Genital herpes

Genital herpes is a common infection that can cause painful blisters in the genital area. The infection is caused by the herpes simplex virus (HSV). There are two types of HSV, type 1 and type 2. Most genital herpes is caused by type 1.

Cold sores around the mouth are also caused by HSV (usually by type 1).

The World Health Organisation estimates that 69% of women and 61% of men in Europe carry the type 1 virus - that is two thirds of the population.

How is it passed on?

Most HSV type 1 infections are acquired during childhood.

HSV enters the body through small cracks in the skin or through the mouth, vagina, rectum, urethra (the tube where urine comes out) and under the foreskin.

It can be passed on through skin to skin contact during oral, vaginal or anal sex, or by sharing sex toys with someone who is infected.

You cannot get genital herpes from sharing baths or towels, from swimming pools, toilet seats or from sharing cups, plates or cutlery.

The virus will not pass through a condom but as condoms do not cover all of the genital area it is possible to infect genital skin that is not covered by the condom.

If you already have one type of HSV it is still possible for you to get the other type (although you may not notice any symptoms).

Symptoms

Not everyone who has the virus will get symptoms, which is why many people do not know they are infected. Only 10-20% of people who carry the infection will have been previously diagnosed.

Some people will get symptoms within four or five days of coming into contact with the virus. In other people, the virus may be in the body for several weeks, months or possibly years before any symptoms appear. Only one third of people will get symptoms at the time of infection. This means that when you get symptoms it doesn’t necessarily mean you’ve only just come into contact with the virus.

Symptoms may be mild or quite severe. If you do get symptoms you may get some of the following:

  • flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back and down the legs or in the groin
  • stinging, tingling or itching in the genital or anal area
  • small, fluid-filled blisters anywhere in the genital or anal area, on the buttocks and the tops of the thighs. These burst within a day or two leaving small, red sores which can be very painful
  • pain when passing urine caused by the urine flowing over the sores.

Recurrent outbreaks are usually milder than with the first outbreak and clear up more quickly (in about a week). You may experience, on average, 4 outbreaks per year and the frequency is likely to reduce over time.

You can only be certain you have genital herpes if you have a test while the sores are present.

Long term effects

It is rare for genital herpes to cause any long term health problems. However, the virus remains in the body and can cause further outbreaks. It is common to get outbreaks at times when your immune system is less able to keep the virus under control, for example, when you feel run down or when you are pregnant. If you experience symptoms of genital herpes during pregnancy then it is important to tell your midwife and/or obstetrician.

Treatment

Many people will not need treatment and will have very few outbreaks. The aim of genital herpes treatment is to relieve the symptoms only - it does not clear the virus from the body.

Some people choose not to take antiviral tablets and instead take over the counter painkillers such as paracetamol whilst their ulcers heal.

Treatment is only effective at reducing the severity and length of symptoms if you start it within 48 hours of the blisters forming or when new blisters are still forming. Usually a short five day course of antiviral tablets is prescribed.

You can also use local anaesthetic ointment such as lidocaine. This will numb the skin where the sores are to ease the pain.

Some people use longer ‘suppressive’ treatment courses if:

  • they are experiencing repeated outbreaks (usually more than six in a year) and their symptoms are particularly severe and causing distress
  • they are with a new partner and want to reduce the chances of passing the infection on
  • if they are in later stages of pregnancy to avoid passing the infection on during childbirth.

Suppressive treatment courses of antiviral tablets are prescribed to try to reduce or stop outbreaks.

The treatment you can buy for facial cold sores is not recommended for genital herpes as topical treatments (such as creams or gels) are less effective than oral treatments.

Telling your partner

You should discuss a new diagnosis of genital herpes with your partner. Genital herpes is most likely to be passed on just before, during or after an outbreak so you should not have sex during this period. When you do not have symptoms, however, there is still a small risk you can pass on the virus to a partner, although using a condom can lower this risk further. You might not need to tell previous partners but it may be helpful to discuss this with someone at your local sexual health clinic.

How to avoid genital herpes

Using condoms reduces the risk of contracting all sexually transmitted infections including genital herpes.

Genital herpes can be passed on even when there are not blisters present.

However, the blisters and sores are highly infectious, so if you or a partner have cold sores or genital herpes:

  • avoid kissing when you, or a partner, have cold sores around the mouth
  • avoid oral sex when you, or a partner, have mouth or genital sores
  • avoid any genital or anal contact when you, or a partner, have genital sores or blisters, or if you feel an outbreak starting.

Where to get tested

You can visit a sexual health clinic or your GP. A clinician can take a swab sample if you have ulcers or blisters present. Once you have had a diagnosis confirmed the clinician will be able to offer you advice for managing future outbreaks.

Questions?

Usually herpes tests are only done at the time when you have visible ulcers or blisters.

  • apply an ice pack for up to an hour or so. Ice should not be put directly onto the skin so use a towel or flannel.
  • take a cool shower to soothe the sores
  • apply a local anaesthetic ointment such as lidocaine - this will help relieve the pain. You can buy this from the pharmacy or get it from a sexual health clinic.
  • avoid washing too often, and dab the affected area gently to dry it
  • gently bathe the area using cotton wool and a warm salt water solution (1 teaspoon of salt to 1 pint of water)
  • if urinating is painful, go to the toilet in a warm bath or shower
  • wash your hands before touching the blisters or sores - this helps to avoid introducing bacteria which may cause an infection and delay the healing process
  • drink extra fluids, such as water or soft drinks. This dilutes the urine so it will be less painful when peeing over the sores.
  • wear loose clothing
  • use a mild pain-relieving drug such as paracetamol if needed
  • rest
  • eat healthily.

Some people find certain things trigger a genital herpes outbreak. These include:

  • being ill, run down, tired or stressed
  • different times in the menstrual cycle
  • friction from sex or masturbation
  • ultraviolet light on the affected skin area (such as from sunbathing or using sun beds)
  • tight clothing and nylon or lycra underwear
  • drinking alcohol or smoking.

It may be useful to avoid any triggers, although this is not always possible. Recurrences eventually stop altogether within 18–24 months for many people, although it may take longer for others.

No, if you have no blisters or ulcers at the time then no one can tell that you carry the infection. This is why it is important to discuss any infection with your sexual partners.