term suppressive therapy. (Note: While taking these meds, ensure that you remain well hydrated.)

A note about episodic vs suppressive therapy and asymptomatic shedding. Episodic therapy for reccurrent outbreaks does not reduce general asymptomatic shedding, so does not necessarily serve to protect sexual partners. Those in monogamous relationships with a negative partner should ideally opt for daily suppressive therapy (e.g., typically 1 x 500mg of valacyclovir per day, as noted previously).

https://www.ashasexualhealth.org/herpes-treatment/

http://www.emedexpert.com/compare/herpes-antivirals.shtml

http://www.ncbi.nlm.nih.gov/books/NBK47444/

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Natural treatments for genital HSV

Many websites and people claim that certain foods/supplements are good/bad for genital HSV. For example, lysine-rich foods and supplements are "good", while coffee, chocolate and nuts are "bad", etc. However, none of these claims have been scientifically proven, or cannot be replicated in subsequent studies.

It is therefore unnecessary to change your diet, provided you already have a balanced one and remain well hydrated (especially if taking HSV antiviral meds), unless you strongly feel that certain foods/supplements are helpful or triggering. Instead, anything that diminishes your body's immunity should be reduced or avoided, like stress, insufficient sleep, alcohol, steroids, etc.

Having said that (and being a tea lover!), I quite like the idea of drinking therapeutic herbal teas, and for genital HSV the following are *supposedly* beneficial: lemon balm, licquorice root, St. John's wort, echinacea. Turmeric is supposedly another good one, but I prefer to use the powder form as an additive to certain meals.

For topical relief/treatment, it's best to keep lesions dry, but *diluted* tea tree oil is both antibacterial and very soothing/cooling. Many people also swear by soaking in an Epsom salt bath.

There is a wealth of other information out there regarding natural treatments, but remember that it may not be backed by research/studies and there is presently NO cure for HSV no matter what any website, product or person claims!

https://www.ashasexualhealth.org/herpes-treatment/

https://www.herpes.org.nz/living-with-herpes/complementary-treatments/

Herbal treatments for skin conditions (see GH section) - http://www.ncbi.nlm.nih.gov/books/NBK92761/

Tea tree oil - http://www.ncbi.nlm.nih.gov/pubmed/11338678

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Genital HSV and increased risk of HIV

HSV-1 is not typically associated with a greater risk of acquiring HIV, unless genital lesions are present and exposed to HIV.

HSV-2, however, IS associated with a double/triple risk of acquiring HIV. This applies to BOTH men and women, and does NOT require the presence of visible lesions.

Lesions may be microscopic/asymptomatic, besides which those with HSV-2 have increased CD4 cells at or near the skin's surface (even when lesions have fully healed), which is what HIV targets. As a result, HSV antiviral meds resulting in reduced or no outbreaks make NO difference to this increased risk for HIV.

While this may be very alarming to those with HSV-2, bear in mind that this increased risk only applies if you engage in risky behaviour with a person with HIV.

A person with both HSV-2 and HIV is also at greater risk of transmitting HIV (and most likely HSV-2).

http://www.ncbi.nlm.nih.gov/pubmed/16327322

https://www.aidsmap.com/about-hiv/herpes

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I love this!

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Thanks! Thought I may as well share what I've learnt, since I've seen so many confused questions and answers, or simply nothing at all regarding things I want to know about!! Will add more sections tomorrow.

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Very good articles to share here and I thank you for the HSV community as everyone needs to get good reliable information.

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Transmission risk via inanimate objects, swimming and blood

Both types of genital herpes virus do not survive for long outside of the body and are readily destroyed by soap and water.

As a result, the risk of transmission via shared towels, clothing, toilet seats and the like is minimal to none (unless you immediately share a damp towel that has been exposed to the virus, then a slight possibility exists).

Swimming/bathing in open bodies of water like the sea and in chlorinated or soapy water (e.g., swimming pools, baths) is also not a transmission route for genital herpes, although I would personally most likely avoid it during an active outbreak, but that's just me!

HSV does not reside in the blood stream (only antibodies), so exposure to blood from cuts and wounds is not contagious. HSV carriers are also fine to donate blood, although it may be advisable to avoid this during a primary outbreak (recurrent outbreaks are okay).

The main thing is to avoid touching lesions, or if you do, to immediately wash your hands with soap and water before touching anything else, including other parts of your body to avoid autoinnoculation (especially during a primary outbreak and until enough antibodies have been established in your body, which is typically 3-6 months).

