Herpes Ulcers

Herpes Ulcers

Signs and Symptoms of Herpes Infection

Most individuals who are infected with HSV 1 or 2 have minimal or no symptoms with the virus as the virus is dormant in their body. Others present with active infection 2 to 7 days after exposure, which is characterised by blisters around the genitalia and/or rectum. Other symptoms include:

  • Itching or tingling sensation around the genital areas;
  • Pain when passing urine (usually over the open sores), most commonly in women
  • Headaches/backaches/myalgia
  • Flu-like symptoms and swollen lymph nodes or fever

The blisters often break, leaving tender ulcers/sores that take as long as a month to heal. After the blisters heal, the infection is by no means cured and can recur again, weeks or months later.

However, subsequent outbreaks are often less severe than the initial episode. Over time, the number of outbreaks get less often.

The herpes virus however, stays in the body indefinitely and while medications can be used to control outbreaks, there is no definitive cure for the infection.

How can I get the disease?

Genital herpes is acquired through skin contact with infected partners usually during sexual intercourse. It is most infectious when lesions appear on the skin during an outbreak. Even when there are no visible symptoms, there is still a risk that the virus is being transmitted through physical contact.

How can Herpes infection be detected?

Signs and symptoms of a herpes infection vary greatly. In most cases of active infection, a visual inspection is usually sufficient. However, to confirm the infection, the following needs to be done:

  • A clinical examination will be done on the genital area
  • A sample will be taken from the sores using a swab or cotton bud
  • Women may need to be examined internally (pelvin exam)
  • A urine sample may or may not be taken
Click here for more info on Screening for Genital Herpes

If symptoms have already disappeared, or if the patient is asymptomatic, a blood test will need to be taken to look for the virus. This blood test looks for antibodies to the HSV 1 or 2 virus which usually will appear 3 months after infection. However, results from such blood tests are not clear cut and cannot differentiate between active infection or a previous infection which is currently inactive.

Can Herpes be treated?

There is no treatment that can cure HSV 1 or HSV 2 infection. However, the severity of the outbreak can be controlled using antiviral medications. In addition, medications can be given to control the symptoms e.g. pain etc.

In some patients, they may experience recurrences of the infection. If the recurrences are very frequent, antiviral medications to suppress the virus may need to be taken for a prolonged period of time.

How can Herpes be Prevented?

Any skin contact can potentially transmit the infection even if there is no obvious signs and symptoms of active infection. However, if sexual intercourse is avoided if there are active sores/ulcers, transmission of infection can be avoided. Unfortunately, barrier methods of contraception, e.g. condoms, only offer limited protection against herpes virus.

Update 25th July 2014 – Condoms only protect against Herpes 30% of the time.

The best method of prevention is to treat the outbreak of herpes promptly and early so it does not transmit from partner to partner. In addition, certain patients may want to consider suppressive therapy even if they have got no symptoms to reduce transmission to their partners.

Complications of Herpes Infections

Individuals who are stressed can be afflicted with more episodes of herpes infection including patients with a suppressed immunity e.g. concurrent HIV infection. Due to the lesions that the infection causes, herpes increases the likelihood of HIV transmission by more than 3 times as it facilitates the entry of the HIV virus.

Click here for New Information on Herpes

Herpes also post a special risk for women who are pregnant. Although herpes does not affect the
women’s fertility, it increases the risk of miscarriage especially in the first 3 months of pregnancy.
The baby also has a risk of being infected. If the mother is infected in the later stages of her
pregnancy, there is a risk of premature delivery.

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  1. Good day Doctor

    I tested positive for herpes simplex (1) 2.99 and negative for herpes simplex (2) 0.30 .

    Just want to know if its possible to spread the herpes virus in general to others by sharing food,drinks and utensils with my friends and family?I know kissing and sexual contact is puts at high risk, just want to take note so that I can prevent it from spreading.

    Thank you

    Best Regards

    • Good question. Nobody really knows. The theory is that it is possible to spread oral herpes via sharing cutlery. This is to explain the very high prevalence rate of oral HSV. This however has not been proven.

      • Dear Dr.Tan,

        Good day! I’ve some questions here and I hope that you can assist me.
        I’ve been diagnosed with genital herpes roughly about 9-10 years back.
        For the first few years after diagnostic I had quite abit of outbreaks which’s a cold sores and its normally subsided within 7-14 days. At the very first year of the outbreaks I used to take valtrex for suppressions but sometimes I’ll still get outbreak even though I’m on treatments. Eventually I gave up taking valtrex due to financially doesn’t permit. As time goes, the outbreak is getting lesser, however I do get outbreaks when I’m stressed or restless. Sometimes I get a mild outbreaks which doesn’t have lesions but just tingling on my inner tighs, tailbone, vaginal lipsor buttock. And now I’m pregnant with 27 weeks. During the first trimester I had 2-3times of tinglings feeling on my tighs and vaginal lips without lesion. But 2 weeks ago I went back to my husband hometown which’s happened to be extremely cold and snows immediately I had 2 outbreak on each side of the vaginal lip on the third day I was arrived. I’m absolutely terrified. I take no anti viral treatment during this time and the outbreak lasted about 10-12days. My question is :-
        Will this recurrent outbreak harm my unborn child?
        If I start anti viral pill now will it be too late?
        Whats the risk of recurrence outbreak during second trimesters?
        I’m intending to have c-section on the safe side, whats your oppinion?
        Kindly advice, thank you for reading.

