Genital Herpes – The Essentials
Genital herpes is caused by two viruses known as Herpes simplex types 1 and 2. These viruses share many similarities and can lead to the development of blisters or ulcers. When these lesions appear on the face, they are referred to as ‘cold sores,’ whereas those on the genitals are termed ‘genital herpes.’ It’s important to note that both types of herpes simplex can be transmitted to various parts of the body, meaning that either type can result in cold sores or genital herpes.
Many individuals who contract the herpes virus remain asymptomatic and never develop sores, making it difficult to identify their infection. For those who do experience symptoms, the initial outbreak can persist anywhere from a few days to several weeks. Symptoms may start with flu-like signs, followed by small bumps on the skin that evolve into blisters or ulcers, which then gradually heal. Typically, symptoms manifest within two days to two weeks following infection, though some may notice sores appearing months or even years later.
After the virus infects the skin cells, it ascends through the nerves to the nearest nerve ganglion—a type of nerve centre located near the spinal cord—where it establishes a latent presence. Here, it evades detection from the immune system. In people who develop skin sores, the virus can travel back down the nerve and re-emerge in the skin, usually in the same area where the initial infection occurred. However, if the virus travels along a different nerve branch, it may trigger sores in a slightly different location.
Individuals infected with herpes may also have contracted other sexually transmitted infections, making it advisable to undergo comprehensive screening at a sexual health clinic. Many family doctors also provide this screening service.
How Common is Genital Herpes?
Genital herpes is very common. In the UK, around 70% of people will have been infected with either type 1 or type 2 herpes by the time they turn 25, by 50 years of age that goes up to 90%. In fact, in some other countries, the number of people with this infection is higher than in the UK.
Understanding How Genital Herpes Spreads
Genital herpes is a virus that spreads through skin-to-skin contact. This means it can be passed on when you touch or rub the infected area. It can happen during different kinds of sex: vaginal, anal, or oral.
When someone has visible sores caused by herpes, there is a higher chance they can spread the virus to their partner. Usually, the virus is found in one specific area of the body. For example, if a partner has herpes on the skin of their penis, the virus can only be caught by coming into contact with that part. The same is true for a partner's vulva; you would only catch the virus by touching that area.
Additionally, many people get genital herpes if they have the virus around their mouth and then kiss their partner's genitals. It's important to know that herpes can't be caught from sharing towels, swimming pools, saunas, or toilet seats.
What Would I Notice If I Had Genital Herpes?
Many people who have genital herpes don’t even know it. This might sound surprising, especially if you have painful sores, but only 1 out of 5 people with herpes are aware that they have it.
If you do experience symptoms, they can start with flu-like feelings, like a fever or fatigue. After that, you might notice that a part of your skin in the genital area becomes red. Bumps can then develop, turning into blisters or spots. These blisters may break open and create painful sores. Some people also notice swollen glands in the groin area.
After a few days, the sores might start to crust over, and usually, within a few weeks, the skin heals completely. It's very rare for herpes to leave scars, but in some cases, people with darker skin tones might notice lighter patches where the sores were.
Getting Tested for Genital Herpes
To find out if you have genital herpes, a doctor or nurse will take a small swab sample from any sores you may have. This sample is then sent to a lab for testing. There is also a blood test for herpes simplex, but it's not commonly done for people who don't show any signs of having it. This is because herpes isn't considered a serious medical issue, and those without symptoms usually don’t need treatment. However, the blood test might be useful in some situations e.g. in pregnancy. Otherwise for most people a blood test can cause more upset and harm than it helps with, so we generally do not advise people to have a blood test. It's a good idea to talk about this with your sexual health doctor.
Treating Genital Herpes
Genital herpes doesn't always need treatment. If you have it for the first time, taking antiviral tablets might help. However, if the sores last longer than six days, treatment may not be very effective because your body's immune system will start fighting the virus on its own. Always check with a doctor to get the best advice.
To relieve pain, you can use painkillers like paracetamol and anti-inflammatory tablets, if they do not work then a topical painkiller like lidocaine can help. It's important to keep the sores clean, so bathing them with salt water every day can help as well as sooth the area.
If the sores are close to where you pee, it might hurt when you go to the toilet. Sitting in a warm salty bath while you pee can help ease the pain. Your doctor might recommend lidocaine anaesthetic gel to numb the area and make it feel more comfortable. You can also buy this gel at a pharmacy without needing a prescription.
Important Information About Your Treatment
If your doctor gives you treatment, it will help make the sores hurt less and help them heal faster. Most treatments from sexual health clinics are provided to you at no cost.
