Genital herpes

Genital herpes is a common sexually transmissible infection (STI) caused by the herpes simplex virus (HSV).

Two forms of HSV#

There are two types of herpes simplex virus:

• HSV-1 occurs most commonly around the mouth, where it causes cold sores, but it can also affect the genitals. Genital HSV-1 usually occurs when a person with the cold sore virus performs oral sex on someone who has not previously been exposed. Recurrence of genital HSV-1 is uncommon and rarely happens in healthy people.
• HSV-2 occurs mainly in and around the genital area. It can occasionally affect the mouth, for example when someone who has not been exposed performs oral sex on a person with HSV-2.

Exposure to HSV is very common. A large proportion of people have been exposed to HSV-1, and HSV-2 is also widespread. Exact figures are hard to confirm because many people have no symptoms, and it is often not possible to tell when a person first acquired the infection, as symptoms may appear weeks to years later, if at all.

Genital herpes is common and manageable#

Many people feel anxious when they learn they have genital herpes. It is important to remember that the virus only affects the skin for short periods of time, and most people have only a few recurrences. Over time, episodes usually become less frequent and may eventually stop altogether.

How genital herpes spreads#

The herpes virus spreads through skin-to-skin contact and can be transmitted during vaginal, oral or anal sex, and through genital rubbing. The infection can occur anywhere on the genitals (including the groin and pubic area) and in or around the anus. Cold sores on the mouth can cause a genital infection during oral sex in someone who does not already carry the cold sore virus.

The virus is most contagious when a person has an outbreak, with a sore, blister, ulcer or skin split present. This is known as viral shedding, when the virus is on the skin surface and can spread through direct contact.

Genital herpes can also spread between episodes, when no sore is visible. This is known as asymptomatic viral shedding. Because many people with genital herpes have no symptoms, they may not be aware they have the infection.

Symptoms#

The first episode of herpes can cause considerable pain and distress. Symptoms of a first episode may include:

• flu-like symptoms, such as feeling generally unwell, headache, back pain and enlarged glands in the groin
• small blisters around the genitals that break open to form shallow, painful ulcers, which scab over and heal after 1 to 2 weeks
• small cracks in the skin, with or without itching or tingling
• skin redness or a distinct rash
• considerable pain and swelling in the genital area, which may make passing urine difficult

Recurrences are usually less painful and shorter than the first episode. Infections caused by HSV-1 are less likely to recur in the genital area than those caused by HSV-2.

Recurrent episodes may be triggered by factors such as stress, menstruation, sexual activity, general illness or low immunity (for example during cancer treatment). In some people, there is no apparent trigger.

Diagnosis#

If you think you have genital herpes, your doctor will usually take a swab from an affected area to confirm the diagnosis. A blood test is sometimes available, but it is not very reliable for people without symptoms. If you have any concerns, discuss them with your doctor.

Treatment#

There is no cure for genital herpes, but treatment can help manage symptoms, reduce their severity, and lower the frequency of recurrences and the risk of passing the virus on.

Options may include:

• antiviral medications (such as acyclovir, famciclovir and valaciclovir), which reduce the severity of an episode if taken early, as soon as symptoms appear
• self-care measures such as salt baths, ice packs to the affected area, and pain-relieving medication (such as paracetamol)

Topical antivirals used for cold sores on the lips or face are not suitable for use on the genitals.

If you get herpes frequently, taking a daily antiviral medication can reduce how often symptoms recur. This is called suppressive therapy, and it also lowers the risk of passing the virus to sexual partners. You will need a prescription from your doctor.

Preventing transmission#

The best protection against STIs is to use barrier methods, including:

• external condoms
• internal condoms
• dams (a thin piece of latex placed over the anal or vulvar area during oral sex)

Keep in mind that condoms do not cover the entire genital skin area, so there is still some chance of catching the virus. Using lubricant with a condom reduces trauma to the genital skin and has been shown to lower HSV transmission, especially in the first 6 months of a sexual relationship. Silicone-based lubricants are recommended.

Transmission can occur when symptoms are present, such as a sore or blister, and also without symptoms through asymptomatic viral shedding. For people who have frequent episodes, antiviral medicines taken as prescribed help reduce transmission to partners.

Pregnancy and genital herpes#

Herpes infection can pass to a baby during pregnancy and labour and, although this is not common, it can cause serious illness. If you are pregnant or your partner is pregnant, let the midwife or obstetrician know about any history of herpes. They may suggest suppressive antivirals through the last weeks of pregnancy to prevent a recurrence.

Ways to reduce the risk of herpes infection during a partner’s pregnancy include:

• not performing oral sex on a pregnant partner if you have a cold sore, unless the pregnant partner is already known to have had HSV-1
• using barrier protection during sex

Support and advice#

If you have found out you have genital herpes, you may feel shocked and have many questions. Try to gather as much reliable information as you can; this can help you make informed decisions about treatment, sex and preventing further recurrences. Talking to a counsellor about your concerns may also help.

Key points#

• Genital herpes is a common STI caused by the herpes simplex virus, and it can be managed even though there is no cure.
• The virus spreads through skin-to-skin contact and can be passed on even when no sore is visible.
• Antiviral medication reduces the severity of episodes and, taken daily as suppressive therapy, lowers recurrences and the risk of passing the virus on.
• Barrier methods and lubricant reduce, but do not completely remove, the risk of transmission.
• Tell your midwife or obstetrician about any herpes history during pregnancy.

Where to get help#