Frequently asked questions

How do I know if I've contracted herpes?

Without symptoms, the only way to find out is to do a blood test. This test only detects antibodies to the type 1 or type 2 virus. It can determine your type of herpes, but not the area of your body where it's located. For example, if you test positive for type 1 herpes, you won't know whether it's located in the mouth or genital area. The results are therefore difficult to interpret and can be stressful.  

 

What's the difference between type 1 and type 2 herpes?

Many people think that type 1 herpes is found in the mouth and type 2 in the genital area. This is not entirely true. Type 1 herpes, commonly known as "cold sores", can be found in the mouth, BUT it can also be transmitted genitally. More than half of all herpes cases in the anogenital region are attributable to herpes type 1. According to the World Health Organization (2017), 67% of the population under the age of 50 is a carrier of herpes type 1. Herpes type 2 is mainly found ano-genitally and is very difficult to transmit buccally. According to the World Health Organization, 11% of the population under the age of 50 carries type 2 herpes.

 

Can I be cured from herpes?

Unfortunately, no. The herpes virus persists for life in the lymph nodes. There is no cure at the moment. However, there are a number of things you can do to prevent recurrences (reactivations of the virus), such as taking medication, managing stress, a healthy diet and so on.

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What causes recurrences?

Several factors can contribute to the onset of recurrences. Each person reacts differently to the virus. What's a trigger for one person may not be for another. Here are a few examples of factors that can cause recurrences:

• Stress

• Lifestyle

• Prolonged exposure to the sun

• Menstrual periods (hormonal changes)

• Fever

• Problems affecting the immune system

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What can I do to avoid recurrences?

It's important to know that activation of the herpes virus is often linked to the state of the immune system. We therefore recommend a healthy lifestyle ( healthy diet, vitamins, exercise, restful sleep, etc.). It is also advisable to develop stress management strategies, as stress is linked to the reactivation of the virus. There are a number of ways to reduce stress levels, such as meditation, exercise, yoga and so on. Another strategy is to take the treatment in suppressive mode. It acts by reducing the number of recurrences, the risk of transmission and the amount of asymptomatic excretion (see "How is it transmitted?" section).

 

Is it possible to have herpes but no symptoms?

Yes, it's possible. In some cases, signs may go unnoticed, may not appear at all, or may appear later after transmission. In most cases, first-episode symptoms are fever, muscle aches and/or burning sensations. Symptoms of recurrences are milder. The most common are general malaise, muscle pain, fever or headache. These symptoms are sometimes attributed to other causes, such as the flu, which can make them difficult to identify.

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Does the virus travel through the body?

No. In the case of recurrences, the virus will generally always appear in the same area. In other words, if your lesions are located on the mouth, that's where they'll reappear. The virus won't travel to the genital area, unless there's direct contact afterwards (see the next question, "How is it transmitted?"). Moreover, the virus is not contagious at all times or anywhere on the body. It will always be activated in the same place.

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How is the herpes virus transmitted?

Herpes is transmitted by direct contact (skin-to-skin) between the affected area (where lesions appear) and an entry point in an unaffected person (mucous membrane, wound, micro-lesion). For transmission to occur, the virus must be active. There are three periods when the virus is active:

1. When there are visible lesions.

2. During prodromes, which are the early warning signs of a herpes outbreak appearing a few hours to 2 days before the lesion appears (itching, tingling, redness, fever, fatigue). Prodromes are present in around 43%-53% of people (PHAC, 2016).

3. During the period of asymptomatic excretion when the virus is in enough quantity on the surface of the skin to be contagious, but causes no perceptible symptoms. This period is unpredictable, but rarely occurs: 3% of the time in the first year of infection and 1% of the time in subsequent years. The number of asymptomatic periods therefore decreases after one year of infection. This is because, over time, the body develops more and more antibodies to combat the virus.

Outside these three periods, the virus lies dormant in the lymph nodes. This means it is not contagious.

 

You say the virus needs an entry point to be transmitted, but is it possible to get it anywhere other than the genitals or mouth?

Yes. Although herpes is generally found in the mouth, genitals and anal region, it is possible for the virus to be transmitted elsewhere on the body. 

For transmission to occur, two conditions must be present:

1. The first is to have an area where the virus is active.

2. The second is to have an entry point (lesion, small wound, mucous membrane).

For example, if this entry point is located on the hands, and the hands are in contact with an area where the virus is active, contagion can occur in this area. That's where you'll find the lesions. Don't worry: talking about a risk of transmission doesn't automatically mean transmission!

 

Can herpes be transmitted through semen or vaginal secretions?

No! The herpes virus is present on the surface of the skin. When inactive, the virus persists in the lymph nodes of the spinal column. If it becomes active, it leaves the ganglia and travels along the nerves to the surface of the skin. The virus is therefore not found in body fluids such as semen, vaginal secretions, blood, breast milk or saliva. However, if vesicles (pimples) are present and there is a fissure in them, it is possible that the herpetic fluid they contain will mix with saliva or vaginal secretions, if they are in direct contact. Otherwise, the virus is not present in body secretions.  

