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Genital Herpes

Information and advice about symptoms, causes and treatments for genital herpes

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Dr Hilary Jones discusses genital herpes and the treatments available at HealthExpress

Genital herpes is a very common infection, in fact the Herpes Virus Association states that around 70% of people in the UK will catch either herpes simplex virus 1 (HSV-1 - oral herpes) or herpes simplex virus 2 (HSV-2 - genital herpes) at some point in their lives.[1] HSV-1 will often manifests itself in the form of cold sores whilst HSV-2 is associated with the genitals. Genital herpes can be sometimes asymptomatic which is why it is even more important to use condoms or other barrier contraceptives when having sex.

Although genital herpes is not yet curable, there has been much progress in controlling and keeping the virus dormant. Treating the infection effectively can help to lessen certain symptoms associated with it. Find out more information about genital herpes below, what symptoms can be present and how to effectively manage it.

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What is genital herpes?

Genital herpes is a viral STI also referred to as the herpes simplex virus that affects both men and women and is present in two of the eight forms of herpes; HSV-1 (type 1) and HSV-2 (type 2). Not all forms of herpes are classed as a sexually transmitted infection. It is more common to contract type 2 herpes as this strain can be highly contagious and can affect many areas of the body through skin-to-skin contact, not just from penetrative sex, although it is more commonly associated in and around the genitalia and the anal passage.

The presence of genital herpes in a person can form of painful blisters that affect the surface of the skin and mucous membranes, however the majority of people with genital herpes don't have any signs at all, and you can live a perfectly normal life without knowing you have herpes. If women or men do experience sores or blisters around the genital region, then the best option is to take an STI test either at your local GUM clinic or sexual health clinic.

Is there a difference in genital herpes between men and women?

No, the virus is the same in both men and women. The only difference is whether you contract HSV-1 or HSV-2, or both.

What does genital herpes look like?

When symptoms reveal themselves, more often than not you will notice blisters, which become sores before healing. Genital herpes (HSV) should not be confused with HPV (genital warts); whilst the signs can look similar, warts will not result in sores and are generally harder to the touch.

There is no outright cure for genital herpes and these blisters are the same for men and women, however treatment is readily accessible. Other signs of genital herpes are gender specific. Below are some picture examples of real genital herpes symptoms.

(Warning: images are of a explicit nature)

Causes of genital herpes

Simply put, genital herpes is most often caused by skin-to-skin contact, but other objects such as sex toys have been known to transfer the infection. It's important to remember this is very uncommon, but for peace of mind you can take the correct precautions to prevent contracting or keeping the virus from spreading further. See more information below about living with and managing genital herpes.

The condition can remain inactive for a large percentage of your life, however when HSV-1 or HSV-2 is on the surface of the skin, it is extremely infectious. This means that you don't need to have visible sores to spread the infection, and you can have recurrent outbreaks over time. In fact, oral sex with someone with a cold sore can lead to genital herpes as well as other sexual activities such as dry humping and kissing (the HSV-1 strain).

HSV-1 herpes causes

This form is usually spread through cold sores, most commonly through kissing, sharing razors, toothbrushes and other similar objects. Sores around the genitals can also cause cold sores through oral sex.

HSV-2 herpes causes

Visible sores are a good indication of genital herpes, however they can be more difficult to spot than you expect, especially when the infection can spread to other areas of the body including the mouth, anus, eyes and hands. Transferring through unprotected intercourse is the most common cause, however just skin-on-skin contact can give you the infection, regardless of whether you're using a condom.

The good news is recurrent symptoms are often more manageable than the initial outbreak, and you will begin to recognise triggers and the most effective route to cure them.

Symptoms of genital herpes

In the UK, the NHS reported that 32,279 people went to the sexual health clinic (GUM clinic) in 2013 with their first bout of genital herpes. Whilst it is wise to have periodic STI tests if you're sexually active, you cannot be diagnosed with genital herpes unless you have a visible sore or lesion, making the virus very difficult to monitor.

For those that do show symptoms, they can be split into the primary outbreak and the recurrence infections. Many men and women find their genital herpes to be extremely mild and therefore have limited disruption in their day-to-day life:

Primary infection Recurrent infections
Small blisters and/or ulcers that can appear on the genitals, back passage (rectum), anus and thighs. Tingling, itching or burning sensation before the outbreak of blisters or ulcers.
Tingling, itching or burning sensation, especially around the sores. Red blisters that quickly burst and leave painful sores around the area that was tingling or burning.
Women can experience blisters on the cervix. Blisters and/ulcers in the cervix for women.
Pain when urinating is common in men and women. Symptoms often last for a shorter period of time than the first outbreak.
Women can experience unusual vaginal discharge that is clear, white or pale yellow.
Cold and/or flu symptoms such as muscle aches, fever, nausea and generally feeling unwell.

