Genital herpes

What is genital herpes?

There are two types of genital herpes virus, HSV I and HSV II - both can infect the genital and anal area (genital herpes), the mouth and nose (cold sores), fingers and hand (whitlows).

Causes of genital herpes

The virus enters the body through small cracks in the skin or through the moist soft lining (mucous membranes) of the mouth, vagina, rectum and urethra.

It may cause an outbreak of genital herpes or become dormant (inactive) and hide around the nerves in the body where you were infected. It can be dormant for long periods, and during this time it's not infectious.

Some people can shed the virus from their skin or mucous membranes without any symptoms of genital herpes. This is called asymptomatic or viral shedding. It's possible to pass the virus during this time, but for most people the risk is low.

Symptoms of genital herpes

Many people don't have any visible signs or symptoms, or are unaware of them. Symptoms can occur within four to five days of coming into contact with the virus, but it can be weeks, months or even years before they appear. This means that when symptoms occur, it doesn’t necessarily mean you've recently come into contact with the virus.

If you get symptoms, they usually follow a pattern. You may have some or all of the following:

• Feeling generally unwell, with flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back, 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 tops of the thighs; these burst within a day or two leaving small red sores, which can be very painful.
• Pain when urinating (caused by urine touching the sores).

The first episode of genital herpes is often the most painful. Recurrent episodes are usually milder and clear up quickly.

Testing for genital herpes

If you think you have herpes, get tested as soon as you have any symptoms. Tests are free on the NHS from genitourinary medicine (GUM) clinics, sexual health clinics or from your GP. Blood tests can be used to detect a herpes infection when someone doesn’t have symptoms, but are only used in certain cases.

A test involves a general examination of the genital area to look at any blisters or sores. To confirm you have herpes, a swab (like a cotton bud) is used to take a sample of fluid and cells from the blister. They may have to gently break a blister to get a sample of the fluid inside. This is then sent to the laboratory to check for the virus.

When someone doesn’t have symptoms (such as blisters or sores) a blood test may be used to look for antibodies to the virus. However there are a number of problems with these tests, and they may give false positive or false negative results, so they are not routinely used everywhere in the NHS to diagnose genital herpes. They may be offered in some centres, or to certain patients, and may become more widely used as they improve.

Treatments for genital herpes

Treatment is usually recommended for a first episode, aiming to relieve pain and prevent the virus from spreading. It involves taking antiviral tablets daily for five days and should be taken within five days of the first episode.

If you're pregnant or trying to get pregnant, tell the doctor or nurse so they can talk to you about pregnancy and herpes.

Over-the-counter treatments for cold sores from a pharmacy will not treat genital herpes.

Self-help treatments can relieve pain or discomfort and may speed up healing. They include:

• applying an ice pack to the sores for an hour or so (but don’t put unwrapped ice directly on your skin)
• putting cold, wet tea bags on the sores
• having cool showers
• applying local anaesthetic ointment, such as lidocaine
• bathing in warm, salted water
• drinking lots of fluids, especially water or soft drinks
• wearing loose clothing

It isn't essential to have treatment as flare-ups will clear by themselves, but treatment can help speed up the healing process.

Advice and support

Go to your GP, GUM clinic or a sexual health clinic. All services are confidential.

You can call FPA's helpline on 0845 122 8690, the NHS Sexual Health Helpline on 0800 567123, or the Herpes Viruses Association on 0845 123 2305.

How to avoid STIs

• Male and female condoms, when used correctly, can help protect against STIs.
• Before you have sex, talk to your partner about using condoms.
• Use condoms every time you have vaginal or anal sex.
• If you have oral sex, use a dam.