New Information on Herpes

Source: Curr Opin Infect Dis. 2014;27(1):75-83.

OK so we all know Herpes is bad news. How bad news? This bad news:

  1. It cannot be cured. Once you have it, you have it for life.
  2. It is highly contagious and spread by skin-to-skin or skin-to-mucosa contact EVEN WHEN a person does not have any symptoms. This is called asymptomatic viral shedding. More on that later.
  3. It increases the risk of contracting HIV 2 to 3 times.
  4. It can infect a baby during delivery and cause the baby to become very sick.
  5. It can cause very painful blisters and ulcers.

Some new information was recently made available on Herpes and I would like to share it with you.

  • Herpes Type 1 infects the mouth and Herpes Type 2 infects the genitals right? WRONG!

HSV 1 (Herpes Simplex Virus Type 1) is found to be twice as commonly found in the genitals compared to HSV 2 (Herpes Simplex Virus Type 2). So if you test positive for HSV 1, it could be because you have had cold sores your whole life. It could also be because you have HSV 1 infection in your genitals. Unfortunately, there is no way for you to know unless you actually develop symptoms in the genitals. How often people who are infected in the genitals with HSV 1 develop symptoms is discussed below.

  • How many people in the world actually carry Herpes?

HSV 1 – 80% to 90%. Oh yes. Scary thought. HSV 2 – 16% (This study is only for people between the ages of 19 and 49. It could be more if the age range was wider.) Yes it is extremely common. Which means universal screening for Herpes might not be too useful. In other words, if you do not have symptoms, you might not want to screen for Herpes as statistically, there is a good chance your test will turn out positive.

  • How many people develop symptoms?

When a person is first infected with HSV 1, 74% of them do NOT develop any symptoms. Same goes for HSV 2 except the number is a little lower at 63%.

As time goes by, 57% of people infected with HSV 1 in the genitals will develop symptoms. The number is much higher for HSV 2 at 89%. Those with HSV 1 infection of the genitals have a median of 1.3 outbreaks per year and those with HSV 2 infections of the genitals have a median of 4 outbreaks per year.

This means there are a good number of people infected with HSV that go through life happily oblivious of the fact.

  • What’s this thing about asymptomatic viral shedding?

That means even when a person does not show any symptoms, he/she is still shedding the virus and can infect someone else. Recent very smart studies using repeat genital sampling and spatial mathematical modelling have demonstrated that reactivations are brief (i.e. <12 h) and occur frequently. More specifically, 80% to 90% of people infected with HSV 2 undergo asymptomatic viral shedding in approximately 20% of days.

This means that many people are spreading Herpes without even realizing it. This makes it very challenging if not impossible to completely protect oneself from getting Herpes.

  • Should I screen for Herpes?

Hmm. No surprise the jury is still out on this one. In Singapore there is no recommendation for universal screening for Herpes. Similarly, in the US, screening is not recommended by the US Preventive Services Task Force. The reason given is that current blood tests are not all that accurate and that is a very fair statement. The other concern is that Herpes screening can lead to ‘detrimental psychological outcomes’. I definitely can relate to that. Many of my patients, completely well and asymptomatic, are driven to near madness because of a positive Herpes test. Of course when there is a clinical need, you should still screen for Herpes. The emotional and psychological aspect of it just has to be dealt with. However, universal screening for Herpes is still not recommended because there are no studies to actually show that people who know that they carry Herpes will change their behaviours to lower transmission rates.

If there is a good reason for you to screen for Herpes, please do it.

  • Any chance of a vaccine in the near future?

Sorry nope. Vaccine trials for Herpes has been nothing short of disappointing. Kinda like vaccine trials for HIV actually. There is a candidate for a Therapeutic Vaccine but it is only in Phase 1. Industry insiders will know to tell you not to hold your breath.

