Genital herpes is an infection of the genitals that is caused by the herpes simplex virus (HSV).
The herpes simplex virus can also affect the skin on the face, causing cold sores to develop, usually around the mouth area.
There are two types of HSV:
- type 1 (HSV-1), and
- type 2 (HSV-2).
Genital herpes is caused by type 1 and type 2 HSV equally.
In most cases, genital herpes is a chronic (long-term) condition. Many people with HSV have frequently recurring genital herpes, recurring an average of four to five times in the first two years after being infected. However, the incidence of genital herpes decreases over time, and the condition becomes less severe with each subsequent occurrence.
The herpes simplex virus (HSV)
HSV is highly contagious and it can be easily passed from person to person by close, direct contact. Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with an infected person.
Once someone has been exposed to HSV, it remains dormant (inactive) most of the time. At least 80% of people who carry the virus are unaware that they've been infected because there are often few or no initial symptoms. However, every so often the virus can be activated, causing an outbreak of genital herpes.
How is genital herpes treated?
When genital herpes does cause symptoms, they appear as painful blisters on the genitals and surrounding areas. However, even if someone with genital herpes doesn't have any symptoms, it's possible for them to pass the condition on to a sexual partner.
There is no cure for genital herpes, but the symptoms can usually be effectively controlled using anti-viral medicines. The symptoms of genital herpes also tend to become less frequent and less severe with each recurring bout of the condition.
Symptoms of genital herpes
Most people with the herpes simplex virus (HSV) do not experience any symptoms of genital herpes when they are first infected and, as a result, do not know that they have the condition.
It is important to note that symptoms of genital herpes may not appear until months, or sometimes years, after you are exposed to HSV (usually by sexual contact with someone who already has the virus).
If you do experience symptoms when you are first infected, they will usually begin to appear between 4-7 days after you have been exposed to the virus. A case of genital herpes that occurs when you are first infected is known as a primary infection. If there are symptoms with a primary infection, they are usually more severe than those of recurrent infections.
Symptoms of a primary infection
If you have a primary infection of genital herpes, you may have several symptoms, including:
- painful red blisters, which soon burst to leave ulcers on your external genital area, rectum (back passage), thighs, and buttocks,
- blisters and ulceration on the cervix (lower part of the womb) in women,
- vaginal discharge (in women),
- pain when you pass urine,
- fever, and
- generally feeling unwell.
The symptoms of a primary genital herpes infection may last for up to 20 days. However, the ulcers will eventually dry out and heal without leaving any scarring.
Symptoms of recurrent infections
Once a primary infection of genital herpes has subsided, your symptoms will have gone, but HSV will still be present in a nearby nerve. It is likely that the virus will be 'reactivated' from time to time, travelling back down the nerve to your skin, causing recurrent infections.
If you have a recurrent infection of genital herpes, your symptoms may include:
- a tingling or burning sensation around your genitals before your blisters appear (this can signal the onset of a recurrent infection),
- painful red blisters, which soon burst to leave ulcers on your external genital area, rectum (back passage), thighs, and buttocks, and
- blisters and ulceration also on the cervix (lower part of the womb) in women.
Recurrent infections of genital herpes are usually shorter and less severe than primary infections. This is because your body has produced antibodies in reaction to the primary infection, and can now fight HSV more effectively.
Your symptoms may last for 7-10 days and, in most cases, you will not have any of the other symptoms of a primary infection, such as a fever, or generally feeling unwell. Your blisters and ulceration may occur in the same area each time you have a recurrent infection.
Over time, you should find that any recurrent genital herpes infections become less frequent and less severe. Genital herpes that is caused by type 1 (HSV-1) tends to recur less often than infections that are caused by type 2 (HSV-2).
Causes of genital herpes
Genital herpes is caused by the herpes simplex virus (HSV). The virus is very contagious and spreads from one person to another through skin-to-skin contact, such as during vaginal, anal, or oral sex.
Whenever HSV is present on the surface of your skin, it can be passed onto a partner. The virus passes easily through the moist skin which lines your genitals, mouth, and anus. In some cases, you may also be infected by coming into contact with other parts of the body that can be affected by herpes simplex, such as the eyes and skin.
However, genital herpes usually cannot be passed on via objects, such as towels, cutlery or cups, because the virus dies very quickly when it is away from your skin.
Once you have been infected with HSV, it can be 'reactivated' every so often to cause a new bout of genital herpes. This is known as recurrence.
Why does genital herpes recur?
After you have been exposed to HSV, the virus stays within the nerves of your skin, even when you do not have any symptoms of genital herpes. Most of the time the virus is dormant (inactive), but it may become active again from time to time.
It is not completely understood why HSV is reactivated, but certain 'triggers' may be responsible for the symptoms of genital herpes recurring. For example, friction in your genital area, such as during sexual intercourse, may bring on a recurrence. Other possible triggers include:
- being 'run down', or ill,
- drinking excess amounts of alcohol, and
- exposure of your genital area to strong sunlight.
