How do I know if I have herpes?
It is difficult to paint a single picture of what herpes infection is like.
The symptoms depend not only on the severity of infection but also on its site.
For the most part, herpes simplex prefers mucous membranes, where
the skin is thin. These include areas like the labia (lips) of the vagina
and the lips of the mouth. However, any area of the body may be fair territory
for herpes.
When genital sores erupt, they usually do so at the site where the virus took
hold, which is usually on the external genitals. Sores generally look like a
cluster of small blisters filled with clear or whitish fluid. The classical
herpes sore is just this: a group of small blisters (vesicles) on a red base
of inflamed skin (see Figure 1).
In
many cases, these blisters are never seen, and the first signs of infection
are small erosions of the skin called ulcers. Ulcers also tend to
come in clusters or groups. They may feel like chafing of the skin or some other
irritation. Genital herpes may never be more severe than one very small sore
on the labia or foreskin, around the anus, or on the thigh. It may be the size
of a pencil eraser or as small as the sharpened lead point. The sore or chafing
may never be painful at all and may not even itch.
In women, herpes sores or lesions are usually on the external genitals,
most commonly on the labia (lips) of the vagina. Another common site is
the area covered by pubic hair. In men, sores are usually on the foreskin or
the shaft of the penis or in the pubic area, but the glans (tip of the penis)
is also possible territory. More than one of these areas may be affected during
primary herpes. Sores may vary in size from very small (1 to 2 millimeters)
to very large (1 to 2 centimeters). There may also be sores in other areas,
such as the mouth. If oral contact occurred with the same sores that infected
your genitals, a mouth infection may result. Rare sites of infection are the
fingers, the breasts, and the eyes.
If
you think you may have herpes, go to your doctor or clinic as soon as possible
and have a trained professional diagnose the problem and confirm the presence
of herpes by a virus test taken from the affected area. A culture test with
typing is preferred, but a direct antigen test or an electron microscope test
is also acceptable - see Figure 2. Early diagnosis and treatment will help you
to feel substantially better more quickly.
Primary herpes infections may cause anything from no symptoms to painful
sores, sore throat, headache, and muscle pains. Infection may be much more
severe because the body has not yet developed a specific immunity to herpes.
More sores will usually develop, especially in women. The person may feel generally
sick, usually with a flu-like illness that feels very much like any other viral
infection, causing muscle aches and pains and possibly fever and headaches.
Often the lymph nodes are swollen in the groin region. For other people, however,
primary infection will actually pass entirely unnoticed or will cause symptoms
or signs that are atypical and may be readily misdiagnosed. An atypical primary
infection, for example, could produce only a small amount of vaginal discharge,
some difficulty with getting urination started, leg pains, headaches, or vaginitis
of unknown cause. A woman may only find out she is in the midst of a primary
infection when a routine Pap smear comes back showing active cervical herpes.
Symptoms will usually disappear within 2 to 3 weeks. The ulcer-like sores
eventually scab over and the dry crusts fall off. This marks the end of the
primary infection.
Will symptoms reappear?
During the first infection, it appears the herpes virus travels up the nerve
fiber until it gets to the body of the nerve cell and remains there in a quiet,
or latent, infection that persists and may reappear later as an active outbreak
on the skin. Latent infection inside the nerve body (the ganglion) does
not hurt you, and it is not curable by any drug, at present. For now, it is
not possible to intervene and control the latent infection with a drug.
There is no way to predict who will have a recurrence - another active
outbreak - and who will not. Most people will have at least a few. For some
people, recurrences get milder and less frequent with time. People with recurrent
herpes often have few or minor physical ailments during recurrences. There are
usually few sores and these are much less uncomfortable. Unlike primary infection,
the recurrent herpes sequence usually takes just a few days from start to finish
- an average of 6 days for men and 5 days for women - and goes through
a series of relatively predictable stages.
It is important to reiterate the wide range of severity here.
Assume that any break in the skin in a previously affected or related area
is herpes unless you know otherwise. Using a mirror, rub a wet finger lightly
over the areas, looking for tender or red or swollen spots that might be active
herpes. Get to know your herpes and anything else that is unusual on your genitals.
You need to know if you're having a herpes outbreak when you're planning to
have sex. If you have only minor skin problems or discomfort that only rarely
turns into a classical herpes sore, then there could well be some other explanation
for your sensations or skin breaks. For example, you might have a bacterial
or yeast vaginal infection or you might be unsure about what is a sore and what
is not. On the other hand, being too cavalier about genital discomfort is not
good either.
People commonly confuse herpes with other things, especially before
they get to know their herpes. Herpes is often misidentified as a spider bite,
especially on a leg or buttock or in an area remote from the genitals; a yeast
infection; a hemorrhoid; pimples (on the buttocks, labia, etc.); shingles; water
blisters; or cuts, slits, or chafing of the lips of the vagina caused by friction
or soreness from vigorous contact.