        • Recurrent herpes outbreaks will NOT harm your unborn child. You do not need a C-section unless you are having an active HSV outbreak at the time of delivery.

          • Dear Dr.Tan,

            Thank you for your replied. I couldn’t thank you enough for ease my worried. Thank you so so much.

  2. Hi dr tan,

    I have hsv type 1 igg 3.5,
    Hsv type 2 igg 1.24
    I have this problem in my body. Can i married? If i marry she get this disease? If my wife have hsv 1 or 2, she can get pregnancy? Is it the baby can also effect?
    Can explain me
    Whether i can married or cannot? I can get baby from my wife?

    Please advise me

    • You carry HSV 1 that is obvious. I am not too convinced of your HSV 2 results. Please seek clarification from your doctor. Many people in this world carry HSV 1 and 2. HSV 1 and 2 are both very contagious and you will very likely pass it to your sexual partners. HSV 1 and 2 does not affect fertility or pregnancy. It can however infect the baby if the mother has an outbreak during vaginal delivery. These are the facts. Whether or not you want to get married is not something I can comment on.

  3. Dear good Doctor.

    I have a problem that my partner was diagnosed with hsv1 and 2 recently and the relationship is going into a hard time with the physical and emotion turmoil and I love her very much. We have been together for a good 4 years now and I’m looking at growing old with her by my side.

    My work requires me to be out of the country for most of the time somewhere around 300 days on and off per year to be exact. Not once did I turned myself to another lady be it looks kinda safe or what and that eliminate one contributing factor from my side and I too never question her honesty in our relationship for I know how she is.

    Ok, back to myself. I used to have lots of stress in my line of work and still do now where at times it leads to eczema forming on my feet (according to a GP, stress contributes to eczema too) but it was not serious, just on and off overtime. Will it be a contributing factor towards hsv because from what I read it can leads to it and stays latent inside you for a long time before making itself known?

    About 7-8 weeks ago while I was in Yangon (another place that my work warrants me to be), I had this kind of pimple like thing at my pubic area specifically at the very base of my manhood, you know at the pore where the pubic hair grows. I used of having this once in a while but after a while it just burst like a pimple and it will be ok after that and I did put on antiseptic for it.

    Once I returned from Yangon, me and my partner had sex as usual and a week or two after, she was diagnosed with it. I was so scared that the harmless pimples had caused all this onto her, the emotion that she had to go through. Will it possible the dried skin on my genitalia from the pimple caused all this and with the history of my eczema too?

    Just got back from the clinic and was advised to go for full STDs since the cost differential is not that wide.


    • I do not understand your question. Your partner has HSV 1 and 2. You want to be with her. So what’s the issue?

  4. Hi dr Tan,
    I have been tested positive for hsv 1 in one of your clinics. Can i check if it is possible to pass hsv 1 virus to a girl which is tested negative for hsv 1 and 2 if she perform oral sex on me? thank you.

    • Yes if the HSV 1 is on your genitals. HSV 1 can infect either the mouth or the genitals (or both). Without symptoms, we cannot tell where it is. If it is in your genitals, your partner can get it in her mouth if she performs oral sex on you.

      • thank you for your reply.. i have another question it was first discover on my genitals (HSV 1) , does it mean that i have a higher chance of further outbreaks on my genitals rather than on my face? if it was first discover on my genitals does it mean that the virius will only stay around my genitals or it will travel to other parts of the body such as my hand or face?

        does contacting HSV 1 also mean that i should not share my utensils with another person and carrying or kissing my sister baby etc? thank you.

        • HSV 1 causes more frequent and more severe outbreaks in the face compared to the genitals. Vice versa for HSV 2. Auto-innoculation (i.e. spreading the virus to other parts of your body) is very rare. If you have HSV 1 in your lips/mouth, you can definitely pass it by kissing. When you have an active lesion in your mouth or lips, you can also potentially pass it by sharing utensils.

  5. Hi Dr Tan,
    May I ask what are the chances of contracting herpes through a single kiss on the lips?
    I was at a company event yesterday and a Caucasian male kissed me on the lips to say hello. Naturally I was taken aback and have been worried about this ever since. He had no open sores on his mouth during then.
    Looking forward to your reply
    Thank you

    • Hmmm. Good question. I would say your risk of contracting herpes from this is extremely low, in fact as good as zero. Although it is true that herpes can spread through kissing, he would have been much more contagious if he had a cold sore on his lips (which he didn’t). Furthermore, it was a very brief contact probably less than a second? I think all things taken into consideration your risk is as good as zero.

      • Hi Dr Tan, I must add that my ex colleague gave me a wet kiss on my lips, as he had been drinking beer beforehand. Not meaning to be rude I waited for a while perhaps 10 mins before excusing myself to the washroom for a rinse. Will this increase my chances?

        • I really do not know how to answer your question. You are obviously coming here to look for some kind of reassurance that you did not catch Herpes. As much as we can discuss your risks and chances, the fact remains that there is always a chance right? So that is a reality you will have to accept and live with.

