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Herpes is a very common viral infection, transmitted through direct skin to skin contact. Herpes Type 1(HSV1) is often transmitted from family members in childhood, and causes cold sores on the mouth. It can potentially be transmitted to genital areas by oral sex, but once it has established itself at the mouth it stays active there. Type 2 (HSV 2) is the virus, which more commonly manifests itself as genital or anal herpes. It is thought that about 1 in 6 Australians have HSV 2, although many of them may have no symptoms and so be unaware they have the virus.
The first symptomatic outbreak of general herpes is usually the most severe. Only about half of those people affected will experience recurrent outbreaks. Over time, subsequent episodes will tend to occur less and less frequently and be less severe than the initial one. What triggers recurring outbreaks is not clear. It may be linked to how strong your immune system is, whether you are "run down" in terms of general health, stress or depression, or friction to the skin, for example from sexual intercourse or masturbation. People experiencing outbreaks might choose to keep a diary of these factors to see if their "trigger" can be identified and maybe avoided or minimised in the future.
The most common presentation of a herpes attack is the appearance of a cluster of small blisters. A tingling or tenderness in the area may have preceded this some hours before the lesions appeared. This occurs because the virus, when reactivated, starts to travel along the nerves to where the first outbreak happened. However, it needs to be noted that many people infected with the virus experience no symptoms. An outbreak can vary from one small split or cut in the skin on the genital area, to clusters of small blisters on the penis or vulva (lips of the vagina). Herpes can also affect the anal and buttocks area. Tingling or itchiness in the genital area can indicate the start of an outbreak. Blisters can then appear and they can turn into small painful ulcers that usually heal over in 7-10 days. Sometimes there is pain or flu-like symptoms. Often there is no signs at all at the time of infection but outbreaks can occur later or the infection can spread to others.
Genital herpes can be spread by vaginal, anal or oral sex when direct skin-to-skin contact with the area affected occurs. Cold sores can sometimes spread from the mouth to the genitals during oral sex. The virus can be active and released onto the surface of the skin (sometimes called "shedding") either with or without there being any symptoms. It is rare for the herpes virus to get through the thicker skin on other parts of the body, as it prefers the soft skin on the genitals, anus or lips. A break in thicker skin might increase the likelihood, but it would still be very rare.
The risk of transmission of genital herpes will be reduced by using condoms during vaginal or anal intercourse, and by choosing sexual activities that do not include skin-to-skin contact with the area affected. However, depending on the location of the lesions, a condom may not fully cover the area affected and so not prevent skin-to-skin contact. Washing hands that may have come into contact with affected areas would be advisable too. Talking matters through with sexual partners is a good idea, so that shared decisions about sex and condom use can be reached. Details of how to use a condom most effectively can be found at our page safe sex practices.
There is currently no treatment, which will get rid of genital herpes. Once infection takes place, the virus will be permanently in the body. An anti-viral drug can help relieve the symptoms of herpes outbreaks and reduce the frequency and severity of future outbreaks.
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