Genital herpes is caused by two viruses called Herpes simplex, types 1 and 2. The viruses are very similar and both can cause blisters or ulcers. When these occur on the face they are known as ‘cold sores’ and when they occur on the genitals they are called ‘genital herpes.’

Most people infected with herpes don’t realise because they have no apparent symptoms. In the UK 70% of the population have been infected with HSV type 1 and/or type 2 by the age of 25

In people who do develop sores, the first illness can last from a few days to several weeks. Some people start with flu-like symptoms, followed by tiny bumps on the skin which turns into blisters or ulcers. The ulcers then slowly heal. Thesesymptoms may appear between two days and two weeks after infection or months or even years after infection.

After infecting the skin cells, this virus travels up a nerve to the nearest nerve ganglion (a sort of nerve ‘junction box’ nearthe spinal cord) where it ‘hibernates’. In the ganglion, thebody’s natural defence mechanism (the immune system)cannot reach it.

Individuals develop sores on their skin when the virus‘reactivates’, travels back down the nerve and into the skin. The virus usually retraces the exact route and the same patch of skin is affected but sometimes it travels a different route and affects a different patch of skin. The virus can ‘reactivate’ but not in sufficient numbers to cause a visible lesion and, under these circumstances, the virus can be transmitted ‘silently’.

Herpes simplex is spread by skin to skin contact, during any kind of sex: vaginal, anal and oral. If a person has a visible skin sore there is a high risk of passing it on but it can also be transmitted in the absence of any visible lesions and only 1 in 5 people infected knows that they are. Herpes cannot be caught from towels, swimming pools, saunas or from toilet seats.

Symptoms may begin with a flu-like illness, followed by soreness and redness of the affected genital skin that develops into fluid filled bumps (blisters) that then break leaving painful open sores (ulcers). Some people get swollen glands inthe groin. The ulcers eventually heal completely over 1-3 weeks.

Genital herpes is confirmed by swabbing the blisters or ulcers and performing PCR tests for HSV type 1 and type 2. In some clinical settings, diagnosis may be confirmed by testing for herpes antibodies in the blood but it is not usual for clinics to do it for people who have no symptoms.

Genital herpes does not always need treatment as mild symptoms will heal naturally with the help of the immune system. A course of antiviral tablets, such as acyclovir or valaciclovir, may be helpful. Oral painkillers such as paracetamol and aspirin (if not allergic) and topical lidocaine anaesthetic gel applied to the skin can be used to ease the pain. The sores can be soothed by bathing them with salt water and, if the sores are near the water pipe (urethra), passing urine whilst sitting in a warm bath can help to reduce the pain when passing urine.

The majority of indivudualss’ only have one episode of genital herpes but for some people the herpes sores come back (recur). Recurrences are usually much less painful, smaller in size and never last as long. Recurrent genital symptoms occur more often with type 2 infections than with type 1. If recurrences are troublesome, taking antiviral treatment as and when recurrences occur (episodic treatment) or on a daily basis to keep recurrences away (suppressive treatment) is helpful.

If your partner has never had any signs of genital herpes,swabbing the skin is not possible but herpes antibodies on a blood test may help interpret ‘silent’ infection. A pregnant partner must always seek specialist advice.

If you and your partner have the same virus you cannot pass it back to each other. You can start having sex again when you feel comfortable about it. If you are planning to have sex with a new partner and have just had your first episode of herpes you should wait until your skin has fully healed. Delaying sex in this way makes it much less likely you might pass on the virus to your partner. However, it is still sometimes possible to infect your partner even when you have no sores on the skin. Using condoms every time you have sex makes it less likely you can pass the virus on. It has been found that people who tell their partners that they have genital herpes are less likely to pass on the infection.

If your partner has not been infected with HSV in the past, it is possible for you to pass the virus on to them even if you have no blisters or sores. This is because of ‘asymptomatic shedding’ (when small amounts of virus are on the skin). The risk is much greater in the first few months after you catch herpes. Asymptomatic shedding happens less over time and is rare after two years. However, after this time it is more common in people who have frequent recurrences. Using condoms offers some protection to your partner.

Most people only catch herpes once, in one part of their skin. However, there is a risk of infecting other parts of your own skin by touching or scratching herpes blisters or sores and then scratching the skin somewhere else on your body. This risk is greatest when herpes sores develop for the first time. Catching type 1 herpes does not protect people from catching type 2 (and vice versa). However, if someone does catch the other type of herpes virus, that person often has few (if any) symptoms.

Links:

HVA e-mail info@herpes.org.uk

HVA Website www.herpes.org.uk