Testing for primary infection of genital herpes
If you think that you may have genital herpes for the first time (primary infection), you should visit your local genito-urinary medicine (GUM) clinic as soon as possible. The condition can be diagnosed more easily and accurately when the infection is still present.
Wherever possible, an initial diagnosis of genital herpes should be made by a GUM specialist. If you cannot get to a GUM clinic, you should see your GP instead. They may refer you to a GUM specialist for a formal diagnosis and treatment. Before being referred for specialist, your GP will ask you about your symptoms and carry out an examination of your genital area.
If it is not possible for you to be referred to a GUM clinic, your GP will take a swab, which means that they will take a sample of fluid from a blister and send it to a laboratory to be tested for HSV. Your GP may also screen you for other sexually-transmitted infections (STIs).
It is important to be aware that even if your swab result comes back negative for the herpes simplex virus (HSV), you may still have genital herpes. Your GP may only be able to confirm a diagnosis of genital herpes by any recurrent infections that you may have.
Testing for recurrent infections of genital herpes
See your GP if you have previously been diagnosed with genital herpes and you think that you may have a recurrent infection.
Your GP will ask you about your symptoms, and about any previous bouts of genital herpes that you have had in the past year. They will ask you whether or not you have noticed any triggers, such as stress, or illness, that have set off your recurrent infections.
You will also need to have an examination of your genital area, so that your GP can assess the severity of your infection.
Pregnancy and weakened immune system
It is very important that you are referred for specialist treatment if you are pregnant, or if you have a weakened immune system - for example, if you are HIV positive, or receiving chemotherapy. See the 'complications' section for more information about genital herpes and pregnancy.
Treating genital herpes
The way that you receive treatment for genital herpes will depend on whether you have the infection for the first time, or whether you are experiencing a recurrent infection.
Treating a primary infection of genital herpes
In most instances, a first case of genital herpes (primary infection) will develop some time after you have been exposed to the herpes simplex virus (HSV). This may be months, or even years, after exposure. However, sometimes you may develop genital herpes 4-7 days after being exposed to HSV.
Treatment from a genito-urinary medicine (GUM) specialist
If you have genital herpes for the first time, you will normally receive treatment from a genito-urinary medicine (GUM) specialist, at a GUM clinic.
A GUM specialist will be able to provide specialist screening for genital herpes, and other sexually-transmitted infections (STIs), plus treatment, counselling, and follow up care.
Treatment from your GP
If you have a primary genital herpes infection, and it is not possible for you to see a GUM specialist, your GP may treat you for the condition. They may prescribe anti-viral tablets, called acyclovir, which you will need to take five times a day.
Aciclovir works by preventing HSV from multiplying. However, it does not clear the virus from your body completely, and does not have any effect once you stop taking it.
You will need to take a course of aciclovir for at least five days, or longer, if you still have new blisters and ulcers forming on your genital area when your treatment begins.
There are also several things that you may be able to do to help ease your symptoms of genital herpes. See the 'self help' section for more information about this.
Treating recurrent infections of genital herpes
If you have been diagnosed with genital herpes before, and you are experiencing a recurrent infection, you will probably receive advice and treatment from your GP. In most cases, you will not need to return to your local genito-urinary medicine (GUM) clinic.
If the symptoms of your recurrent infection are mild, your GP may suggest some things you can do to ease your symptoms, without the need for treatment. However, if your symptoms are more severe, you may be prescribed anti-viral tablets (acyclovir) which you will need to take five times a day, for five days.
If you have less than six recurrent infections of genital herpes in a year, your GP may prescribe a five day course of aciclovir each time that you experience symptoms. This is known as episodic treatment.
If you have more than six recurrent infections of genital herpes in a year, or if your symptoms are particularly severe, and causing you distress, you may need to take aciclovir every day as part of a long-term treatment plan.
This is known as suppressive treatment, and it aims to prevent further recurrent infections from developing. In this instance, it is likely that you will need to take aciclovir twice a day, for 6-12 months.
It is important to note that while suppressive treatment can reduce the risk of passing HSV on to your partner, it cannot prevent it altogether. Your GP may refer you for specialist advice if you are concerned about transmitting the virus to your partner while you are taking suppressive treatment.
Once you have been taking aciclovir for 12 months, your GP will usually stop your suppressive treatment. You may continue to experience further recurrent infections of genital herpes after treatment is stopped.
As long as recurrent genital herpes infections are infrequent, and mild, you will only need to take a five day course of aciclovir as and when it is needed. You may also find that there are things that you can do to improve your symptoms without the need for aciclovir.
If you have further genital herpes infections after stopping suppressive treatment, or if you have severe recurrent infections, your suppressive treatment may be restarted. Your GP may refer you for specialist treatment if you continue to have recurrent infections of genital herpes while you are taking suppressive treatment.