  6. Hi Dr,

    I recently had an outbreak of rash and blisters at the back of my thighs, in the middle between my butt and knee. Is it possible it is herpes? I did not experience flu like symptoms nor back pain, how ever there was a tingling sensation before the rash appeared.I went to see 2 docs, one said it was and another said it wasn’t. I requested for a blood test. But the doctor was so sure it wasn’t herpes. What is your take on this? Should I get it tested? And what is the window period for the test to be conclusive?


  7. Hi, I just received my test result as per below and is it means I have herpes? can this be pass on to my partner who we just stay together lately (3 weeks)

    HSV Type 1 IgG Ab Antibody status 2.38
    HSV Type 2 IgG Ab Antibody status >3.5
    Candida Antibody 0.5
    Chlamydia igG Ab 0.81


    • Yes it looks like you do and yes you can pass it to your partner. You need to see the doctor who did the test for you for more information.

  8. Hi doctor, I’m a little confused. I had sex 2 yrs back. 2 weeks after the intercourse I had fever diarrhea and vomitting.After one month I felt that I had lymph nodes on my groin. I feel that I have sores inside my mouth dunno wat it is but I feel it’s normal. It is not painful. My lower back sometimes will be pain. My right side of my stomach near the ribs seldom hurts. I have encountered 3 times white milky discharge on my penis, during the discharge when I urine it will be pain. I have encountered blister on my foot. I already went for rapid hiv test 2 months back the result is negative. Am I infected with herpes???

    • Hi Mike,

      your penile discharge is suggestive of uretheritis, likely chlamydia or gonorrhea. The oral sores may be herpes but it’s hard to say without reviewing. You do need to see a doctor to go through your symptoms and receive the appropriate treatment though.

    • drtan

      Yes it could be Herpes. Of course it could also be CMV or HTLV or a medical problem completely unrelated to the sexual encounter. The milky discharge and pain passing urine also suggests a urethritis commonly caused by Chlamydia. Either way, what you need is to see a doctor and get a thorough work up to see what’s going on.

      • So just wanna check if I have chlamydia and herpes would I be able to cure chlamydia as for herpes I know there is no cure. That means I can’t marry and have kids rite if I have herpes??

  9. I am having hsv 1&2. I have blisters on my buttock on and off. at the same spot. itchiness sensation. not much pain. lymph node enlargement at the groin area. before this only 1 patch n heal by its own. but lately I had the outbreak again. n its spreading. what should I do? take oral medicine or apply topical cream?

    • drtan

      You should see your doctor to get more advice. Topical anti-viral creams like acyclovir have been shown to have limited efficacy in clinical studies. Oral tablets seem to work much better. You should speak to your doctor about ad-hoc and suppressive treatment for Herpes. You are also welcome to visit our clinics anytime.

  10. I had a blister on my vagina but it only burned when I touch it and I got a std check and it came back 45%

    • Uhhh…. 45% of what? A painful blister on the genitals we usually suspect herpes.

  11. Angelique Cahill

    Hi Dr Tan, id just like to point out that in the first paragraph it sounds like you are suggesting that hsv1 is only contracted orally and hsv2 is only contracted genitally. As im sure you are aware, this is not entirely precise; because they are variations of the hsv virus, genital herpes is not automatically ‘hsv2’ just because it is genital, it is possible for it to be hsv1, just as it is possible to contract hsv2 orally.

    Im sure you didnt mean to confuse people but as a reader who is not a health professional I found your statement to be misleading.

    I think readers would benefit if you changed the wording so that people understand that hsv1 and hsv2 can be contracted in all areas of open skin or mucous membranes, although each version has a preference in the teritory.

    Thank you.

  12. Immature

    Tq Dr Tan,I have few concern here,can herpes transmit to my expecting new born baby and to my wife?my wife was pregnant last year November and I was found infected by the virus on a month before which is October and when we have contact that time there is no blister,swollen,sore,outbreak on penis and in between this period we have few times contact and is not protected,how to prevent it the chances to transmit to my baby and wife,and will the virus attack back at my other body part which is not found now whereby now just appeared on the penis area,and how to prevent the outbreak to come back,any medication?and is that mean from now onwards I need to ise protection at all the times?and Dr Tan when is the best time for me to fly over to get your consultation and medical treatment! many many thanks

    • drtan

      You do not know how long you have been infected with Herpes and therefore have to assume your wife might have already been infected. You are contagious even when you do not have symptoms. Your baby will not be infected in the womb but may be infected if your wife has an outbreak during delivery. You are welcome to come to our clinics anytime.

  13. Doctor, thanks for all the replies.

    my girl did her herpes test (by blood) and this was the result stated: HSV IgM = 8.00 ‘negative’ (DU<9), HSV IgG = 53.00 'Positive'. She was told she has herpes. But not told whether it's oral or vaginal. from the stated results, could u explain?

    Thank you!

    • You cannot tell where the Herpes has infected unless there are symptoms.

  14. Hi Dr Tan,
    I am certain i am infected with HSV 1. However the outbreak occurs on my face near the cheek area.2 days after the outbreaks, the cold sore had spread to areas like my nose and forehead.
    May i know if there is any thing i can consume or do to prevent the spreading of cold sore through out my face?
    For your infomation, i am on Antiviral med now “Valtrex”.