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Can I transmit it to myself at another site?

Infection at more than one site is possible, but rare. It occurs mainly during the first outbreak of herpes, when the minimal presence of herpes antibodies would not prevent the virus from infecting another part of the body. As the virus rapidly disintegrates in the open air, self-infection is highly unlikely.

 

If I already have cold sores (oral herpes), can I get genital herpes?

If you already have herpes, this creates a certain barrier to new infection. For example, if you have cold sores, your body has developed antibodies that help it fight the virus. The risk of transmission at another level (genital, for example) is therefore reduced.

 

If my partner has herpes and so do I, is it possible for us to infect each other?

It is possible, but the risks are fairly low. When herpes is transmitted to you, your immune system produces antibodies to fight the virus. These antibodies act as a barrier against contamination by the virus. However, you need to be careful about the type of herpes you have. If you and your partner have the same type of herpes, the antibodies you have developed considerably reduce the risk of contracting it elsewhere. In this case, it's advisable to follow basic hygiene rules, such as washing your hands after touching an area where the virus is active. This will considerably reduce the already low risk of infection. On the other hand, if you and your partner have a different type of herpes, your antibodies create a barrier, but the risk remains. All you have to do is take the measures of your choice (see the section "How can I avoid passing it on to my partner?") to reduce this risk and continue to flourish in your life and sexuality.

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Am I contagious when I'm not having an outbreak?

Most of the time, no. However, it is possible during the asymptomatic excretion period, when the virus is present in sufficient quantity on the skin's surface to be contagious, but causes no perceptible symptoms. Rest assured: this period occurs quite rarely. So, when there are no symptoms, the risk of transmission is low. In fact, taking the treatment in suppressive mode (once a day) reduces recurrences and asymptomatic excretion. The risk of transmission to a partner therefore drops to 1.1% of the time in the year, with or without a condom.

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For how long am I contagious after an episode of herpes?

It's advisable to wait a few days after the lesions have completely healed (no more redness) to ensure that the virus is completely inactive. In fact, the period of asymptomatic excretion could occur some time before the lesions appear and a few days after they heal.

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Is it possible to continue to have a normal sex life?

Absolutely! Herpes should in no way prevent you from enjoying your sexuality. Several effective methods can reduce the risk of transmission. Furthermore, the fact that you have herpes can lead you to communicate more about sexuality with your partner, and this can have beneficial effects on the blossoming of your sex life.

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Should I avoid sexual intercourse during a herpes episode?

Abstinence is recommended during recurrences and for a few days after recovery. HOWEVER, abstinence does not mean no more sex! You simply need to avoid direct contact between the area where the virus is active and an entry point. This can be an opportunity to explore other spheres of sexuality, other sexual practices.

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Are condoms effective in protecting my partner?=

Condoms reduce the risk of transmission by around 50% during sexual relations. For a condom to be as effective as possible, it must cover the area where lesions appear, since transmission occurs through direct contact between an area with an entry point (lesion, small wound, mucous membrane) and an area where the virus is active.

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How can I avoid transmitting it to my partner?

There are several ways to reduce the risk of transmitting the virus to your partner. Combined, they are all the more effective.

• Using an inner ( women's ) or outer ( men's ) condom is a good method, as it reduces the risk of transmission of herpes AND other sexually transmitted and blood-borne infections (STBBIs). One of the advantages of the inner condom is that it covers the vaginal lips, offering greater protection. However, it's important to bear in mind that condoms don't protect all areas that can be affected by herpes (thighs, pubic area, buttocks, etc.).

• Dental dam (latex square used for oral sex) can be an effective method of protection against transmission during oral-genital intercourse (cunnilingus and anulingus).

• The use of a lubricant may also be recommended, as it reduces friction and therefore micro-lesions, which are entry points for the virus.

• Taking the treatment in suppressive mode (once a day) reduces the number of recurrences and the risk of transmission to 1.1% over one year, with or without the use of condoms.

• Be on the lookout for the prodromal signs of a recurrence, as this is a sign that the virus is active.

• Abstinence or modification of sexual practices during recurrences and for a few days after healing is recommended to limit the risk of transmission. This simply means avoiding direct contact with the affected area during this period, but it does not mean abandoning all sexual activity. This is the time to explore other sexual practices and other spheres of sexuality, such as sensuality, erotic massages, mutual masturbation and so on.

• Prompt disclosure to partners is advisable, as it enables better negotiation of condom use and the establishment of strategies for taking care of the sexual health of both partners, thereby reducing the risk of transmission (Money et al., 2008). In short, it's important to ask yourself which methods suit you best and which ones you're most comfortable using.

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Do I have to tell my partner? How do I do it?

There is no obligation to disclose herpes to a partner. It's a personal choice. If you decide to disclose, there are different ways of doing so. What one person is comfortable doing, another may not be. Here are a few ideas to help you make the disclosure easier.

 

Motivation

It's a good idea to examine your personal motivations for doing this disclosure. What encourages you to talk about it? What motivates you to tell this particular person? Already, by identifying these elements, you'll have a better idea of how to approach the discussion.