  • Conclusion

Statistically, it is more likely that you are carrying Herpes than not. If you develop symptoms like blisters or ulcers in the genital region, go see your doctor immediately. Swab tests of the blister or ulcers are much more accurate than blood tests for Herpes. There are medicines that you can take that will reduce the number of days you have to suffer with the symptoms. There are also medicines you can take to prevent outbreaks and reduce the risk of passing it on to your partner.

If you truly have been found to have Herpes don’t freak out. I know it sucks to be diagnosed with an STD that will stay with you for life but really things could be worse. At least Herpes is not going to kill you. It may cause you to have painful blisters or ulcers that can be controlled with medicines. It will not be passed to your children. The way infants are infected is if the mother has active Herpes blisters in the genital region at the time of delivery. If that is the case, your doctor can discuss alternatives with you like delivering the baby via a C-Section.

If you have Herpes don’t freak out. Manage the problem.

Click for the old article on Herpes.


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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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  1. Hi Dr

    I had exposure 3months ago. At 2nd month, I started have joint pain and body ache randomly all over my body. I read other article, this is one of the symptom of Herpes.

    What do you think? Please advise. Thanks

  2. Hi, i have genital herpes but would like to know how accurate is herpes culture test? Is it the same as herpes blood test?

    If I have no symptoms or lesions, how is this test taken? will result show a false positive OR that I am shedding the virus?

    Kindly advice as I’m not sure if this test is necessary.

    • Genital herpes infections are caused by viruses (HSV-1 and 2) – these are not cultured (i.e. grown on a culture medium), but I believe you are referring to HSV DNA PCR. This is a direct swab to look for HSV-1 and 2 DNA molecules – because it is a direct swab, it must be done at the correct area where HSV is suspected – for instance, there would be no point of having suspected genital herpes and doing an HSV DNA PCR swab from the mouth. There is no chance of false positive result, because if there is no HSV DNA detected, there is no reason for the test to be positive. It is mostly performed when there is a visible lesion. If you have any further questions or concerns, it is best to visit us for a proper consultation and assessment.

  3. Dear doctor, recently I decided to do a full STD test whic covers herpes and I was so shocked when the test results came back as I have 0.4 (negative) for herpes 1 and 2.2 (positive) for herpes 2. I have never had any symptoms in my life. No blisters and no leisons. What are the chances mine is a false positive and i read from what tou wrote, is it true most people will get a positive result judging from statistics even if no symptoms? Im so traumatised as I have only one sexual partner.

    • Dr. Grace Huang

      Dear Mish,

      False positives are generally rare but not impossible. There are many people who may be completely asymptomatic despite having been exposed to Herpes Simplex Virus type 1 or 2. It is also true that HSV is very common in the population and a proportion of people may be asymptomatic and only realise (like yourself) on doing a blood test. An antibody level of 2.2 is suggestive of a recent infection. If you are worried this may be a false positive, you can repeat a blood test in a month’s time. I would encourage you not to be too stressed out by this as not everyone will develop symptoms, and even if you do, there are antiviral medications to help suppress flares.

  4. Hi Dr,

    12 months after a protected vaginal sex encounter with a sex worker. I have tested all standard stds and all have been negative.

    Would you test for genital herpes? What are the chances of contracting this from a one off condom protected exposure?


    • If you have no symptoms of genital herpes, it would be highly unlikely that you contracted it from this exposure. However, we cannot say for certain unless you were to test, so please speak to your doctor if you are still concerned.

  5. Father koh

    If I am diagnosed having hsv2, can I handle my baby? Such as carrying them, touching them and bathing them?

  6. Hi, i have had lesions on genital many years ago, however I wasn’t tested. Based on symptoms, dr told me it was herpes. Does herpes outbreak occur on the thighs? I get it mostly there sometime on my genital.

    However I am pregnant now, is my baby safe now since i should have build antibodies by now as first outbreak was many years back?

