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Lois McGuire, R.N., M.S.N., W.H.N.P.
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Lois McGuire, R.N., M.S.N., W.H.N.P.
Lois McGuire, R.N., M.S.N., W.H.N.P.
Lois McGuire was a registered nurse in Obstetrics and Gynecology for 20 years. This experience made attending Planned Parenthood of Minnesota for the Women's Health Care Nurse Practitioner Program a natural step. Later she attended Case Western Reserve University to achieve her Master's in Nursing. She has been employed at Mayo Clinic as a nurse practitioner for 15 years. She works with women from adolescence though all the life cycles. Lois is committed to a holistic nursing approach, empowering women to take care of their health.
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Safe sex blog
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Dec. 5, 2008
Herpes symptoms, diagnosis and how it spreads
By Lois McGuire, R.N., M.S.N., W.H.N.P.
I started the discussion on herpes in my last blog. Today, I want to address herpes symptoms, diagnosis and spreading the virus. The symptoms can vary depending on the category of herpes. The categories are primary, non-primary and recurrent. I described these in more detail last week.
Herpes symptoms
Primary outbreak symptoms: Many people do not have symptoms. Others may have symptoms so mild that they do not recognize the symptoms as being from herpes. Still others may have painful attacks with whole body involvement and can feel very ill for a few weeks.
The symptoms may be flu-like including; headache, aching joints, tiredness, fever or pain in the legs. The lymph nodes in the groin are often enlarged and tender and may feel like large peas under the surface of the skin. Genital symptoms may include sores (often on both sides of the genitals), painful urination, itching and a discharge from the penis or vagina.
The sores begin as blisters and are often grouped in clusters. After the blister stage, they break open and form ulcers in the skin or mucous membranes. Crusts or scabs form over the ulcers and eventually fall off and the tissue heals. Women will usually have sores on the cervix and men may have them inside the penis. Infected cells are sloughed off from the cervix and inner penis causing a discharge in men and women. Frequently, a new crop of herpes lesions will appear 5-7 days after the first batch is seen. The typical primary outbreak will last 2-3 weeks.
Non-primary outbreak symptoms: Remember, this group already had HSV-1 or oral herpes and now is exposed to HSV-2 or genital herpes. The existing antibody to HSV-1 allows the symptoms of HSV-2 to be less severe or nonexistent. The sores will usually cover a smaller area. The whole body symptoms, described above, are less likely to occur. The time to recovery is generally shorter.
Recurrent outbreak symptoms: Most people do not experience the whole body symptoms like headache, fever, etc. with recurrent outbreaks. The sores cover a still smaller area; often the person will experience only one sore. Many people do not experience pain with their outbreaks. The average recurrence last about 2-10 days. Frequency of recurrence varies greatly.
Because the symptoms can be so mild or vague, men often self diagnose thinking one of these are the cause of his symptoms:
- Jock itch
- Zipper burn
- Hemorrhoids
- Acne
- Tight jeans
- Bug bites
- Irritation from sex
- "It's normal to itch"
- Allergy to condoms (this is scary because then they don't use condoms and expose their partners to herpes)
- Bike seat rubs
Women often self diagnose thinking one of these is the cause of her symptoms:
- Yeast infection or some type of vaginitis
- Bladder infection
- Hemorrhoids
- Irritation from sex
- Heat rash
- Irritation with her period
- Allergy to sperm, condoms, spermicide, pantyhose or hygiene products
- Bike seat rubs
- Irritation from shaving
Herpes diagnosis
It is difficult to make a diagnosis of herpes by symptoms or looking at the sores. Sometimes the sores have a different look; they may be a small crack or fissure in the tissue or present as itching without a sore. Conversely, sometimes a sore can look very suspicious for herpes but is not herpes. Here are the most frequently used laboratory tests for herpes:
- Culture or swab of the sore: This has a high false negative rate, which means it often reports a negative culture when the person really does have herpes.
- Polymerase chain reaction (PCR): This test is very similar to a culture but it has a much higher sensitivity. It is 4 times more sensitive than a traditional culture. The PCR is more expensive than a traditional culture.
- Blood tests: Herpes blood tests look for an antibody to herpes virus. The body develops antibodies to fight the virus but these antibodies can take a while to develop in the blood. It is important to wait 3-4 months from the time you think you were exposed to get a blood test. The newer blood tests are accurate and can tell the difference between HSV-1 and HSV-2.
How do you get herpes?
Most children with HSV of the mouth have acquired it very innocently. They have probably just kissed a family member that had a sore. Many people with "cold sores" don't realize it is herpes and can easily be spread from one person to another by kissing or sharing towels, etc. They also do not realize they are able to spread the virus without having a "cold sore" or other symptoms.
Genital herpes is spread through sexual contact, including:
- Intercourse
- Outercourse or rubbing genital areas together with direct skin contact or no clothing between partners.
- Autoinoculation or transmitting the virus from one body part to another. For instance, if a person touched his or her mouth and then wiped his or her own genital area after urinating without good hand washing, he or she could spread the infection to another body part. This does not happen frequently.
- Oral to genital contact: HSV-1 or oral herpes can be spread to a partner's genital. In this situation, the receiver of oral sex does not get HSV-2. The receiver will have HSV-1 of the genital area. The cold sore can recur in the genital area, acting the same way as HSV-2. Because oral sex has become more common, spreading herpes this way has increased significantly in the last 10 years. If you have HSV-1 of the mouth, it is important that you prevent an outbreak happening in the genital area to your partner.
- Genital to oral contact: In this case, a person can acquire HSV-2 of the mouth. Once again, it is important to protect your partner.
In 70 percent of patients, transmission or spreading the disease happened when the person known to have HSV had no symptoms! The virus can be spread through microscopic breaks in the skin. This is called asymptomatic viral shedding. The next blog will cover treatment and prevention of spreading HSV.
Please share your questions or experiences with us.
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