Due to the sporadic nature of the condition, women and men may experience lots of outbreaks over your lifetime, or hardly any at all. Severity also varies, however the first outbreak tends to be more intense. You will have noticed that some symptoms are similar to other STIs (the vaginal discharge for example) so if you are in any way unsure, contact your local surgery for an appointment.

How long does a genital herpes outbreak last?

On average, an outbreak can last up to 3 weeks. This includes the initial tingling, the height of the discomfort and the recovery time. The good thing is you always tend to feel a bout of the virus coming on, rather than experiencing the full impact at once. This means you can have a treatment ready in preparation.

Triggers of genital herpes

You may notice certain prompts can cause a recurrence. Whilst these aren't 100% confirmed, they can include:

  • A weakened immune system – If you're feeling unwell, are undergoing severe treatment (chemotherapy or if you have HIV) or have had surgery.
  • Feeling stressed or anxious – There are no confirmed studies showing a mood change being a catalyst, however only you can be the judge of this.
  • Drinking excessive amounts of alcohol – Reducing your alcohol intake may help as a high level of sugar can adjust the natural balance.
  • A poor diet – Linking to the same sugar intake, you may find certain foods in abundance can aggravate the condition. Documenting your diet can help you recognise what to exclude.
  • Sexual intercourse – The friction during sex can irritate the skin and it's highly advisable to avoid intercourse until your symptoms are under control.
  • Menstrual cycle – Some women find a certain time of a month can encourage an outbreak.

Once you know your triggers, it becomes easy to keep on top of the condition. For example, if you know there's a chance during a certain time of the month, you can order treatment in advance to cure symptoms as quickly as possible.

Myths surrounding the causes of genital herpes

Sharing objects will give me herpes - Whilst certain objects can transfer the infection from one individual to the next, according to the NHS, it is exceedingly doubtful as the virus will die quickly after leaving the skin. However, it is advisable to take extra caution when sharing objects such as razors, towels and toothbrushes.

"Genital herpes will only survive around 10 seconds away from the skin so the likelihood of you contracting the virus is extremely low, however moist items such as towels can harbour the infection for longer."

I can't get herpes if a sore isn't present – In contrary to popular belief, you can catch herpes at any time, although it is far more likely when there are sores, making it essential for you to communicate with your sexual partner(s) and practice safe sex.

Hardly anyone actually show signs of genital herpes. In fact, up to 80% of infected people may have no or barely noticeable symptoms.

My mood will trigger an outbreak – It is possible that stress can trigger the symptoms of herpes, and some find this with cold sores, however this is not the case with everyone. Any triggers listed above depend on the individual and only you can be the best judge.

Standard STI tests doesn't look for herpes – If you are concerned you have herpes, you will need to ask your doctor specifically about the virus as the usual tests only include chlamydia and gonorrhoea. You will need to have a sore present.

It will make you infertile – Unlike other STIs, this infection does not affect your fertility, nor is there any link with cervical cancer. Nonetheless, you can pass on the virus to your baby. Please see the below section on how herpes can affect your baby.

I can spread my virus all over my body – It is highly unlikely to spread from the initial area of infection, as your body is clever enough to begin producing additional antibodies to prevent the infection from spreading.

Can you get genital herpes from a cold sore – In short, yes. If you have HSV-1 and have a cold sore present, you can pass on the virus to your partner through oral sex.

Living with genital herpes

Your relationship – If you are in a committed relationship with someone who has genital herpes, or have genital herpes yourself, there is no need to panic. Using condoms is key and avoiding sex when an outbreak occurs is best practise, although there is a small chance you may pass on the infection even when it is dormant, which both parties should be aware of. Genital herpes medications such as valacyclovir can not only reduce the symptoms of cold sores, genital herpes and even shingles (another strain of the herpes virus), it can be used to reduce the chance of the herpes virus growing.

"Preparation is key with the herpes virus; there is no reason why you should steer clear of sex. Speak to your GP about protecting yourself and others from herpes using antiviral medication and safe sex practices so you are prepared."

Genital herpes in pregnancy– If you have had an outbreak of HSV-1 or HSV-2 in the past, or contract genital herpes whilst pregnant, there is a chance it can be passed on to your child. This shouldn't be taken lightly as this can make your baby extremely ill. You can follow these steps:

  • Talk to your doctor if you have herpes or have had symptoms in the past
  • Keep your doctor informed if you have an outbreak during your pregnancy, especially if it is the latter stages
  • Antiviral medicines can be used safely during your pregnancy, however contact your GP if you have any concerns

Managing your triggers – Over time you will gain a more thorough understanding of what can bring on a bout. It is not as simple as saying "just avoid them", especially if it concerns your diet, time of the month or mood, however keeping a note of when your symptoms appear and why can means you see patterns in when and how they develop. This means you can keep prescription drugs on-hand to help alleviate discomfort quickly in the form of creams or tablets, and learn to adapt to different scenarios when they arise.

