Genital herpes is a common infection caused by the herpes simplex virus (HSV). It causes painful blisters on the genitals and the surrounding areas. As genital herpes can be passed to others through intimate sexual contact, it’s often referred to as a sexually transmitted infection (STI).
HSV can affect any mucous membrane (moist lining), such as those found in the mouth (cold sores).
Genital herpes is a chronic (long-term) condition. The virus remains in your body and can become active again. The average rate of recurrence is four to five times in the first two years after being infected. However, over time, it tends to becomes active less frequently and each outbreak becomes less severe.
The herpes simplex virus (HSV)
There are two types of herpes simplex virus (HSV), type 1 and type 2. Both types are highly contagious and can be passed easily from one person to another by direct contact.
Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with an infected person. 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.
At least eight out of 10 people who carry the virus are unaware they have been infected because there are often few or no initial symptoms. However, certain triggers can activate the virus, causing an outbreak of genital herpes.
Who is affected?
Genital herpes is a common condition, especially in people from 20 to 24 years old.
In 2013, 32,279 people attended a sexual health clinic in England with an attack of genital herpes for the first time.
Genital herpes can cause problems during pregnancy. These complications can be more serious depending on whether you already have genital herpes, or develop it for the first time while pregnant.
Most people with the herpes simplex virus (HSV) don’t experience any symptoms of genital herpes when first infected. As a result, many people don’t know they have the condition.
Symptoms may not appear until months or sometimes years after you’re exposed to the virus.
If you experience symptoms when first infected, they usually appear four to seven days after you have been exposed to the virus. The symptoms are usually more severe first time around than in cases of recurrent infections.
The symptoms of genital herpes for the first time include:
- small blisters that burst to leave red, open sores around your genitals, rectum (back passage), thighs and buttocks
- blisters and ulcers on the cervix (lower part of the womb) in women
- vaginal discharge in women
- pain when you pass urine
- a general feeling of being unwell, with aches, pains and flu-like symptoms
These symptoms may last up to 20 days. However, the sores will eventually scab and heal without scarring.
Although the initial symptoms of genital herpes clear up, the virus remains dormant (inactive) in a nearby nerve. The virus may be reactivated from time to time, travelling back down the nerve to your skin and causing recurrent outbreaks.
Symptoms of a recurrent outbreak may include:
- a tingling, burning or itching sensation around your genitals, and sometimes down your leg, before blisters appear
- painful red blisters that soon burst to leave sores around your genitals, rectum (back passage), thighs and buttocks
- blisters and ulcers on the cervix (lower part of the womb) in women
Recurrent outbreaks are usually shorter and less severe. This is because your body has produced protective antibodies (proteins that fight infection) in reaction to the previous infection. Your body now recognises the virus and mounts a response that is able to fight HSV more effectively.
Over time, you should find any recurrent genital herpes infections become less frequent and less severe.
Treating genital herpes
Although there’s no cure for genital herpes, the symptoms can usually be controlled using antiviral medicines.
However, it’s important to prevent the spread of genital herpes by avoiding sex until symptoms have cleared up and continuing to use a condom afterwards.
Treatment for genital herpes will depend on whether you have the infection for the first time (a primary infection) or your symptoms keep coming back (a recurrent outbreak).
If you have genital herpes for the first time, see your GP or visit your local GUM clinic (also called sexual health clinics). They may prescribe antiviral tablets, such as aciclovir, 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 open sores forming on your genital area when your treatment begins.
Aciclovir can cause some side effects, including being sick and headaches.
Other antiviral medications that may be used to treat genital herpes include famciclovir and valaciclovir.
You should visit your GP if you have been diagnosed with genital herpes before and are experiencing a recurrent outbreak.
If the symptoms are mild, your GP may suggest things you can do at home to help ease your symptoms without the need for treatment:
- Keep the affected area clean using either plain or salt water. This will help prevent blisters or ulcers from becoming infected and may encourage them to heal quicker. It will also stop affected areas from sticking together.
- Apply an ice pack wrapped in a flannel, or cold, wet, tea bags on the sores to help soothe pain and speed up the healing process.
- Do not apply ice directly to the skin.
- Apply petroleum jelly, such as Vaseline, or an anaesthetic (painkilling) cream, such as 5% lidocaine, to any blisters or ulcers 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 bath or while pouring water over your genitals may also help.
- Avoid wearing tight clothing because it may irritate the blisters and ulcers.
If your symptoms are more severe, you may be prescribed antiviral tablets (aciclovir), which you will need to take five times a day for five days.
If you have fewer than six recurrent outbreaks of genital herpes in a year, your GP may prescribe a five-day course of aciclovir each time you experience tingling or numbness before symptoms begin. This is known as episodic treatment.
If you have more than six recurrent outbreaks 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 aims to prevent further outbreaks developing. In this instance, it is likely you will need to take aciclovir twice a day for six to 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.
Suppressive treatment will usually be stopped after 12 months. As long as recurrent outbreaks of genital herpes are infrequent and mild, you will only need to take a five-day course of aciclovir as and when it is needed. Episodes of recurrent genital herpes usually become less frequent and less severe after around two years.
Suppressive treatment may be restarted if you have further severe outbreaks. Your GP may refer you for specialist treatment if you continue to have outbreaks of genital herpes while you are having suppressive treatment.
HIV and genital herpes
If you are experiencing recurrent outbreaks of genital herpes you should also consider being tested for HIV. This may be a sign of a weakened immune system (the body’s natural defence against infection and illness), which may indicate you have HIV.
If you have HIV and genital herpes you will be referred to a GUM specialist. This is because genital herpes can be a more serious condition in people with HIV.
The following advice can help prevent the herpes simplex virus (HSV) spreading to others:
- Avoid having sex (vaginal, anal and oral) until any blisters or ulcers (open sores) around your genital area have cleared up. It’s best not to have sex if you have symptoms of genital herpes because at this point the condition is highly contagious, even from the first tingle or itch.
- Avoid sharing sex toys as they can also pass on sexually transmitted infections (STIs). If you do share them, make sure you wash them and cover with a condom.
- You should also avoid kissing your partner if either of you have a cold sore around your mouth.
- Always use a condom while 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 prevent genital herpes from spreading, the condom only covers the penis. If the virus is also present on or around your anus (the opening where solid waste leaves the body), it can still be passed on through sexual contact.
As HSV survives within the nerves of your skin, the virus may still be present on your skin after you no longer have any symptoms. This means there is still a chance you could pass it to someone else.
Testing your partner
If you have genital herpes, and your partner experiences symptoms, they should be encouraged to visit a genitourinary medicine (GUM) clinic (also called sexual health clinics) so they can be tested for the condition.
A first case of genital herpes (a primary infection) often develops some time after exposure to the virus, so they may be unaware they are infected.