Genital Herpes

This factsheet is for people who have genital herpes, or who would like more information about it.

Genital herpes is caused by the herpes simplex virus (HSV). It can be transmitted by skin-to-skin contact, such as during unprotected sex or passed from an infected mother to her baby during a vaginal birth.

Symptoms of genital herpes include:
* small fluid-filled blisters around your genitals, thighs and inside or around your anus, which burst after a day or two and leave painful sores;
* redness, discomfort, itching or tingling in the genital or anal area;
* feeling generally unwell with flu-like symptoms, such as a fever and a headache;
* pain on passing urine;
* an unusual discharge from your urethra (the tube that carries urine from the bladder and out through the penis or vulva), vagina or anus;

If you have another outbreak of genital herpes, your symptoms will probably be milder than during the first episode and won't last as long. You may have tingling or itching in the infected area before having any blisters or sores on your skin. There are usually fewer blisters which are less painful and which clear up faster.

On average, you're likely to have four to five recurrent outbreaks in the first two years after getting genital herpes and after this the attacks happen less often and get milder.

Complications of genital herpes
Complications of genital herpes include:
* difficulty in passing urine;
* spread of the infection to other parts of your body, such as your lips, nipples, buttocks, fingers and eyes;
* meningitis - although this is very rare;

Having genital herpes increases your risk of getting or passing on HIV infection during sexual contact, particularly if there are blisters.

Causes of genital herpes
Genital herpes is caused by HSV. There are two types of this virus, HSV-1 (this type is mainly linked with oral herpes - cold sores) and HSV-2, both of which can cause genital herpes.

HSV infection usually passes from one person to another just before, during or straight after an outbreak. The herpes virus leaves the skin (this is called shedding) from just before a blister appears to until the blister is totally healed. It's possible for the virus to shed (and infect another person) when there are no signs of an outbreak.

You can get genital herpes if you have unprotected vaginal or anal sex, share sex toys or have close skin to skin contact with someone who has the infection.

HSV-1 infection is usually passed to the genital area through unprotected oral sex with someone who gets cold sores. It can also be passed to the genital area on the fingers.

Diagnosis of genital herpes
If you think you may have genital herpes, you can see your GP, visit a genitourinary medicine (GUM) clinic, or a sexual health clinic to be tested. You can have a test for genital herpes even if you don't have any symptoms.

You don't have to ask your doctor to refer you to a GUM or sexual health clinic; you can make your own appointment. All visits are confidential and you don't have to give your real name. Details won't be sent to your GP without your consent.

Your doctor or nurse will ask about your symptoms and examine you. He or she will take a swab from the infected area - and may have to gently break a blister to do this. The sample will be sent to a laboratory to confirm that you have the herpes virus.

Treatment of genital herpes
Self-help
There are things that you can do to help relieve any pain or discomfort from genital herpes:
* Take an over-the-counter painkiller, such as paracetamol;
* Bathe in salt water (add half a cup of salt to your bath);
* Apply ice packs to the affected area. Never apply ice directly to your skin as it can give you an 'ice burn' - always place a cloth between the ice and skin;
* Apply petroleum jelly (such as Vaseline) to the infected area;
* Apply a mild anaesthetic cream or lotion (such as lidocaine) to your urethra if passing urine is painful;
* Wear loose fitting underwear and clothes;
* Try not to touch the sores and if you do, wash your hands to prevent spreading the infection;
* Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice;

Medicines
There is no cure for genital herpes. Once you're infected with the herpes virus, it will remain in your body, even if you never have another episode.

Your doctor can prescribe antiviral tablets (for example acyclovir), which can help the outbreak clear up faster and reduce the severity of the symptoms. You will probably need this the first time you have the infection. These will be prescribed to you within five days of getting genital herpes or while new blisters are forming. You will need to take these tablets for five days, or longer if new blisters are still forming.

Recurrent episodes of genital herpes tend to be milder. You may not need treatment unless you have a serious outbreak.

If you have regular outbreaks of genital herpes, you may wish to ask your doctor about suppressive treatment. This is where you take a dose of antiviral medicine over a longer period of time to stop the infection recurring.

Special considerations
If you're pregnant
* If you have genital herpes outbreak when you're pregnant, it's important to see your doctor or your obstetrician (a doctor who specialises in pregnancy and childbirth) for treatment and advice;
* Although rare in the UK, there is a risk that you can pass the infection to your baby during the birth. This is known as neonatal herpes and can cause your baby to be seriously ill;
* If you get genital herpes for the first time after you become pregnant, your doctor may prescribe an antiviral medicine to reduce the severity of your symptoms and the length of time you have them. If you have repeat outbreaks of genital herpes during your pregnancy, you may be given treatment to stop an outbreak occurring when you're due to give birth;
* If you get genital herpes for the first time in the last three months of your pregnancy (the third trimester), you are more likely to pass the virus to your baby during a vaginal birth and you may need to have a planned caesarean section;

Prevention of genital herpes
There are ways that you can lower your risk of getting or passing on genital herpes:
* Don't have genital or anal skin-to-skin contact while you or your partner has symptoms of genital herpes;
* Don't kiss or have oral sex while either you or your partner has a cold sore around the mouth;
* Use condoms when having vaginal, oral or anal sex;
* Try not to share sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them;

Sunbathing, being run down, stress, having sex and drinking heavily can trigger recurrent episodes of genital herpes. Being aware of these and taking measures to prevent them can help reduce your risk of having an outbreak.

Related topics
* Sexual Health Advice & Leaflets

Further Information
*Herpes Viruses Association
0845 123 2305
www.herpes.org.uk

* Terrence Higgins Trust
0845 12 21 200
www.tht.org.uk

* fpa (Family Planning Association)
0845 122 8690
www.fpa.org.uk

Sources:
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* www.rcog.org.uk;
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* Genital herpes. Terrence Higgins Trust (THT). www.tht.org.uk, accessed 16 November 2009;
* Scotland's sexual health information. Health Protection Scotland. www.hps.scot.nhs.uk, accessed 16 November 2009;
* Sexually transmitted infections (STIs): Genital herpes. Fpa (Family Planning Association). www.fpa.org.uk, accessed 16 November 2009;
* National guideline for the management of genital herpes. British Association for Sexual Health and HIV, 2007. www.bashh.org;
* Genital herpes - CDC factsheet. Centers for Disease Control and Prevention. www.cdc.gov, accessed 16 November 2009;
* Who can I contact for more information and advice? Fpa (Family Planning Association). www.fpa.org.uk, accessed 11 November 200;
* Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database of Systematic Reviews, 2008, Issue 1. www.cochrane.org;
* Vaccine for herpes simplex. Centre for Reviews and Dissemination. www.crd.york.ac.uk, accessed 17 November 2009;