Genital herpes

Genital herpes is a common viral infection caused by a virus known as the herpes simplex virus (HSV).

It can cause a painful rash and blisters on the genitals and surrounding areas.Because genital herpes can be passed to others through sexual contact, it is often referred to as a sexually transmitted infection (STI)As many as one in three adults has the virus that causes genital herpes. There are two types of HSV:

  1. HSV type 1 most commonly causes cold sores, but it can also cause genital herpes.
  2. HSV type 2 is the usual cause of genital herpes, but it can also infect the mouth.

Both types are highly contagious and can be passed easily from one person to another by direct contact. Once you have herpes simplex virus (HSV) it remains in your body and can become active again.

On average, symptoms of genital herpes are likely to recur four to five times in the first two years after being infected with HSV. However, over time the virus tends to become active less frequently and each outbreak is less severe.

Key points:

  1. The symptoms of genital herpes are similar to cold sores found on the mouth, except they appear on genital skin.
  2. Most people with genital herpes don’t have any symptoms. The virus can be passed on by people with no symptoms.
  3. Genital herpes can not be cured, however symptoms can be treated. It is important to understand treatment options so you can make a choice that is right for you. Daily medication can prevent recurrences and reduce the risk of transmission to partners.
  4. The emotional impact of being diagnosed with genital herpes is often much worse than the condition and it does not deserve the upset it causes.
  5. Avoid sexual contact when symptoms are present.

For more information see the New Zealand Herpes Foundation or talk with one of their trained counsellors on 0508 11 12 13 (9am–5pm, Monday to Friday)

Causes

Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with an infected person. 

Called viral shedding, the virus can be passed on even when there are no symptoms present. Most people who infect others do not realise they are even putting their partners at risk.

  • Around 80% of people infected with genital herpes do not know they have the virus, because they have very mild symptoms or none at all.
  • Over 50% of people who have genital herpes get it from people who are entirely unaware that they have it themselves.

Using condoms reduces the risk of passing on the virus, but does not eliminate it completely.

Having genital herpes is not associated with causing cervical cancer.

Symptoms

Symptoms vary from nothing, to a mild area of irritation, blister or rash, through to more marked discomfort, fever, malaise. These symptoms can appear on the thighs, back, fingers, and, of course, the genitals.

There is effective treatment available if symptoms are problematic.

Diagnosis

An accurate diagnosis of genital herpes includes taking a history, doing a physical examination and taking a swab from the area affected, to test for herpes simplex virus.

Diagnosis is easier if early ulcers or blisters are present.

Because people’s experience of genital herpes varies so greatly and because the treatment of each sexually transmitted infection (STI) is distinctive and specific, accurate diagnosis is essential.

The usual procedure is for the doctor to take a swab from the area affected. A sample of the fluid from a blister or from ulcers is taken and sent away for analysis.

In order to confirm genital herpes it is necessary to prove the presence of herpes simplex virus types 1 or 2 (HSV-1 or HSV-2). The test can identify whether the virus infection is caused by HSV-1 or HSV-2.

Because it is possible for a person with genital herpes to have another sexually transmitted infection at the same time, a full genital check for STIs should be made.

Treatment

Genital herpes is manageable. Over the years a number of treatments offering effective relief from symptoms of genital herpes have been developed.

Simple treatments for the relief of discomfort

The following treatments may alleviate the pain and discomfort of genital sores.

  • Salt baths, used to wash the genital area, can clean, soothe and dry the sores. Use 1 teaspoon of salt in 600ml of water or a handful in a shallow bath.
  • Pain relievers include simple analgesics (such as aspirin and paracetamol), ice (which can be soothing if applied directly to the sores) and creams with an anaesthetic component. Creams, however, can slow down drying and should, therefore, be used sparingly and only for pain relief.
  • Loose underclothes, preferably cotton (not nylon), can help minimise discomfort and allow healing.
  • For anyone who is experiencing extreme pain when urinating, sitting in a warm bath or using a pump bottle full of water and spraying water on yourself while urinating can make the process less painful. It is extremely important to drink plenty of fluids as this dilutes the urine.

Antiviral therapy

The standard, effective and specific treatment for genital herpes is antiviral therapy, which is usually in tablet form. Antiviral drugs work by stopping HSV from replicating in the body. The antiviral drug only works in body cells where the herpes virus is present, therefore making the drug safe and free from side effects.

The treatment only works while you are taking the drug and cannot prevent future outbreaks once you stop taking it.

Antiviral treatments can shorten the duration of a genital herpes outbreak and help speed healing. They can also reduce the number of outbreaks suffered – or prevent them completely.

Antiviral medications can be used in two ways:

  1. To treat outbreaks as they happen – this is known as ‘episodic’ treatment. With episodic treatment, the aim is to shorten the time each outbreak lasts and to relieve symptoms. This works best in persons who experience symptoms some hours before blistering occurs.
  2. To prevent or reduce recurrences – this is known as ‘suppressive’ therapy. If your recurrent outbreaks are frequent or severe – or if you find them particularly problematic – your doctor may recommend that you take oral antiviral medication every day to help prevent recurrences happening. Suppressive therapy is taken continuously, ie. daily, for months or even years. Suppressive antiviral therapy may help reduce the risk of transmitting the virus to sexual partners. Recent studies have shown suppressive treatment with valaciclovir (Valtrex) reduces transmission of symptomatic herpes by 75%.

Oral antivirals currently available in New Zealand are:

  • Aciclovir, which is available fully subsidised by prescription. Aciclovir is very safe and effective, even when taken for long periods of time.
  • Valaciclovir (Valtrex), which is available fully subsidised by prescription from your doctor through a Special Authority application, for individuals with problematic recurrent herpes not responding to aciclovir.

Topical therapy

Topical antiviral creams are available over-the-counter but are not recommended as a treatment for first episode or recurrent genital herpes as they are of little benefit.

Counselling

If you have just found out that you have genital herpes, it is likely you will have a lot of questions. A diagnosis of genital herpes often comes as a shock. Seeing a counsellor may be a good idea to discuss any concerns you may have. Counselling offers a way of dealing with your concerns.

To speak to a New Zealand Herpes Foundation counsellor free call (landline only) 0508 11 12 13 or 09 433 6526.

Learn more

Genital herpes – the facts NZ Herpes Foundation
Herpes myth vs fact NZ Herpes Foundation
Recognising Genital Herpes NZ Herpes Foundation
Herpes & Relationships NZ Herpes Foundation
Herpes in Pregnancy NZ Herpes Foundation
What is herpes? NZ Sexual Health Society
Images of genital herpes DermNet NZ
Genital Herpes  NHS Choices UK
New Zealand Herpes Foundation

Credits: Sources include Herpes Foundation NZ, Sexual Health Society NZ. May 2014. Reviewed By: Health Navigator Team Last reviewed: 03 Feb 2015