If your symptoms of genital herpes are mild, you may not need to have any treatment from your GP, or genito-urinary medicine (GUM) specialist. However, the advice listed below may help to ease your symptoms.
Painkillers, such as paracetamol, or ibuprofen, may help to ease any pain. However, you should not take ibuprofen if you have asthma, high blood pressure, kidney, or heart, problems, or if you have, or have had in the past, stomach problems, such as a peptic ulcer.
Keep your genital area clean by using either plain, or salt water. This will help to prevent the infection from spreading to other parts of your body, and may also help any blisters, or ulcers, to heal more quickly.
Apply Vaseline, or an anaesthetic ointment, to any blisters, or ulcers, in order to reduce the pain when you pass urine.
Drink plenty of fluids to dilute your urine. This will make passing urine less painful. Passing urine while sitting in a warm bath may also make urinating less painful by reducing the stinging sensation.
Avoid wearing tight clothing on your lower body because it may irritate your genital area further.
Avoid sharing towels, or flannels, with others to ensure that you do not spread the herpes simplex virus (HSV).
Avoid having sexual intercourse, including vaginal, anal, and oral sex, until your GP, or GUM specialist, advises you to, or until all your blisters and ulcers have cleared.
If you have a recurrent infection of genital herpes, you should avoid anything that seems to trigger an infection, such as excess alcohol and stress.
Complications of genital herpes
It is important to dispel some myths about genital herpes.
If your symptoms of genital herpes are mild, you may not need to have any treatment from your GP, or genito-urinary medicine (GUM) specialist. However, the advice listed below may help to ease your symptoms.Painkillers, such as paracetamol, or ibuprofen, may help to ease any pain.
However, you should not take ibuprofen if you have asthma, high blood pressure, kidney, or heart, problems, or if you have, or have had in the past, stomach problems, such as a peptic ulcer. Keep your genital area clean by using either plain, or salt water. This will help to prevent the infection from spreading to other parts of your body, and may also help any blisters, or ulcers, to heal more quickly.
- does not affect fertility,
- is not hereditary (passed from parent to child), and
- is not associated with developing cervical cancer.
- In rare cases, the blisters that are caused by the herpes simplex virus (HSV) can become infected by other bacteria, potentially causing a skin infection to spread to other parts of your body.
Genital herpes and pregnancy
In some instances, the herpes virus can pose problems during pregnancy. If you had genital herpes before becoming pregnant, the risk to your baby is very low.
This is because during the last few months of pregnancy, your baby develops antibodies to all the infections that you have had in the past. The antibodies protect your baby during the birth, and for several months afterwards.
If you develop genital herpes for the first time during the first trimester (weeks 0-13), or second trimester (weeks 14-26) of pregnancy, the risk of passing the virus on to your baby is slightly increased. To prevent this, you may need to take anti-viral medicine, such as aciclovir, while you are pregnant.
If you develop genital herpes for the first time during the late stages of pregnancy, the risk of passing the virus on to your baby is considerably higher. This is because your baby will not have time to develop any antibodies, and the virus can be passed on just before, or during, the birth. Therefore, in order to prevent this happening, you may need to have a caesarean section delivery.
If you develop genital herpes during the latter stages of pregnancy, you will need to take anti-viral medicine continuously for the last four weeks of your pregnancy. However, this may not prevent the need for a caesarean.
There is also a risk of passing HSV on to your baby if you have recurrent infections of genital herpes during the third trimester (week 27 until birth). However, you will not need to have a caesarean section delivery unless you have blisters and ulcers on your genital area at the time of birth.
Preventing genital herpes
The following advice can help to prevent the herpes simplex virus (HSV) spreading to others.
Avoid all sexual intercourse
If you have genital herpes, you should avoid having sex, including vaginal, anal, and oral sex, until after any blisters, or ulcers, around your genital area have cleared up. It is best not to have sex if you have symptoms of genital herpes because at this point the condition is very contagious (even from the first tingle, or itch).
Always use a condom
You should always use a condom while you are having any kind of sexual intercourse (vaginal, anal, and oral) even after your symptoms have gone. This is particularly important when having sex with new partners.
However, while using a condom may help to prevent spreading genital herpes, the condom only covers the penis. If the virus is also present on your anus, or the surrounding area, it can still be passed on through sexual contact.
As HSV survives within the nerves of your skin, there is a chance that the virus can be present on your skin, even after you no longer have symptoms. Therefore, there is still a chance that you could pass it on.
Advise your partner to be screened for genital herpes
If you have genital herpes, you should encourage your partner to visit a genito-urinary medicine (GUM) clinic to be tested for the condition, even if they do not have any symptoms of genital herpes. As a first case of genital herpes often develops some time after exposure to the virus, they may be unaware that they are infected.
Avoid sharing towels or flannels with others
Although it is very unlikely that HSV would survive on an object long enough to be passed on, it is sensible to take steps to prevent this. Therefore, you should avoid sharing towels or flannels, to ensure that you do not spread HSV on to others.