Your sex life – When sores are present, you should steer clear of having vaginal, anal or oral sex whether you are in a committed relationship or not. It would be easy to say genital herpes doesn't affect your sex life, however from now on in you will need to consider your approach. Your partner should always be informed about the condition, even if the symptoms are dormant for the time being, as well as the risks. Males with genital herpes, for example, tend to show less symptoms. Being informed and informing your partner is easy with brilliant online resources. For example, Webmd offers advice on herpes and sex life such as mutual masturbation and oral sex when no sores are present as well as what to do if you're dating with the herpes virus including breaking the news and dealing with "let's just be friends" talk.[2]

How to treat genital herpes

Treating herpes is simple and can reduce the duration of your infection significantly allowing you to carry on living your life blister-free. Not only does treating herpes mean the symptoms are alleviated more swiftly than if you left by itself, but it means the likelihood of you spreading the virus is greatly reduced, and outbreaks can become less aggressive over time.

Alternative treatments for genital herpes

Some herbal supplements such as Echinacea plant are reported to help with this condition. However. Researchers in the UK gave Echinacea to 50 people with genital herpes over 6 months, followed by a placebo for a further 6 months. There was no noticeable difference in the number of herpes outbreaks during the two periods.

Alternative and natural treatments aren't placed under extensive clinical trials in the same way as prescription medicines, so their efficacy is more difficult to determine.

Prescription medicine for genital herpes

Prescription medications are one of the most effective forms of genital herpes treatment and they are clinically proven. The most common medications are Valtrex, Famvir and Aciclovir. All are available at HealthExpress. They work by preventing the virus from spreading, helping your immune system kick into action to defeat the virus and soothe symptoms. Sadly, there are no over-the-counter treatments for genital herpes, though there is some on-hand for cold sores and petroleum jelly products such as Vaseline can help soothe sores.

First outbreaks are often treated with Aciclovir hard capsules taken for 10 days but you can use additional cream with this medication (be sure to thoroughly read the patient leaflet before taken any prescription medication). For future outbreaks, Valtrex and Famvir can be used as well as Aciclovir, and you may only need a 5-day course of treatment.

There are self-help methods out there that can help in conjunction with genital herpes medicine. This includes the following:

  • Lightly cleaning with lukewarm plain or salted water to soothe and heal tender blisters and the surrounding area.
  • In the same way you use Vaseline for cold sores and chapped skin, they can also help alleviate the pain caused by blisters.
  • Pain whilst urinating can be helped by methods used for the usual urinary tract infection. Primarily, drinking lots of water.
  • Steer clear of tight and/or synthetic clothing that will aggravate bouts and cause unnecessary friction.
  • Apply a cool flannel to the infected area to speed up the healing process.

For any further information on what prescription treatment you need, or treating severe bouts of herpes, please head to the NHS.[3]

How to prevent genital herpes

Using a condom - The most effective herpes prevention is to use barrier contraception such as condoms that are 98% effective at preventing STIs. It is still possible to get herpes when using a condom due to the nature of the virus spreading to the thighs, buttocks and mouth.

Practising safe sex – As well as using a condom, if you notice sores or ulcers, you're well within your right to stop intercourse immediately and communicate with your partner. If you are in a steady relationship, it is best to avoid sex when sores are present.

Recognising your triggers - Even during the first stages of tingling, the virus is highly contagious and intercourse should be avoided. This includes kissing if you have cold sores present.

Recognising your triggers – Cutting back on alcohol or altering your diet to include less sugar, considering meditation techniques if you're stressed or keeping a batch of antibiotics on-hand for when spontaneous tingling begins.

What options do we offer to treat genital herpes

We only offer prescription treatment at HealthExpress as they are the only clinically proven method of treating genital herpes, meaning all three of our treatment options are clinically proven to help reduce the severity of the symptoms as well as the length in which you have a bout of the virus for. These are the most commonly used treatments for genital herpes and three most popular prescription options:

Benefits of treating Genital herpes

  • May prevent further transmission
  • Reduce appearance of visible symptoms
  • Avoid potential complications of pregnancy due to the infection
  • Lessen chance of other viral infections

  • weakened immune system A weakened immune system

    If you're feeling unwell, are undergoing severe treatment (chemotherapy or if you have HIV) or have had surgery.

  • Feeling stressed Feeling stressed or anxious

    There are no confirmed studies showing a mood change being a catalyst, however only you can be the judge of this.

  • Drinking excessive Drinking excessive amounts of alcohol

    Reducing your alcohol intake may help as a high level of sugar can adjust the natural balance.

  • poor diet A poor diet

    Linking to the same sugar intake, you may find certain foods in abundance can aggravate the condition. Documenting your diet can help you recognise what to exclude.

  • Sexual intercourse Sexual intercourse

    The friction during sex can irritate the skin and it's highly advisable to avoid intercourse until your symptoms are under control.

  • Menstrual cycle Menstrual cycle

    Some women find a certain time of a month can encourage an outbreak.