Genital herpes

About genital herpes

Genital herpes is often referred to as a sexually transmitted infection (STI) because it’s usually spread through having unprotected sex. It's most common in adults, particularly women, between the ages of 20 and 35.

There are two types of HSV, HSV-1 and HSV-2. Genital herpes is most often caused by HSV-2, although HSV-1 can also cause it. From the first time you get HSV, which is known as the primary infection, it stays in your body for the rest of your life.

Symptoms of genital herpes

The primary HSV infection may not cause any symptoms at all. If you do get symptoms, they usually appear four to seven days after you come into contact with the virus, but can sometimes take weeks, months or years to develop.

Symptoms of genital herpes include:

  • a flu-like illness with fever and headache
  • pain when passing urine
  • redness, discomfort, itching or tingling in your genital or anal area
  • an unusual discharge from your vagina
  • small fluid-filled blisters around your genitals, thighs and inside or around your anus, which burst after a day or two leaving painful sores and can last up to 20 days

After you’ve had the primary infection (with or without symptoms), the virus lies dormant (asleep) in your body. HSV can reactivate (wake up) and cause further reoccurring outbreaks, usually in or around the same place each time. You may have tingling or itching in the infected area before you get any blisters or sores on your skin. The blisters are usually less painful than they were in the primary infection and clear up faster – usually in about a week.

These symptoms may be caused by problems other than genital herpes. If you have any of these symptoms, see your GP for advice.

Complications of genital herpes

Complications of genital herpes include:

  • spread of the infection to other parts of your body, such as your lips, nipples, buttocks, fingers and eyes
  • nerve damage that can cause an inability to pass urine, but this is very rare
  • meningitis, but this is very rare

Having genital herpes increases your risk of getting or passing on the HIV infection during sexual contact, particularly if you have, or your partner has, blisters.

Causes of genital herpes

Genital herpes is most often caused by HSV-2. You can get the virus if you have unprotected vaginal or anal sex, share sex toys or have close skin-to-skin contact with someone who has the infection.

The infection usually passes from one person to another just before or straight after an outbreak, but it's possible to become infected by someone else even if they don’t have any symptoms.

Diagnosis of genital herpes

If you think you may have genital herpes, you can see your GP, visit a genito-urinary medicine (GUM) clinic, or a sexual health clinic to be tested. You don't have to ask your GP to refer you to a GUM or sexual health clinic; you can make your own appointment. All visits are confidential and you don't have to give your real name. Details won't be sent to your GP without your consent.

Your GP or nurse will ask about your symptoms and examine you. He or she will take a swab from the infected area and may need to gently break one of your blisters to get a sample. It will be sent to a laboratory to confirm HSV infection.

Even if you don’t have any noticeable symptoms, you may be able to have a blood test to find out if you have herpes. However, this test won’t be able to pick up signs of a very recent infection.

Treatment of genital herpes

Self-help

Treatment for genital herpes usually involves self-help measures to ease your symptoms. There isn’t a treatment that can get rid of HSV. Once you’re infected, it will remain in your body, even if you never get any symptoms.

The following steps may help ease any pain or discomfort, particularly if you have sores on your genitals.

  • Take an over-the-counter painkiller, such as paracetamol.
  • Clean the area with plain or salt water (one teaspoon to one pint of water).
  • Put petroleum jelly (such as Vaseline) or a mild anaesthetic cream or lotion onto the infected area.
  • Wear loose fitting underwear and clothes.
  • Try not to touch the sores, but if you do, wash your hands to prevent spreading the infection.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Medicines

If it’s the first time you’ve had genital herpes, your GP can prescribe antiviral tablets such as acyclovir, valaciclovir and famciclovir. These can help to clear the outbreak faster and reduce the severity of your symptoms. You will usually need to take the tablets for five days, or sometimes longer if your symptoms are severe.

If you have regular outbreaks of genital herpes, usually more than six in a year, your GP may prescribe you a longer course of antiviral tablets or creams. This is known as suppressive therapy.

Special considerations

If you're pregnant

If you have an outbreak of genital herpes when you're pregnant, it's important to see your GP or your obstetrician (a doctor who specialises in pregnancy and childbirth) for treatment and advice. This is because there is a risk that you can pass the infection on to your baby during the birth (neonatal herpes). If this happens, your baby can become seriously ill.

If you get genital herpes for the first time in the last three months of your pregnancy (the third trimester), you’re more likely to pass the virus on to your baby if you have a vaginal birth. You may therefore need to have a caesarean section. Speak to your GP or obstetrician for more advice.

Prevention of genital herpes

There are ways that you can reduce your risk of getting or passing on genital herpes. Some examples are listed below.

  • Don't have genital or anal skin-to-skin contact when you or your partner has symptoms of genital herpes.
  • Don't kiss or have oral sex when either you or your partner has a cold sore around your mouth.
  • Use condoms when you have vaginal, oral or anal sex.
  • Try not to share sex toys, but if you do, wash or cover them with a new condom before your partner uses them.

Also, sunbathing, being run down, stress and drinking heavily can trigger reoccurring episodes of genital herpes. Being aware of these and taking measures to prevent them can help reduce your risk of having an outbreak. For women, different times in the menstrual cycle can also bring on reoccurring episodes.

Is there a test to check if I have the herpes virus, even if I don't have any symptoms?

Answer

Yes, there is a test, but you won't usually be checked unless you have signs or symptoms of genital herpes.

Explanation

A blood test can detect if you have the herpes virus or not, even if you don’t have any noticeable symptoms. However, this test isn't routinely used and can't pick up signs of a very recent infection.

Usually, you will only have a blood test for genital herpes when you get symptoms of the virus. Your GP or nurse will also take a swab from the infected area. He or she may need to gently break a blister to do this. The sample will be sent to a laboratory to confirm that you have the herpes virus.

What will happen if I have genital herpes but don't get any treatment?

Answer

Even without treatment, the genital herpes infection will usually clear up on its own. But if your symptoms don’t improve, or they get worse, you should see your GP for advice about treatment.

Explanation

Although it isn't essential to get treatment for genital herpes, as it will usually clear up on its own, treatment can be very beneficial. It can help manage your symptoms, improve healing and reduce the risk of spreading the infection to others.

If you decide to see your GP when you first notice signs of genital herpes, he or she can prescribe you an antiviral medicine that can reduce the severity of your symptoms and reduce the time it takes for the infection to clear up. You will need to take these tablets for five days, or longer if new blisters are still forming.

Can HSV-1 and HSV-2 both cause genital herpes?

Answer

Yes, both HSV-1 and HSV-2 can cause genital herpes.

Explanation

HSV-1 usually affects your mouth and lips, causing sores and blisters (commonly known as cold sores). However, this virus can pass to your genital area through oral sex and cause genital herpes. For this reason, it’s important not to have oral sex if you or your partner has a cold sore.

HSV-2 is the usual cause of genital herpes, but it can spread to your mouth, usually through unprotected oral sex, and cause oral herpes.