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For example, if you want to discuss it with your partner because you feel confident in the relationship, it's possible to start the discussion by telling the person that you feel comfortable with them and that you'd like to share a situation you're experiencing. It's also a good idea to identify your expectations. What do you want to get out of this disclosure? In addition to identifying your personal expectations, it would be interesting to identify your expectations for the other person. What do you expect the other person to do as a result of the disclosure? What are your expectations of your partner's reaction? What are your expectations of what the other person will do with the information you give them?

 

Message

First of all, it's worth thinking about the message you want to convey. One element that can cause stress in someone is the way in which the subject is presented. For some, this will be done more or less explicitly. For example, leaving an Info-Herpes pamphlet in plain sight, going for a screening test with your partner, testing the field to gauge the other person's reaction in order to build your message, leaving your medication (antivirals, if any) in plain sight, and so on.

 

Afterwards, you can reflect on your choice of words. Here are a few examples:

Avoid saying                                        Say instead

Infected                                                Carrier or person living with herpes.

Herpes crisis                                        Herpes episodes

Risks of transmission                        Possibility or probability of transmission

Contagious                                          Transmissible or the virus is active

I've caught herpes                             I live with herpes

 

Next, some people may ask you questions following your disclosure. These questions can be intrusive and sometimes even judgmental. It's a good idea to be prepared, for example, by seeking information and reading about the virus. The Internet can be a good source of information, but it's important to remain vigilant about the information you find. Websites often use extreme examples to draw attention to a subject. It's a good idea to check the sources of information on websites to see if they are credible and official.

 

For information on the herpes virus, you can visit the Herpes page on the Portail website, the Government of Quebec website or the Clinique l'Actuel website. You can also write to us for answers to your questions (info@infoherpes.org) or call us (1-844-847-4242).

 

It's a good idea to identify your limits. For example, the context in which the transmission took place, the impact it has had on you, and so on. Also consider what you know about the other person's knowledge of the virus. When disclosing, you don't have to say everything if you don't feel comfortable sharing certain personal information. What's more, you don't have to play the role of specialist if you don't feel comfortable educating your partner about the virus. Some information may be relevant, but you don't have to know everything about herpes. You can target resources (such as Info-Herpes) that your partner can contact if he/she has more specific questions.

 

Context

When it comes to context, you can plan the time and place. For location, you can identify where you feel most confident and secure, whether in person (at your place, your partner's place, etc.) or remotely (by phone, text message, e-mail, Skype/FaceTime, etc.). Ask yourself when you're most comfortable talking about it: at the beginning of the encounter or at the end, before/after sex, etc?

 

Remain sensitive to your partner's state of mind to see if he/she is disposed to listen to you during the disclosure. If the person has had a bad day or bad news recently, he/she may be less receptive.

 

An important element is to listen to yourself. It's important to ask yourself if you're ready to make this disclosure and if you're comfortable doing so. Are you in a position right now to receive the other person's emotions? If you've had a bad day, it's probably best to wait until another time.

 

Here we've provided some tips and questions to guide your reflection and preparation for disclosure, if you wish to do so. We'd like to remind you that disclosing your herpes virus is not mandatory, and that it's a personal decision based on your comfort level.

 

Do I have to wash my bed sheets every time I have an outbreak of herpes?

You don't have to! Indirect transmission is exceptional. Herpes is not transmitted by everyday objects, i.e. the toilet seat, a towel, a glass, utensils, bed sheets, etc. The virus disintegrates very rapidly (within a few seconds) when outside the human body. There would have to be immediate contact and an entry point (e.g. lesion, mucous membrane) for transmission to occur in this way.

 

Is it possible to catch herpes at the esthetician's for my waxing?

No. The herpes virus is not transmitted on objects such as depilatory instruments, since it disintegrates rapidly on surfaces (within seconds). However, hair removal can cause trauma to the skin or micro-lesions that can reactivate the virus. You may therefore experience a recurrence of the virus.

I've been in an exclusive monogamous relationship for X amount of time and my partner has just been diagnosed with herpes. Does this mean he/she has been unfaithful?

Not necessarily. The first manifestation of the virus does not always coincide with the time of infection. Sometimes, the first signs (fever, muscle aches, burning sensation, etc.) can go unnoticed and the person may attribute them to something else, such as the flu. Sometimes, herpes is asymptomatic (without symptoms), only to manifest itself a few years later. There are many reasons why herpes lesions may appear, but it's not automatically because your partner is unfaithful.

 

Can I have children if I have herpes?

Of course you can! Transmission of herpes during childbirth is very rare. It's advisable to keep a close watch on your condition with your doctor. It is also possible to take antivirals from the 36th week of pregnancy. In case of doubt, delivery by cesarean delivery is recommended.

 

I need to talk to someone... What resources are available to me?

The Info-Herpès project offers several support services:

• A support line at 1-844-847-4242

• An e-mail service to answer your questions at info@infoherpes.org

• A support group once a month (go to the Events page)

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Created by Andréanne Dupont and Ludovick Ouellet-Harvey, Info-Herpes interns

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Bibliography

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