My Doctor Online The Permanente Medical Group

Symptoms and Diagnosis

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It can take 2 to 3 weeks for symptoms to appear. Many people with herpes have no symptoms. Symptoms could include:

• A single blister or a cluster of blisters.
• Blisters that may burn, itch, or hurt. Usually, they turn into open sores, crust over, and heal in 1 to 3 weeks.

The first outbreak is usually the worst. You may have a fever, swollen glands, a headache, or muscle aches. Or you may have such mild symptoms that you do not even notice them. Often, a person with herpes will notice tingling or itching at the site of infection a few days or a few hours before an outbreak. This is called the prodrome stage.  It is a warning that the virus is rising to the surface of the skin. You can transmit herpes during prodrome, even before you have any sores. Avoid sexual contact if you notice any of these symptoms.

If you are experiencing these symptoms or if you are concerned, contact us.

Testing for herpes

The best time to test for herpes is when there are sores or blisters on a person's body. You will only need to be tested once. If you notice a blister or sore, contact us immediately so the sore can be tested for herpes before it heals.

Blood tests for herpes antibodies are not very useful because most people carry antibodies to herpes—often from having had cold sores in childhood. The blood test will tell you only whether the virus is HSV-1 or HSV-2, not where herpes sores will appear. For these reasons, this test is not routinely ordered.

Causes and Prevention

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You can get herpes when healthy skin touches or rubs skin that is infected with herpes. This can happen whether or not a sore is present. Kissing, oral sex, and sexual intercourse are the most common ways to transmit herpes.

The virus also can be moved from one body part to another. Because of this, it is important to wash your hands immediately after touching a sore. For instance, if you touch a herpes sore on your mouth and then touch your genitals, you can become infected with herpes on your genitals.

There are no reported cases of herpes being transmitted from toilets, hot tubs, or towels.

You can prevent contracting herpes by avoiding direct skin contact with someone with an active sore. Since herpes can be transmitted through sexual contact, using condoms when you have sex can protect you from infection.

Talk with your partner

Talk openly and honestly with your partner about your risk for STDs and the importance of safer sex. Remember that a person can be infected with an STD without knowing it. Be clear about what you will and will not do sexually. Also, respect what your partner will and will not do. Decide together what is right for both of you.

Find Help if Your Partner Has Ever Hurt or Threatened You

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Unfortunately, abusive relationships are common. Abuse can include pressuring or forcing you to have sex, or refusing to use a condom to protect against pregnancy or STDs. If you think you are being abused, you can get help by talking to us or you can:

• Contact the National Domestic Violence Hotline, 1-800-799-7233 or 1-800-787-3224 for hearing/speech impaired.
• Visit the National Sexual Assault Hotline or call 1-800-656-4673.

Protect Yourself With Condoms

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The only certain way to prevent getting an STD is to abstain from sex. If you do choose to have sex, using condoms correctly and consistently is the best way you can protect yourself.

• Condoms can protect you from pregnancy and many STDs, even HIV.
• Most drugstores and supermarkets carry condoms.
• Condoms must be used before the start of any sexual contact to be effective in preventing pregnancy and STDs.

Risk Factors

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Herpes and pregnancy

We ask all pregnant women to inform us if they have any history of herpes.

If you are pregnant, you should take extra care to avoid getting infected. You could pass the infection to your baby during delivery, which can cause serious problems for your newborn. If you have an outbreak near your due date, you probably will need to have your baby by cesarean section (C-section). If your genital herpes outbreaks return again and again, we may talk to you about medicines that can help prevent an outbreak during pregnancy.

Herpes can be a serious problem if a woman gets genital herpes for the first time during the third trimester of her pregnancy. The unborn baby can become infected and will need treatment right after birth.

During the third trimester of pregnancy, herpes-negative women should use condoms and take special precuations if their partner has herpes.

Treatments

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Herpes can not be cured, but it can be treated. Once you are infected with herpes, the virus will always be in your body. Treatment can help reduce the number of days that an outbreak will last and decrease the frequency of outbreaks. Medications can:

• Relieve the symptoms.
• Make the outbreaks shorter.
• Prevent future outbreaks.

If you have occasional outbreaks, you can take medicine for 5 to7 days, starting as soon as you feel an outbreak is about to happen. If you have frequent outbreaks (more than 6 in a year), you may take medicine daily to reduce the frequency. The medication is safe, inexpensive, and well tolerated.

Here are some ways to keep your immune system strong and decrease the number of outbreaks:

• Make sure you are getting enough sleep.
• Manage your stress well.
• Eat a healthy diet.
• Exercise regularly.
• Avoid smoking or drinking excessive amounts of alcohol.

Your Care with Me

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If you are worried about being exposed to herpes and:

• You have a sore or lesion, make an appointment to see me. We can test the sore to see if it was caused by the herpesvirus and then decide on the best course of treatment.
• You do not have any sores or lesions, it will not be possible for us to tell for sure whether or not you have herpes. The only way herpes infection can be diagnosed is by testing an open herpes sore or by evaluating your clinical symptoms.

If you are diagnosed with herpes, we will recommend a medication that will treat your herpes sores. The next time you have an outbreak, you can use more of the same medication to shorten the outbreak and reduce any discomfort.

If you have more than 6 herpes outbreaks a year, you may want to take daily medication to suppress your outbreaks. You can request a prescription for suppressive medication by e-mailing me or by calling the Appointment and Advice line.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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