    • You can get herpes on the thighs as well, as long as there was direct contact with an infected region. Although people with herpes will have antibodies present, they are not protective against recurrent outbreaks. As such, it is best to speak to your OBGYN if you are concerned about herpes virus transmission during childbirth.

  7. If I only ever had 1 sexual partner and contracted genital herpes (hsv2), what are the chances that it was transmitted to me via that sexual partner? Is it a definite yes?

    • Dr Elaine Loh

      HSV2 is transmitted through sexual contact. So yes, you most likely contracted HSV2 from your partner.

  8. I performed oral sex on my male partner, he ejaculated in my mouth. Within the next 2 days my throat was swollen, I felt fatigued with chills and lots of sweating at night. I also noticed some white spots on my upper gums close to where a cold sore recently developed on my upper lip (4 days after performing oral sex on him) I’ve never had a cold sore before. Did he give me herpes?

    • It is possible to contract herpes, chlamydia, gonorrhea, and a few other STDs through oral sex. I would not be able to make a diagnosis unless we evaluated you in clinic. Please visit us for a proper consult and assessment.

  9. Hi Doc,

    I had an exposure a week ago. It started as a high fever for 2 days and then followed by ulcers on the tongue and severe sore throat. Now I notice a few blisters on the lips and mouth. So i am 100% sure it is herpes. My question is: since herpes is incurable, does it make any difference to know if it is type 1 or 2? What will be the time needed after exposure to ascertain the type of herpes? If it is incurable, it is necessary to take the med to suppress the virus?

    Thank you.

  10. HI DR,

    I have done full STD and HIV test including hep 5 months after exposure all came back negative except HSV1 which i already have it.

    Can this test be conclusive i am worries sick

  11. dr.tan
    sir I have positive hsv 1and2 4month before I got the wife pregnant now 3month so far she don’t have any hsv symptoms and my wife don’t know I have this. I just worry baby can be effect of this hsv?what can I do sir can you give me any suggest please.thanks

    • You should see a doctor for a proper discussion on herpes and perhaps get your wife tested so that there are no issues during delivery.

  12. sandeep

    Herpes test is reliable after 45 days exposure

    • Herpes serology at 45 days is a good indication but not conclusive. You need to wait at least 3 months for a more conclusive result.

  13. my 4month old son was test for hsv1 with complication of hfmd which afect his whole body. he recover well for a month, recently got some outbreak on him hand. will it be 2nd outbreak after the primay outbreak?

    • Hi,
      Sorry but I don’t really understand your question. HFMD is caused my coxsackie virus or enterovirus, not herpes simplex virus (HSV). If your son had HSV-1 ulcers, then it is possible for them to recur.

  14. Greetings Doctor,

    Thank you for taking the time to read my message and the many others who needed help.

    I had a Herpes blood test along with a couple of other tests at DSC a couple of months ago and the results states that everything is normal. Does this mean I am completely clear? How accurate are the herpes blood tests these days?


    • Hi,
      Most Herpes blood tests available currently will have a sensitivity and specificity of over 90%. However, please speak to your doctor at the DSC if you have any further concerns regarding their tests.

  15. Herbert

    Hi Dr Tan,

    When is the best timing to test for STI & HIV, last exposure on 1st March. Had deep kissing & oral sex.

  16. Hi,

    I got tested for HSV1 IGG. Result was 1.2. What are the chances that this is false positive?

    • If you do not have symptoms, it is a false positive. The caveat is when the test was done after the exposure. It is the responsibility of the doctor who ordered the test for you to explain it to you. Please approach him/her for more advice.

      • Hi Dr. No recent exposure. Probably 9 years

        • No symptoms as well.

          • Then it is likely a false positive. Please verify this with the doctor who did the test for you.

  17. I got burning penis,tingling and itchy once ahwile,on the day 9 i start to have fever become worse during the middle of the night, now my penis got rash sometimes come and go for about 10 to 13 days from the days the symptoms start

    • Dear Ck

      You should have yourself examined by a doctor in view of these symptoms . If you had unprotected sex, I would advise that you get tested from STI and HIV.

