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. There is no difference in the visible symptoms caused by the two types and both types can be caught on the genitals or the face (cold sores).

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 4 or 5 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 5 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 6 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.