Herpes transmission- https://herpes.org.uk/frequently-asked-questions/passing-transmitting-herpes/

Donating blood - https://my.blood.co.uk/eligibility/health/article/?id=01707h25&title=Herpes-genital+%3A+Herpes+Simplex

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Genital herpes and menstruation

Menstruation MAY be a trigger for outbreaks in some women, since the hormonal changes during a woman's menstrual cycle can alter the immune system. For the same reason, peri/menopause MAY worsen genital herpes outbreaks in some women. However, there seem to be few studies available regarding this, which is both surprising and frustrating!

While menstruation may have an effect on outbreaks, the reverse is not true. Genital herpes and outbreaks do NOT affect menstruation, so if you notice any significant changes in your menstruation, you should seek medical advice. During menstruation, it is okay to use tampons or pads - whichever you feel more comfortable with.

http://www.healthcentral.com/genital-herpes/c/86/16378/herpes-cycle

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Genital herpes and BV and yeast infections

Genital herpes, in particular HSV-2, is associated with a reduction in the number of hydrogen peroxide-producing lactobacillus in the vaginal tract (most notably l. crispatus and l. jensenii), which are known to keep BV at bay. As a result, some women find that they suffer from BV in addition to genital herpes (talk about adding insult to injury!).

In studies, a probiotic vaginal suppository has been shown to restore a healthy and balanced vaginal flora, but there appear to be few such products available in the market, and I could find none containing the two lactobacillus mentioned above! Oral probiotics may offer some help, however, although vaginal suppositories are thought to be more effective.

Many women also seem to get yeast infections with genital herpes. Oddly enough, I could not find any research to support this, but if genital herpes can sufficiently upset the normal vaginal flora to cause BV, it makes sense that yeast infections may also arise.

If vaginal suppositories like Monistat are too painful to insert or irritating, oral medication like Diflucan can be taken instead. Personally, I would rather take systemic oral medication than localised treatment in an already sensitive and compromised body area! As for topical treatments to prevent external itchiness, steroidal creams/ointments should be avoided, as these are immunosupressants, so no hydrocortisone!

http://www.ncbi.nlm.nih.gov/pubmed/17989585

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659027/

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Is there a vaccine for HSV-1/2?

Unfortunately, no.

However, there are a handful of promising studies currently underway in both the US and Australia that are looking to develop a therapeutic vaccine for those already carrying HSV-2 (but not HSV-1, I'm afraid). The goal is to reduce outbreaks and asymptomatic shedding (not to eliminate HSV-2), with a preventative vaccine as the next step.

While promising, these studies are still in the clinical study phase, so sadly it will be some years before they will be made available to the general public, assuming they are successful and pass all of the necessary human trials and other requirements/approvals, etc.

http://medcitynews.com/2014/10/race-tight-genital-herpes-vaccine-agenus-genocea-announce-positive-data/

https://en.m.wikipedia.org/wiki/Herpes_simplex_research

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"Women are more likely to acquire HSV-2 from an infected male partner then men are from women. On average, the risk for women acquiring HSV-2 sexually from an infected partner is about 10 percent per year, though there is a large range - from 7 percent to 31 percent - in different studies.

"For uninfected men, the risk of sexually acquiring HSV-2 from an infected woman is about 4 percent per year.

"Having HSV-1 infection may lower the risk of acquiring HSV-2 sexually, but studies on this provide conflicting results.

"Condoms reduce the risk of transmission by about 30 percent [edit: some say 30-50%], and daily suppressive therapy reduces the risk of transmission by about 48 percent, studies show. Using condoms and taking daily suppressive therapy reduces the risk even further than either measure alone, though studies were not large enough to provide reliable numbers.

"Unfortunately, there is no available data on the rate of transmission for same-sex couples."

Source: Dr Peter Leone, STD expert and associate professor

http://consults.blogs.nytimes.com/2010/06/18/giving-your-partner-herpes/

Remarks: Genital HSV-1 both recurs and sheds less, plus HSV-1 prefers the oral region, so the risk of genital-to-genital transmission is much lower than HSV-2. Genital HSV-1 is mostly acquired via oral sex, with individuals who have never had oral HSV-1 being the most susceptible and likely to show symptoms if infected.

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FelisCatus, do u know what it means when they say GH is unilateral? Does it mean it affects one side of the body per out break, meaning it can either be left or right? Or maybe the recurrents will only occur on one particular side always, meaning if it affects left it's going to always be on left side? Have you found any ifo on that yet ?thanx:-)

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Yes, apparently first outbreaks are typically bilateral, with lesions appearing on both sides. Recurrent outbreaks, however, tend to be unilateral, with lesions appearing on one side, up to and including the midline (to do with nerves not crossing the midline). I'm sure there are exceptions, though, as GH rarely seems to follow a rule book!