  18. Nicholas

    Hi Doc,

    I have went for a blood test for HIV testing and my Hspv 2 was at the borderline 1.1. Anything above 1.1 is considered herpes positive. So I was prescribed Acyclovir tablets. Please advise should I go another testing say three mths or six mths time?

    • In my opinion the HSV 2 IgG test titer about 1.1 is not considered positive. This is a complicated topic. You should discuss it with your doctor who did the test for you.

  19. Good day Drs.
    worried sick about Herpes..8 days post exposure ( protected as far as i remember). i came down with a bad bout of frequent small volume urination. this lasted for approx 12 hrs and urination was back to normal but had on and off Dark urine for the next few days.. once again on the 18 day had the same bout of frequent short urination whic lassted for just 5 hrs. both these occasions my urination didnt burn. but my low volume and ocasion dark urine still persist. I am in the process of testing for HIV and 21 days later as of date have cleared the RNA and 21st day P24 antigen antibidy test.
    have also completed my Urine stds 10 days post exposure Gonnorea etc tested negative.. however the urine did indicate bacteria but the culture indicated no significant growth. also Pus+ Ketones ++ epithelial cells 15 wbc 1
    mucus 1.. proteins +*.. Am very concered as the culture showed no growth it could be a viarl such as herpes.. please help need your expert advice.. I am totally stressed out and sadly my alcohol consumption rocketed.
    thanking yoy kindly

    • What I can say is that your symptoms do not sound like Herpes to me. Whether or not you have Herpes can only be determined by screening tests. I suggest you go back to the doctor who did your initial tests for you to talk about your Herpes concerns.

      • Good day Dr.Tan,
        Thank you for your reply. Also a very big thank you for all your articles and forums.
        It has been a great source of comfort in this extremely stressful time.
        I will be dropping in nxt week to do the entire Std checks. (30 days).
        Sorry to repeat myself. But given my Urine parameters. Could the Dark urine be a lingering UTI or because of the presence of proteins could it be more so because of a kidney problem. given that there is no pain and the dark urine shows up every 3rd to 4th Pee..
        Thanking you again.

  20. Good day

  21. Good day Drs.
    worried sick about Herpes. i have completed all the urine based test and all is clear. my concern is that on the 8th day post exposure i had a bout of frequent urination and this lasted for about 12 hours.. the symptoms stopped but slight irritantion and on and off dark urine persisted.. 18 days post exposure had the same episode of urination and it too lasted for just 5 hrs.. however dark urine on and off dark urine still persist. my urine culture 11 days post exposure indicated no growth however there was bacteria in urine.. with wbc 1. epithelial cells were high 15. ketones high and proteins +* also plus +. worried if this could be the signs of Herpes.. besides the urination problem no other signs.. please advise.. thanking you

  22. Recently I had done a HSV type 1 and 2 lgG Ab test. I had a 3.21 result for type 1 and 0.29 for type 2. What does the result mean? Is my type 1 highly contagious? I have never have cold sore on my lips but had at one period had serious acne outbreak at my chin area more than 10 years ago which I thought was due to late night sleep. It is already healed and no recurrence after that period. I am having a new man in my life and is worrying about the herpes transmission to him.

    • I’m surprised your doctor did not explain this to you. HSV 1 is very common and it usually affects the mouth region. You can also get it in the genital area. It is difficult to tell unless you have had symptoms before.
      It is best to speak to your doctor about this and discuss what you can do to reduce the risk of transmission.

  23. i read online that herpes rash will heal after some days and disappear. but can a rash that has no symptom and that stays more than 16weeks be herpes?

    • How can a rash have no symptoms? A rash is a symptom. I don’t understand your question.

      • hi doc,

        i mean apart from appearance of the rash there is no other symptom like pain. so was wondering whether a rash that stays for more than 16weeks can be herpes or some other thing like bacterial or fungi.infection.