    • You could be having Shingles instead. Also, if the HSV 1 affects the tip of your nose, your eyes also might be affected. Please see your doctor.

  15. Regards Dr,
    i am most certain i’m infected with HSV 2 cause of my blisters on my penis. I visited DSC, and he told me it most likely looked like it. Eitherways, a cell culture swab was taken and im awaiting my results. I’ve prepared for the worst. Whatever it is, i want to protect my family and friends most importantly. Should it be best i wash my own clothes(underclothing esp)? and does having a more noticable first flare up necessarily translate to a weaker immune system? Is it also true that HSV 2 is very common, but goes un-diagnosed in most parts of the world? Sorry for hording you with questions Dr.

    Thank you for your time

    • Whether or not HSV 2 transmit via clothes is controversial. I do not think doing your laundry separately will make any difference. The first outbreak for HSV 2 is usually the worse. It does not mean your immune system is weak. HSV 2 is very common.

  16. Hello Doctor,

    I am very confused with my situation. I have been in a relationship with my girlfriend for over 1 year now. We used to have unprotected sex (she’s on pill) every time with no issues. However, one time while we were having such aggressive sex that I broke the skin on the area under my foreskin. A few days later i experienced strange tingling feelings on my penis. When I went to my doctor the first thing he said was it was most likely genital herpes. Days later I experienced my first ‘outbreak’ which looked far from what any outbreak of herpes i have seen looks like. Basically i had a small red scab and dry area around the scab, but i still feel like this may have just been from the breaking skin during sex. One whole YEAR and a few valtrex suppression tablets (not sure if i really needed these, but it seemed to help?) later I got a blood test to confirm herpes. My igG was 1.68 which is supposedly positive but i have heard that if it’s under 3 it may still be a false positive?? Anyway, my main issue is, my foreskin is ALWAYS sticky to the point where sometimes it hurts to pull back my foreskin, i have no idea why it’s sticky! I shower, it’s dry for a few hours then goes back to being sticky again. Another problem is when i masturbate my penis goes incredibly dry, like I’m going to rip my skin dry. Could this be to do with herpes?? I have never experienced this before breaking the skin… Also ever sense breaking the skin my penis head has been extremely sensitive, i mean really REALLY sensitive. To the point where it can be painful to touch. Do you think this could be because of herpes? Do you think this is even herpes? HELP

    • The best thing to do is to swab the lesions for a HSV PCR test.

  17. worryman

    hi doc.

    i did a blood test on STD & HIV. and the result came in negative for the other STD & HIV, except Herpes Simplex Type 1. I’m very worry that i might have infected anyone.

    Can the virus spread by sharing washing machine? or eating utensils? how can i prevent it from spreading?
    can i die of this Virus?

    • You cannot prevent it from spreading. More than 70% of people in this world have it. You will not die from this infection.

  18. Hi Dr
    I did visit WL and had protected sex and no protected BJ from the WL that was like few weeks back.
    Last week I did saw a white spot under the skin of my penis.
    so I start to panicked.
    Just nice last week on sunday I started to vomit and my appetite drop till today more then a week.
    I went to see normal Family doctor 3 times till today and I cant eat more and I lost almost 4kg and starts abit of diarrhoea and lips starts to dry and crack and I feel cold easily and blur blur.
    Back to the white spot, last Monday I becomes very worried and actually did a very stupid thing.i used incense to touch the white spot and I use the chinese medicine 青草油 on the burn spot. Actually is like burn and after using the oilment it burn the irritate the injured spot and now it yet recover and becomes like a deep sores..
    I not sure all my vomiting, diarrhoea, crack lips,and headache is it link to the herpes.
    pls advice ..tks

    • Your symptoms do not sound like Herpes. It sounds more like injuries you inflicted on yourself with your home remedies. Please see your doctor and get this treated.

  19. How is it possible to be negative for HSV1 but positive for HSV2? All this would mean is that you have herpes but it hasn’t spread to your face yet, right?

    • HSV 1 and HSV 2 are completely different viruses. Its like asking how is it possible to have apples and not oranges. HSV 1 can infect the face and/or the genitals. Similarly HSV 2 also can infect the face and/or the genitals.

  20. Hi Dr Tan,
    I was wondering what is the window period for a herpes blood test ? I tested negative 60 days after exposure (IGG test). I have not had any symptoms. The doctor said I was fine but I read online that the window period was 3-6 months.
    Should i get retested at 6 months?
    Thank you

    • Or get a IgM test.

      • Hi Dr Tan,
        Correct me if I am wrong, did you mean I should get an igM test at 6months? Could I do with an igg test instead?

        Also, just as a second opinion, how conclusive is an igg test at 60 days post exposure?

        Thank you

        • Did I say that? A IgG test at 6 months is more than enough. At 60 days is very indicative.

  21. Curious

    I did a Herpes Simplex type 1 (IGG) blood Test at Malaysia and the result is 60++ U/ml.
    From the report indication, > 20 U/ml is considered positive.
    But from some of the websites, it says less than 100 U/ml is considered negative.
    May I know how should I interpret the result?

  22. HI,

    I had unprotected sex with a female sex worker a month ago.

    I have since had several incidents of protected sex and unprotected oral sex with female sex workers.

