What is Genital Herpes?

Genital herpes is a very common and highly contagious infection usually spread through sex.

This infection is usually caused by the herpes simplex virus-2 (HSV-2) or the herpes simplex virus-1 (HSV-1), the virus usually responsible for cold sores. 

Most cases of genital herpes are caused by infection by the herpes simplex virus type 2 (HSV-2).

Herpes simplex virus type 1 (HSV-1) is more often the cause of cold sores or fever blisters. But it can also be a cause of genital herpes. 

Most people with genital herpes don't know they have it. That's because in most people it produces either no symptoms or very mild ones.

• Genital herpes is caused by the herpes simplex virus (HSV).
• Genital herpes is very similar to the herpes that appear on the hands and face ('cold sores'), but is found on or around the penis, anus or vagina.
• There are two types of herpes virus, HSV-1 and HSV-2. Both types can cause genital herpes. The first episode of infection (primary) with genital herpes is often quite severe. There are blisters and inflammation at the site of infection and the sufferer may feel generally unwell. It is common to have symptoms of burning when passing urine.
• After the first episode of infection with HSV the virus enters into a dormant phase in the nerve, which supplies feeling to the area where infection occurred.
• The dormant virus reactivates from time to time to cause recurrences.
• Some people get symptoms warning them that a recurrence is about to occur, such as itching, tingling or pain in the genital area; blisters or sores may then develop. These tend to be less severe than the symptoms that occurred at the time of the first episode of infection.
• From time to time the virus may reactivate without causing any symptoms of infection at all.

Who gets Genital Herpes?

Anyone who has sex can catch genital herpes. The people at most risk are those having unprotected sexual intercourse (i.e. not using condoms), especially those with more than one sexual partner and those who change sexual partners.

How do you get infected with Genital Herpes?

• Genital herpes is spread by direct contact with the infectious virus, via unprotected vaginal or anal sex, genital contact or through oral sex with someone who gets cold sores.
• Genital herpes and cold sores are both very infectious when an infected person has blisters or sores.
• It is possible for an infected person to transmit the virus when they have no symptoms of infection. The risk of this happening is probably reduced by using condoms.

What Are the Symptoms of Genital Herpes?

Even though you can still pass the infection, you may never notice symptoms from an HSV infection. On the other hand, you might notice symptoms within a few days to a couple of weeks after the initial contact. Or, you might not have an initial outbreak of symptoms until months or even years after becoming infected. 

When symptoms occur soon after a person is infected, they tend to be severe. They may start as small blisters that eventually break open and produce raw, painful sores that scab and heal over within a few weeks. The blisters and sores may be accompanied by flu-like symptoms with fever and swollen lymph nodes. 

Any of the following symptoms of a genital HSV infection can occur in a man or a woman:

• Cracked, raw, or red areas around your genitals without pain, itching, or tingling
• Itching or tingling around your genitals or your anal region
• Small blisters that break open and cause painful sores. These may be on or around your genitals (penis or vagina) or on your buttocks, thighs, or rectal area. More rarely, blisters may occur inside the urethra -- the tube urine passes through on its way out of your body.
• Pain from urine passing over the sores -- this is especially a problem in women.
• Headaches
• Backaches
• Flu-like symptoms, including fever, swollen lymph nodes, and fatigue

How Serious is Genital Herpes

• The majority of people with genital herpes experience mild and infrequent symptoms. Some people may experience more frequent and severe recurrent episodes.
• The risk of transmission from a mother to her baby is greatest for babies born to a woman with first episode genital herpes around the time of delivery. Neonatal herpes is potentially life threatening but occurs very rarely in the UK.
• Women with recurrent herpes prior to pregnancy are at very low risk of transmitting the infection to their babies.

Genital Herpes Treatment

Antiviral tablets available to treat genital herpes include: aciclovir and valaciclovir. They work by stopping the herpes virus from multiplying. They do not clear the virus from the body. If an antiviral medicine is started early in an episode of symptoms, it tends to reduce the severity and duration of symptoms during an episode of genital herpes. 

Aciclovir

Aciclovir tablets are effective in treating a full outbreak of genital herpes. 
It can also be used as a suppressive treatment, especially if you suffer from multiple outbreaks a year. Valaciclovir (Valtrex)

Valaciclovir is a "prodrug" meaning it is converted into Aciclovir by the body. The effectiveness is similar but Valaciclovir tablets are better absorbed by body. Valaciclovir is also known by the brand name

Valtrex. What is Valtrex?

Valtrex is a brand name for Valaciclovir. Valtrex is commonly sold in the USA but in the UK it usually sold under the generic version, which is known simply as Valaciclovir. Valtrex is substantially more expensive than generic Valaciclovir tablets but medically they are identical and there is no effective difference.

Effectiveness

Aciclovir and Valaciclovir start working straight away to reduce the severity and duration of an outbreak by one to two days. 

If taken within five days of the start of an outbreak should shorten your outbreak by one to two days and make the symptoms less severe. It might even prevent the outbreak if taken early enough. 

Side Effects of Anti-Viral Herpes Treatment

Common side effects include: headache

• nausea
• diarrhoea
• fatigue
• abdominal pain

Patient Information Leaflet

Always read the patient information leaflet before commencing treatment. Patient information can be found here.

Alternatives

Self-care measures may be helpful for some people:

• Clean the affected area with plain or salt water to help prevent secondary infection and promote healing of lesions.
• Apply vaseline or a topical anaesthetic (e.g. lidocaine 5%) to lesions to help with painful micturition, if required.
• Increase fluid intake to produce dilute urine (which is less painful to void). Urinate in a bath or with water flowing over the area to reduce stinging.
• Avoid wearing tight clothing (which may irritate lesions) and use adequate pain relief (e.g. oral paracetamol).
• Avoid sharing towels and flannels with household members (although it is very unlikely that the virus would survive on an object long enough to be passed on, it is sensible to take steps to prevent this).
• Try to avoid identified trigger factors (e.g. ultraviolet light, excess alcohol).