  24. I’ve been diagnosed with HSV-1. The lab results came back and sadly it was positive, however are you guys able to prescribe suppressive therapy? If so, i would like to book an appointment.

  25. Hello Doc,

    On a medical checkup for my work I had an IgG HSV 2 test come back positive, with a measure of > 200 U/mL. For info, IgG HSV 1 also came back positive – which am really not so concerned about, but both IgM tests for HSV 1 and 2 came back negative.

    I have never shown any symptoms in my life, and in 2009 my wife and I were also tested, and my results for IgG HSV 2 were negative (albeit on that test, at a different hospital, the results were given using an index figure (although the results don’t show the number, only that I fell within the negative range)). Just as for this recent test both my wife and I were tested, and her results for HSV 1 and 2 are both negative.

    I have not had any extramarital affairs, so there has been no ‘funny business’, so am very confused as to how I can now be positive for HSV 2 (or rather, am now showing antibodies present for HSV 2), when my last results from 2009 show that I had no infection?

    Therefore I would like to ask if you had any thoughts on this? I am also not sure on how to compare the U/mL results to that of index figures, so am unable to see if the possibility of a false positive is more or less likely.

    Lastly, we are actually based in Indonesia, but would be very willing to travel to your centre if you think there might be a possibility that this could be a mistaken result.

    Thank you,


    • It is difficult to comment based on what you described. You had 2 tests at different hospitals and different labs. The best way to go forward is to get yourself re-tested again to be absolutely sure. False negative/false positive result is a possibility. The other possibility is that when you did your first test, you just got infected therefore IgG was still negative.

      • Thank you Doctor. I really appreciate that you have created and are active in this forum – it’s very helpful, obviously for many people.

        If I may ask, given that I was last tested in 2009, and have only been with my wife since then – is it possible that after 7 years that she has not contracted it from me, since we are not regularly using protection? And if it is possible, are you able to comment on the likelihood of the virus not having spreading to her? I realise am asking for speculation, and over the internet no less, but everything I’ve read seems to suggest that the transmission risk is high, even in those without symptoms. So if it is very unlikely that she would not by now also be positive, I’m looking to get on the next plane to SG to get tested there.

        Any advice you could share would be much appreciated. Thank you.

        • Getting yourself tested again is the right thing to do. There is no point asking yourself all these questions because you are not even sure if the test results were reliable.

  26. Hi Doctor,

    I recently did the blood test and i found out the herpes 2 igG result is borderline 1.0. I am wondering whether the test is accurate. Is it mean i have this virus?? I am worrying of it so much!! will the test be fasle-positive? My doctor gave me Acyclovir 7 days treatment and asked me to draw the blood for testing in early May. But i saw some forum and stated their doctor wont have any treatment for borderline.


  27. Hi, recently I develop some blisters wearing my New shoes. But suddenly recently my legs became itchy and develop some itchiness on my foot and foot sore.

    Even my outer Anus side became itchy. I’m not sure whether it is due to the weather and I have eczema history. Can I have some advice?

    • I’m sorry. We cannot make a diagnosis or give medical advice over the internet. You are welcome to visit us at any of our clinics. For location info, please CLICK HERE.

  28. hi dr tan

    My recent lab results for HSV-1: 0.07 and HSV-2: 1.77. I was totally shocked when the doctor told me I was positive for herpes. I read from you earlier reply was that anything < 3.5 might yield false positive results. May I ask what other tests can I opt for to confirm that? Thanks.


  29. Worried

    3 weeks ago I fingered a sex worker and had ulcers in my mouth. Now I’m very worried that I have herpes as I had put the finger in my mouth. No symptoms at all till now but I am freaking out. Does mouth ulcers increase the chance of getting herpes? Also, 3 months ago I had swollen lymph node on my neck. Could it be caused by herpes as well?