    Prior to this i was fully screened and free of all STDs. I today noticed reddish patches at the base of my penis that have small lumps. I have experienced flu symptoms and stomach sickness this week but it seems many at my work have also.

    The bumps do not itch and do not hurt and are very small. I have no discharge or pain when passing urine.

    Obviously i need to get these looked at and am concerned about herpes. What is the turn around time for test results for herpes? I went to DSC clinic for my full screen previously and it was two weeks, is there a way to get rapid testing done?

  23. Dear Doc,

    I had oral sex wearing condom. But my partner licked my scrotum. on 3rd day I fall sick by having fever, headache and muscle aches. I had blister at scrotum. I suspect it is hsv1 on my scrotum. Should I need to test and how can I live with it. Any drugs required or no need at all. Hope u can help me. Thank you.


    • Do not try to diagnose yourself. See your doctor and get a proper diagnosis. Only then can he decide if you need treatment or not.

  24. Worry-12345

    Dear Doc.

    I went to STD test, and was founded HSV Type I and II were founded, at >3.5. the doctor tell me no treatment is necessary. what should I do? I feel pain on my head. What medicine should I take?

  25. Hi Dr Tan,

    When I asked my GP to run STDs blood test, the results came back with a grey zone at 275 units/ML for Oral Herpes. The index for negative is <250 for Herpes Type 1. The test is IGG. I got very worried and then went to see a gynae for consultation as I have none of the systems mentioned in all the websites for oral herpes. Could it be an error?

    The gynae suggested I do a IGM which I just did and precribed me with antiviral drugs – Valtarex. My question is – should I take the medication now or wait till the IGM results come back next week? Is it safe to take Valtarex if my IGM comes back negative? I would appreciate your advise in this as I have been very worried.

    Freaking Out

  26. Dear Dr Tan,
    I contracted with a stranger (female) on 04/03/12; month later, I tested HSV (+pos), they told me I got HSV1&2, after 3 weeks I sufferred mild fever 37.4C, then there was follow: headache, adobmen pain, diarrhea, sore throat, backpain, muscle pain, fatique, recently nightsweat at week 11, I cough sometimes, they keep on progressive, I took Acyclovir 800mg it had bad side effect, I stopped for 2 week and come back with lower 400mg, there still period terrible headache, adobmen pain & loose down; my eyes are fuzzy a bit, but I have never seen anything like skin problem on my body today 06/26/12!
    The HIV Melisa test at week 10 (-neg),
    I don’t want to think about it but on this 07/03/12 is the full 3 months/ Last test for Herpes (+pos) & HIV (-neg) is processed on 06/19/12; I’m so scared doctor, what happened to me? my heart beats heavily everytimes I think of another test,
    I’m in emergency situation, Dr

  27. Worry

    Hi doc,

    Understand herpes can cause Encephalitis and/or meningitis (serious brain infections) and Herpetic keratitis — herpes infection of the eye leading to scarring within the cornea and possible blindness .. May I know is there any symptom ?
    Is there any treatment?

    • drtan

      Hi Worry,

      Please post your question on http://www.askdrtan.com


      Dr Tan

      • Dear Dr Tan,
        Regretfully felt a encounter with a strange female on 04/03/12; month later, I tested HSV (+pos), they told me I got HSV1&2, after 3 weeks I sufferred mild fever 37.4C, then there was follow: headache, adobmen pain, diarrhea, sore throat, backpain, muscle pain, fatique, recently nightsweat at week 11, I cough sometimes, they keep on progressive, I took Acyclovir 800mg it had bad side effect, I stopped for 2 week and come back with lower 400mg, there still period terrible headache, adobmen pain & loose down; my eyes are fuzzy a bit, but I have never seen anything like skin problem on my body today 06/26/12!
        The HIV Melisa test at week 10 (-neg),
        I don’t want to think about it but on this 07/03/12 is the full 3 months/ Last test for Herpes (+pos) & HIV (-neg) is processed on 06/19/12; I’m so scared doctor, what happened to me? my heart beats heavily everytimes I think of another test, it might be a hair line of luck, so tired, I can’t think of anything else! I’m in the US
        Appreciate your advice so I can rest my days easier, please help me! Thank you so much and God bless you Dr

  28. Worry

    Understand herpes can cause Encephalitis and/or meningitis (serious brain infections) and Herpetic keratitis — herpes infection of the eye leading to scarring within the cornea and possible blindness .. May I know is there any symptom ?
    Is there any treatment?

  29. Dear Dr Tan,

    My son was infected with herpes type 1 IgG 2.90.
    His result also shows HAV IgG antibody positive.

    My question is what is HAV.

    We share food and drink from the same cup. Would we be affected too?
    Must we go for checkup too?

    What should we do now?

  30. Dear Dr Tan,

    I had a medical check for Herpes type 1. I was told that my reading was 319 (Units/ML).

    Nagative is 400.

    I fall in the grey area. What are the chances of being positive with Herpes type 1?
    Thanks doctor..

  31. How to know if mouth or gential is infected ? I have blisters like on my buttock. Just two tiny water blisters, painless. Outbreak seldom. That means my mouth is not infected? Mouth infection is type one herpes right? If I don know where means I cannot kiss too. :(. This is really disappointing to know.

