HSV or herpes simplex virrus, can come in 2 forms: HSV-1 and HSV-2. The World Health Organisation estimates that 3.7 billion people under 50 have HSV-1 globally, while 491 million people aged 15-49 have HSV-2.
HSV-2 usually results in genital herpes but can also present with cold sores. HSV-2 is exclusively contracted during sex and is therefore, a sexually transmitted disease. HSV-1 is not considered a sexually transmitted disease and is usually acquired through oral-to-oral contact.
After contracting HSV-2, individuals may not experience any symptoms initially. During an outbreak, individuals can expect to find small, painful blisters around the genitals, cervix, thighs, rectum or buttocks. These blisters can burst, leaving open sores, but they will not leave scars. Individuals may also experience pain during urination and flu-like symptoms. Women may even notice unusual vaginal discharge.
Symptoms usually last around three weeks, and the sore should scab and heal on its own. However, after experiencing one outbreak, individuals can expect more outbreaks in the future.
Outbreaks tend to be less severe and unpleasant over time.
When you have your first HSV-2 outbreak, you should take a break from sex. However, having HSV-2 does not mean you have to give up sex altogether. The initial outbreak usually occurs after two to three weeks of contracting the virus, although some people may not have their first outbreak for weeks, months, or even years.
With an initial outbreak, you may develop symptoms as outlined above, along with flu-like symptoms like fatigue and muscle aches. Along with sores around the genitals, buttocks, thighs, and legs, some individuals may develop sores on their lips, although this is uncommon.
It is imperative not to have sex during a herpes outbreak. This is because the virus is most contagious at this time and can be spread very easily. Usually, the first outbreak is the worst and most unpleasant, so you will probably not feel like having sex regardless.
Fortunately, effective antiviral medications are available for treating and suppressing HSV. These include acyclovir, valacyclovir and famciclovir. Sadly, while medication will reduce the frequency and severity of outbreaks, HSV is a lifelong infection, and there is currently no permanent cure.
Once the outbreak has cleared and you have no more cold sores, you can go back to planning sexual activity.
Transmission can occur from female-to-male or from male-to-female. As long as one sexual partner has an active HSV-2 infection and is partaking in unprotected sex, there is a high chance of transmission. Cold sores contain high concentrations of the virus and hence increase the chances of transmission significantly.
Using condoms is very important. It is the only form of contraception that can offer protection from sexually transmitted diseases. Condoms do not entirely remove the risk of transmission, but it do make a significant difference. One study showed that using a condom reduces the risk of transmission of HSV-2 from female to male by 65% and male to female by 96%.
Antiviral medications also stop the spread of infection by reducing viral shedding. Another study concluded that taking valacyclovir antiviral therapy makes a person 48% less likely to transmit the infection to their partner.
Herpes simplex 2 is a lifelong infection that can result in multiple outbreaks throughout your lifetime. Even though the chances of spreading HSV-2 is most likrly during an active outbreak, there is still a transmission risk without an active infection. It is important to tell your sexual partner about your HSV-2 as they are also at risk of contracting the virus. It can be a difficult conversation, but it does not have to be a negative experience. Make sure you have the conversation when you feel comfortable and before you first have sex.
Reviewed by Dr Roy Kedem, MD
Information last reviewed 10/13/21