Will My Genital Herpes Come Back?
For some people, genital herpes can come back after the first time they have an outbreak. These returning sores are usually smaller and hurt less than the first ones. It's important to know that people with type 2 herpes tend to have more repeat symptoms than those with type 1.
Treating Recurrent Genital Herpes
Most people with genital herpes don’t have many flare-ups. When it does come back, it usually only causes mild symptoms and clears up quickly, even without medicine. However, some individuals may find that their flare-ups happen more often and can be bothersome.
For these cases, antiviral medication can be helpful. There are two main options:
Episodic Treatment: This means taking medicine for a few days each time symptoms appear.
Suppressive Treatment: This involves taking medication every day for a few months to stop flare-ups from happening.
Your doctor or nurse at your sexual health clinic can help you decide which treatment is right for you.
What About My Partner?
Testing for genital herpes isn’t a normal part of sexual health check-ups. If your partner has never experienced any symptoms of genital herpes, it’s not necessary for them to visit a sexual health clinic. However, if your partner is pregnant, thinks they might have had genital herpes, or is concerned about your diagnosis, they should definitely go to the clinic for advice.
When Can I Have Sex Again? Understanding Your Options
Same Sexual Partner
If you and your partner both have the same virus, you can’t pass it back to each other. You can start having sex again whenever you feel comfortable. Listen to your body and choose what feels right for you.
New Sexual Partner
If you want to have sex with a new partner after just having your first herpes outbreak, it’s important to wait until your skin is completely healed. This helps reduce the chances of passing on the virus. However, keep in mind that you can still transmit the virus even if you don’t have any sores on your skin.
Using condoms every time you have sex can also lower the risk of sharing the virus. It's been shown that people who tell their partners they have genital herpes are less likely to spread the infection. If you're unsure how to talk to a new partner about this, a clinic doctor or sexual health adviser can provide helpful advice.
Can the Virus Spread Without Symptoms?
Yes, you can still pass the herpes virus to your partner even if you don’t have any visible blisters or sores. This is because of something called ‘asymptomatic shedding.’ This means that tiny amounts of the virus can be on your skin, even when you feel fine. The chance of spreading the virus is highest in the first few months after you get it. Over time, asymptomatic shedding happens less often, and it becomes rare after about two years. However, if someone has frequent outbreaks, it may happen more often. Using condoms can help protect your partner from getting the virus.
What If I Don’t Treat My Genital Herpes?
If you have your first episode of genital herpes, it will eventually heal on its own, even without treatment. However, it may take longer to heal compared to if you had started treatment soon after you noticed the sores.
Can I Get Infected Again?
It's very unlikely that you'll catch herpes again in a different part of your body. Most people only get it once. However, it’s possible to spread the virus to other parts of your skin if you touch or scratch a sore and then touch a different area. This risk is highest during your first outbreak.
Getting type 1 herpes does not stop you from catching type 2 herpes, and vice versa. Yet, if you do get the other type, you usually have few or no symptoms.
Genital Herpes in Pregnancy
First Episode Genital Herpes Before 28 Weeks of Pregnancy
If a woman has her first episode of genital herpes before 28 weeks, it’s advised to start taking antiviral medication from week 36 until she gives birth. She can usually expect to have a normal vaginal delivery if that’s what she and her midwife or doctor plan. However, if she goes into labour before 32 weeks (which is six weeks early), there might be a need for a caesarean section. This is to reduce the risk of the baby catching the virus during a normal delivery. Her doctor will talk to her about the best options.
First Episode Genital Herpes After 28 Weeks of Pregnancy
For women who have their first episode of genital herpes after 28 weeks, it is also recommended to continue antiviral medication until the baby arrives. In this case, a caesarean section might be needed. This is because there’s a risk that the baby could get the virus during a vaginal delivery. One common treatment, called aciclovir, is safe for use during pregnancy.
Recurrent Genital Herpes in Pregnancy
Having recurrent genital herpes while pregnant does not harm the baby. The antibodies from the mother's immune system help protect the baby against the virus. Doctors may recommend taking antiviral medication starting from 36 weeks until the baby is born to avoid a recurrence during delivery. If a woman has a recurrence of genital herpes, even if it happens when she is in labour, she can usually still have a normal vaginal delivery.
The Herpes Viruses Association (HVA)
The Herpes Viruses Association (HVA) is a support group that has been helping and advising people with herpes infections for many years. They offer assistance and information for those in need. If you would like to reach out to them, you can call their helpline on 0845 123 2305 during weekdays, or email them at info@herpes.org.uk for support, they also have a website: www.herpes.org.uk