    • Hi Rena,

      We have to rely on the presence of physical symptoms to determine the location of infection. There is not test available for this.


      Dr Tan
      Check out our new forum at http://www.askdrtan.com

  32. Dear dr tan, what is suppression therapy? How much is that. By doing so can I safely have sex with my partner? I seldom have outbreak. Once a year when I m stress, I would have two tiny water blisters on my butt. I have type two herpes

    • Hi Rena,

      Supression therapy is a method to control frequent Herpes outbreaks. It involves taking anti-viral medication everyday. It is NOT 100% safe. Your partner still can catch Herpes from you when you are on supression treatment. It just lowers the risk. If your outbreaks are so infrequent, there is really no indication for you to be on supressive therapy. Cost varies from clinic to clinic. Best to ask your doctor.


      Dr Tan

  33. Dear dr tan

    I have tested herpes igg 1.63 for type two. Does this mean i m positive? Do I need to take DNA prc or any other test to confirm this? I m sad and don know how to move on, who will want to marry someone with herpes. I have type two herpes, can I pass to my partner by kissing him? Exchange saliva etc. As long as we avoid sex and wear shorts every night should not infect right?

    Can I know when will the vaccine against herpes be available in Singapore? U will help keep track right?

    • Hi Rena,

      Assuming you did a type specific Herpes test then yes, it means you carry the Herpes Type 2 virus. So does half of the people in this world. If everyone stops moving on with their lives because of Herpes I’m afraid the human race will come to an abrupt end. The message I am trying to get across to you is that you should not let the diagnosis of Herpes affect you in any way. You can pass Herpes to your partner if there is direct contact with the infected region. I do not know if it is your mouth or genitals that is infected.


      Dr Tan

  34. Confused

    Dr Tan,

    If I received unprotected oral sex about 1.5 months back, is it possible to have a blister (if caused by herpes virus) on my leg instead of on penis 6-7 weeks after the episode ?


    • Hi Confused,

      Possible but not likely. Herpes symptoms can appear as early as 8 to 10 days post exposure. Although symptoms usually appear within the same dermatome (skin that is supplied by the same nerve) as the point of infection, sometimes, the virus can jump one or two levels and appear at a seperate dermatome. Best to see a doctor and determine if the blister is Herpes or not in the first place.


      Dr Tan

  35. hi Dr.

    I have received oral sex from my friend(female). I am wonder what kind of test should i check? i had developed slight uncomfortable on my right testis few days ago and no blister and sore on my penis.

    • HI jj,

      Unprotected oral sex puts you at risk of Chlamydia, Gonorrhea, NSU, Syphilis and Herpes. Given your symptoms you should probably test for the 1st 3 i.e. Chlamydia, Gonorrhea and NSU.


      Dr Tan

      • Hi Dr.

        I have visited local GP today with an antibiotic injection. I have told him everything(receive oral sex and discomfort on my right testis and no blister & sore on my penis).

        He advise to have circumcision because he claimed that my foreskin is too long. Based on your experience, how would i know if my foreskin is too long or not & is it good to have circumcision? would it affect my future sex ability/feeling after circumcision?

        I would like to have an independent party to advise me on this matter as i am concerned the GP probably is profit minded.

        • Hi jj,

          It is not possible to advise you whether or not you require circumcision without a proper physical examination. I suggest you see another doctor or a urologist for a second opinion.


          Dr Tan

  36. HI Dr Tan,

    pls advice me, i have got a type specific test for herpes and diagnosed with type1.

    latterly i notice some blister appear on my chest and my hand, is that due to herpes type 1,

    i experience some type of pain and burning sensation on my finger tips and toes.

    recently i had found my mum having fever and dry cough, so i am quite nervous to understand is herpes could transmit due to normal contacts..

    • Hi ben,

      There are many causes of blisters. There is no way for me to be able to tell you if your blisters are due to Herpes or not. Herpes blisters can appear on the hand but rarely on the chest. I am also unable to tell if your mother has Herpes or not. Herpes attacks usually has a prodrome that looks exactly like any viral cold. Or maybe all she has is a viral cold.


      Dr Tan

  37. Clarification


    You mentioned having HSV1 has more risk of contracting HIV. Why? How do the % change if you have unprotected vaginal sex and unprotected oral?


    • Hi Clarification,

      Co-infection with HSV increases the risk of HIV transmission. There are multiple reasons. The 2 big theories now is an increase in concentration of immune cells in the infected area which are targets for HIV infection. And the presence of ulcers which breach the natural skin barrier. It is impossible to tell how much the risk increases. And frankly, it is pointless to do such risk assessment. At the end of the day, you will still need to test.


      Dr Tan

      • Clarification

        Hi Doc

        If I wanna get complete certainty, is it right that besides antibody test, I need to take DNA PCR and CD4 count? How much is that?
        I am not a Singaporean, but if I do it at your clinic, how long will it take, and how will I get the results?


        • Hi Clarification,

          I don’t see why you need to but you can if you really require that peace of mind. The DNA PCR costs $700 and the CD4 cell count costs $80. The turnaround time is about 7 working days.


