What is it?
Genital herpes is a common sexually transmitted infection affecting about one in five adults. It is caused by the Herpes Simplex Virus (HSV). There are two types of herpes simplex viruses - Type I (HSV-1) and Type 2 - (HSV-2). Type I generally causes sores on or near the mouth (cold sores) - oral herpes. Type 2 typically causes sores on the genitals - genital herpes. These viruses are very similar and either type can cause genital herpes or cold sores.

What are the symptoms?
Symptoms of genital herpes vary greatly from person to person. Some people have mild symptoms, so mild that they may be totally unaware of them. It is estimated that more than half of the people who have genital herpes do not know it. Symptoms may include:

• fluid-filled blisters in the genital area (vaginal lips, vagina, cervix, head/shaft/foreskin of penis, scrotum, in or at the urethra, buttocks, anus or thighs)
• pain in the genital or anal area
• pain with urination
• flu-like feelings (fever, aches in the joints/muscles)
• painful swelling in the lymph nodes of the groin

Herpes symptoms usually appear 2 to 20 days after contact with an infected person. The first outbreak of herpes is usually the worst. It may take 2 to 3 weeks for symptoms to go away. Genital herpes tends to be less severe when it is caused by HSV-1 rather than HSV-2.

How is herpes spread from one person to another?
Herpes is spread from one person to another by direct skin-to-skin contact:

• genitals to genitals
• mouth to genitals
• mouth to mouth

Herpes is most easily passed if a person has sex during an outbreak (when sores or other symptoms are present) or during the period just before an outbreak. This time before an outbreak is called the prodrome and is often associated with genital itching or tingling. Some people have recognized triggers for an outbreak.

They may include:

• stress (emotional and physical)
• exposure to sunlight
• hormonal changes (e.g. menstruation)
• poor nutrition
• sexual intercourse
• lack of sleep
• any time your body's immune system is low (e.g. following surgery, injury or when you have a fever or other illness)

The herpes virus remains in the body after symptoms are gone. Between outbreaks it stays in nerve cells near the spine and can be passed to another person even when no symptoms are present. This is because the virus has come to the skin surface without causing noticeable symptoms (this is called "asymptomatic shedding").

How is it diagnosed?
Genital herpes is ususally diagnosed by a visual exam a sexual history and/or previous symptoms. A swab of the fluid from a herpes sore can be taken to try to identify the virus. This test should be done within 48 hours of start of symptoms. If the sore/lesion is very small, or if it is healing, there may not be enough virus present for an accurate test. It is important also that women with herpes have yearly Pap tests.

Is there a treatment for herpes?
There is no cure for herpes. There are antiviral drugs available that may help speed healing during an outbreak, reduce the number of outbreaks and reduce the chance of spreading the virus to others during and between outbreaks. These medications - e.g. Acyclovir (Zovirax), Valacyclovir (Valtrex) and Famiciclovir (Famvir) - must be prescribed by a doctor. There are also alternative therapies available. You may wish to consult a naturopath or homeopath. Research is ongoing into new treatments and a possible vaccine.

How to prevent spreading the virus?

• Do not have intercourse or skin-to-skin contact when symptoms/sores are present or during the prodrome - wait until symptoms/sores are completely gone.
• Use a condom/latex barrier between outbreaks.

Condoms do not provide complete protection because they do not cover all gential skin, however the penis is the major site of shedding in men. Condoms should also be used as people with open sores are more likely to get HIV infection.

Herpes and pregnancy
Neonatal herpes (herpes infection in the newborn) is rare. An estimated 20-25% of pregnant women have gential herpes, while less than 0.1% of babies get infected during birth. Herpes can have serious consequences for a newborn.

• If you have herpes and are pregnant, talk to your health care provider - a cesarean section may be needed if there are symptoms at delivery.
• If you are a male with a history of genital herpes and your partner is pregnant:
  o abstain from sex when you have active outbreaks|
  o use a condom/latex barrier for intercourse between outbreaks
  o possibly abstain from intercourse during the last trimester
• If you have oral herpes, avoid oral sex when you have an outbreak - 20% of neonatal herpes is caused by herpes type 1.