          Dr Tan

  38. Hi Dr Tan,

    Yesterday I notice that next to my frenulum under the glan I see 4-5 blisters. But they didn’t hurt or itch. It look white but due to being very small around 1mm in size I can’t see clearly whether it is a blister or pus. Can this be a possible case of herpes? My Encounter was 46 days ago and it was a protected fellatio + protected vaginal sex + unprotected cunillingus.

    I’m intending to have it check tomorrow at the clinic.

    Thank you.

    • Hi Taro,

      Does not sound like herpes. But I cannot make a diagnosis via this forum. You should see your doctor.


      Dr Tan

      • Thanks for the reply.

        But I like to check as well, does herpes blisters break easily or it can be intact for a while?

        Thx again

        • Hi Taro,

          Both. It can be intact for a while and it breaks easily. There is no use discussing this. You will need to see a doctor for a proper diagnosis.


          Dr Tan

  39. Hi Dr

    I have been having cold sores since my teenager ages. I’m pretty sure that I got it from my mum. Last year only I was informed by my GP that it is herpes. Previously my outbreaks were 3 to 4 times a yr. Now I have cold sore about a yr plus later. I wanted to know whether it can hinder my sexual life and pregnancy. I am sexual active with my partner. I don’t want to spread it to my partner. Should I go for a proper test for my case as I am pretty sure that it is HSV 1 by the symptoms and my GP has confirmed upon seeing my cold sore. Am I vulnerable to get other types of sexual disease?

    • Hi Worrier,

      You have HSV 1. And so does more than half the people on earth. It should not affect your life in any way. There is no need to go for any tests. You will almost certainly pass it to your partner. You will also likely pass it to your children unless you intend never to kiss them. People with HSV 1 have a higher risk of contracting HIV when exposed. Not that you would need another reason. Not to expose yourself to HIV. So in summary my advice is lead your life as normal. There is nothing to fear from HSV 1.


      Dr Tan

      • I should never kiss children even when I don’t have outbreak of cold sore? Will it be better for me to take HIV and STD related tests? As my previous partner had sexual activites with numerous partners.

        • Hi Worrier,

          You obviously got me all wrong. I brought up the example of not kissing your children to illustrate how stupid, meaningless and pointless worrying about HSV is. Which parent can resist kissing their children? I kiss my baby a hundred times a day. Getting a full STD screen before marriage for both parties is always a good idea.


          Dr Tan

          • Dr tan,

            So if we are hsv1. We kiss our children and They will get it too.?

          • Good question. The short answer is yes. Herpes is called the ‘kissing ulcer’ for a very good and obvious reason. The vast majority of the time, HSV 1 infects the face and especially areas round the mouth. Kissing, and especially parents kissing children, is by far the commonest way in which HSV 1 is spread. The only caveat to that is if a person has HSV 1 infection confined to the genitals. In such an uncommon situation, kissing will not pass HSV 1.

  40. Hi Dr Tan

    I am looking for a place that can do anonymous testing for all stds. Can you help direct me to one?

    • Hi Andy,

      Anonymous STD testing is not available in Singapore. Perhaps you can look elsewhere.


      Dr Tan

  41. Hi doc,

    Can herpes spread through hug, holding hand, or sharing food?

  42. Can herpes spread through hug, holding hand and sharing food?S

    • Hi Worry,

      No it cannot.


      Dr Tan

      • Thank alot doc.. Can I have baby in future and if yes is the risk very high?

        • Hi Worry,

          Of course you can have as many babies as you want without any worries. HSV will not affect your pregnancy or your baby.


          Dr Tan

      • Hi doc,

        The reason I ask about spread through hugging, holding hand and sharing food.. Is I afraid of asymptomatic viral shedding that I spread to my family.. I’m diagnose with hsv 1.

        • Hi Worry,

          Do not worry. The only way you can spread it is by kissing and sexual contact.


          Dr Tan

  43. Dear Doctor

    Thank you. I have been referred to a medicine called Valtrex, is this the ‘nuke option’?

    Many thanks for your help


    • Hi A Query,

      Yes that is the nuke medicine. The dosage is different if it is used for prevention or treatment. Please check with your doctor.


      Dr Tan

  44. Dear Doctor

    I have had cold sores on the lips for years and find that with a stressful job that they appear at the most irrating time, causing emabrrassment.

    Are there options to reduce the frequency of these events?


    • Hi A query,

      You have the option of undergoing suppressive therapy. In other words you take tablets everyday and this will prevent most cold sores from appearing. Otherwise, you can take a high dosage of the anti-viral medication at the first onset of symptoms. Like ‘nuking it’.

      Dr Tan

  45. Hi Dr, I went for a massage 41 days ago. After 15 mins of massage, she gave me a hand job (hand-genital contact). I also fingered her with only my middle finger for 30 sec. My middle finger had no cuts. But my index finger had a small cut at the area where the nail is connected to the skin. The cut was 2 days old. And I touched my penis after fingering her. It wasn’t immediate, maybe 7 mins after fingering her. I have been having diarrhea which is on and off and had a slight fever and runny nose a week after the exposure. I’m also having back aches but I’m not sure if it is because of herpes or because of weight lifting. I realized that I have Pearly Penile Papules but there is no other unusual blisters on my penis. And there is also no unusual discharge from my penis. But since yesterday I have been experiencing a burning sensation not during, but after urination and masturbation. I do not know if this is a normal infection or herpes. I also have a habit of rubbing my penis against my clothings after masturbation to remove the semen. I have doubts if this habit of mine could have caused abrasions on my penis to cause the burning sensation. I have also read that symptoms of herpes occur 2-7 days after exposure. Hence I feel that having symptoms such as mine after 40 days has caused me to doubt whether it is herpes or not. Your opinion on my condition would be of great help to me. It will ease my anxiety. Thank you Doctor.

    • Hi Unknown,

      Doesn’t sound like Herpes at all. I am concerned about your burning sensation after urination and masturbation. It could be a prostatitis. You should see your doctor about it.


      Dr Tan

      • Hello doctor, just to follow up on the previous question. Just wondering if prostatits can be sexually transmitted and and also does prostatits have a cure? Thank you so much for your help doctor. 🙂

        • Hi Unknown,

          Yes prostatitis can certainly be caused by STDs. Whether or not prostatitis has a cure depends on what is the cause of the prostatits.


          Dr Tan

  46. Hi Dr.Tan,

    I would like to understand more about my test reports.
    I got confuse for these results.

    My last explosion was 6-Oct, and i tested the following under Pathlab(Malaysia) about 1 week later.

    NEGATIVE 400


    NEGATIVE 300


    However, i was confused for “grey area” hence i went to hospital for further test after 2 weeks again. But the result was shown different method and stated “herpes hsv I and II igg 1.2 (>1.1), igm 0.0”.
    Doctor said i got positive on igg for both types, but he can’t explain further. He requested me to have another test again, as the current result could be false positive.
    1.1-1.5 ==> 85% chance it’s false positive
    1.5-2.0 ==> 45% chance it’s false positive
    2.0-2.5 ==> 50% chance it’s false positive
    2.5-3.0 ==> 40% chance it’s false positive
    3.0-3.5 ==> 26% chance it’s false positive
    > 3.5 ==> 2% chance it’s false positive

    About 8 weeks, i went to hospital and retested, however, i am still waiting for the result by tomorrow.

    Around 9 weeks, i went to pathlabs again and tested the following, and found Type1 still under grey area and Type2 has been reduced to negative.


    NEGATIVE 400


    NEGATIVE 300

    Now is about end of the 10 weeks, should i proceed to have another test around 13 weeks?

    I got confuse for both test method, it seems different results for both. And i can’t really remember hospital is using igm or igg test.

    Please kindly to advice me if you have any comment. Appreciate and Thanks!!

    • Just to update, i don’t have symptom (blister or lesion) but a pimple appeared on genital. Could i assume that it is not a herpes? As i understand it should feel itchy and burning sensation which i am not feeling it so far.

      I got some minor fever last 2 weeks and there is a blister (but looks like “pimple”) on my lips. And again, i didn’t feel itchy and burning sensation on it.

      • Sorry, i had done VDRL and HIV (ELISA) around 10 weeks, both under negative. Thanks!

        • Hi BBDog,

          That’s good but does not solve the Herpes question.


          Dr Tan

          • Immature

            Hi Dr Tan,I experienced a few tiny red dots on my penis head after an oral done by a service provider,and is painful when touching or pressing on it,and immediately I went to the nearest clinic the next day after the exposure,and the doctor give me a jab and a cream to apply on it and it goes off the red dots but still left a faded red dots there for few weeks,but the pain is relieved,but I have an internal groin pain last for few months just after that exposure and in fact still having it right now,and after 5mths it came back with full of tiny red dots with white dots on top of the red dots but is not painful,and I went to specialist for urine and blood test,result came out is HIV negative but with herpes positive,and doctor gives me pills and cream to apply and the red dots goes off day after and seems come back again recently,and the worst thing now is red swollen on tip penis,and is painful when pass urine and press on it,is that STD is herpes or some other possibilities,and the blood test and urine result can be trusted?can it be HIV?i went for the blood test is after 5mths of that unprotective oral sex…..

          • drtan

            Your symptoms certainly sound very suspicious of Herpes. I cannot comment on the accuracy of the tests you did.

      • HI BBDog,

        A pimple is not a sign of Herpes. We can diagnose Herpes clinically if the symptoms are typical. If you do develop typical symptoms (i.e. painful blisters) you should see your doctor immediately.


        Dr Tan

    • Hi BBDog,

      No point barking up this tree anymore. What you need to do is a Herpes Type Specific Serologic Test. Or, if you develop any blisters, you need to swab the blisters for a PCR test or Tzank smear or Herpes Culture.


      Dr Tan

      • Thanks for your professional advice. Your comment really help to clear my doubt.
        I will go for another test around 13 weeks.
        If i encountered blister or lesion, i would see my doctor immediately.

    • I can’t go into all the detail on my story, it would take a whole new webpage! I’ll cut to the end, I found Viradux-AU. I am now cured. I mean cured. As in got back 2 ELISA IgG tests and they are both negative. It’s a new product so word is just getting out.

      • I am very happy for you. At the risk of being a wet blanket, I must say that having 2 negative IgG tests does not mean that there is no more Herpes virus lying dormant in your body. I am not trying to doubt you. If there really is a cure for Herpes I would be more thrilled than anyone else. But I think we should be a little prudent until we see more studies on this new cure. Nevertheless, I am very happy for you.


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