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Genital Herpes

 

Genital herpes is usually a sexually transmitted infection. Many people who are infected with this virus never have symptoms, but can still pass on the infection to others. If symptoms occur, they can range from a mild soreness to painful blisters on the genitals (vulva or penis) and surrounding area. A first episode of symptoms can last 2-3 weeks, but may be shorter. Recurrent episodes of symptoms then develop in some cases from time to time, but are usually less severe than the first episode. Antiviral medication can ease symptoms when they develop. Some people who have frequent recurrences of symptoms take antiviral medication each day to prevent symptoms from developing.

What is genital herpes?

Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. It is caused by the herpes simplex virus. The buttocks and anus may also be affected. There are two types of herpes simplex virus:

  • Type 1 herpes simplex virus is the usual cause of cold sores around the mouth. It also causes up to half of cases of genital herpes.
  • Type 2 herpes simplex virus usually only causes genital herpes. It can sometimes cause cold sores. 
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How do herpes simplex infections occur?

The herpes simplex virus is passed on by skin-to-skin contact. The virus can pass through the moist skin that lines the mouth, genitals, anus (and sometimes the eye). The skin of the rest of the body is less susceptible to herpes infection. Therefore, herpes simplex infection of other parts of the body is rare if the skin is not damaged or cut.

The first time you are infected is called the primary infection. This may, or may not, cause symptoms. Following a primary infection, the virus is not cleared from the body but lies inactive (dormant) in a nearby nerve. In some people the virus 'activates' from time to time, and travels down the nerve to the nearby skin. This causes recurrent symptoms of genital herpes if the primary infection was in the genitals, or recurrent cold sores if the primary infection was around the mouth.

The rest of this leaflet deals just with genital herpes. There is a separate leaflet that deals with herpes simplex infection around the mouth ('cold sores').                                                               

Genital Herpes Causes

Genital herpes is caused by the herpes simplex virus (HSV). There are two types: HSV-1 and HSV-2. Most genital herpes infections are caused by HSV-2. HSV-1 is the usual cause of what most people call "fever blisters" in and around the mouth and can be transmitted from person to person through kissing. Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores caused by either virus look the same.

  • Genital herpes is spread by direct contact with an infected person. Sexual intercourse and oral sex are the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is capable of spreading herpes.

Note: People with herpes may spread the disease even if they do not realize they have an infection. Furthermore, there is strong evidence that people with herpes can transmit infection even while their disease appears to be inactive and no sores can be seen.

  • Many people remember having an episode of genital herpes when it occurs. But as many as 90% of those infected fail to recognize the symptoms or have no symptoms at all. It is not clear whether these people never had an initial herpes outbreak or whether they never noticed a mild infection. They are contagious and may have additional outbreaks, nonetheless.

What are the symptoms of genital herpes?

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  • A first episode of symptoms

At first you may feel generally unwell with a mild fever, and aches and pains. Groups of small, painful blisters then appear around your genitals and/or anus. They tend to erupt in crops over 1-2 weeks. The blisters turn to shallow, sore ulcers. The glands in your groin may swell and feel like lumps at the top of your legs. It is common to have pain when you pass urine, especially in women. A vaginal discharge may occur in women. The ulcers and blisters last up to 10-14 days, and then gradually heal and go without scarring.

Sometimes less typical symptoms occur. For example, you may just have a small raw area, one or two small ulcers, or just an area of irritation with nothing to see. Sometimes symptoms last just a few days.

  • Recurring episodes of symptoms

After the first episode, further episodes of symptoms occur in some cases from time to time. These are called 'recurrences'. It is not clear why the dormant virus 'erupts' from time to time. Recurrences tend to be less severe and shorter than the first episode. It is more usual to have 3-5 days of symptoms with a recurrence, unlike the 2-3 weeks of symptoms that may occur during the first episode. A tingling or itch in your genital area for 12-24 hours may indicate a recurrence is starting. The time period between recurrences is variable.

Recurrences tend to become less frequent over time. In people who have recurrences, their frequency can vary greatly. Some people have six or more a year. For others it is less frequent than this. Many people do not have recurrences at all after a first episode of symptoms.   

  • It is common not to get symptoms

Most people (about 4 in 5 infected people) never develop any symptoms when they are infected with the virus. (Or, they only have a short bout of very mild symptoms which is not recognized as genital herpes. For example, just a slight area of itch or a small red area which soon goes.) The virus stays inactive (dormant) in the root of a nerve that supplies the genitals, but never causes recurrent episodes of symptoms. However, even people who do not get symptoms may, on occasions, have virus in their genital area and therefore be infectious to their sexual partners.

Note: sometimes a first episode of symptoms appears months or years after being first infected. This is why a first episode of symptoms can occur during a current faithful sexual relationship. You may have been infected months or years ago from a previous sexual partner who did not realize that they were infected.

It is not clear why some infected people develop symptoms, some don't, and some have a first episode of symptoms months or years after first being infected. It may be something to do with the way the immune system reacts to the virus in different people.                                                                                   

How Long Until Symptoms Appear?

Someone who has been exposed to genital herpes will notice genital itching and/or pain about 2 to 20 days after being infected with the virus. The sores usually appear within days afterward.

Who gets genital herpes?

Many people in the UK are infected with the herpes simplex virus in the genital area. However, about 4 in 5 infected people never have any symptoms, or only have one short bout of very mild symptoms which is not recognized as genital herpes. So, many people are not aware that they are infected.

However, if you are infected, you can still pass the virus on to others even if you have not had symptoms (see below). It is estimated that in at least half of people who develop genital herpes, the virus came from a a sexual partner who did not know that they were infected with the virus.

What are the possible complications of genital herpes?

In a small number of cases the infection spreads to other areas of skin on the body. Occasionally, the blisters become infected by bacteria (other germs) to cause a spreading skin infection.

In some cases, people have the wrong idea about herpes simplex. Usually, this will be due to wrong ideas about the infection, thinking it is far worse than it really is. Good counselling is thought to help in these cases.

Note: genital herpes does not damage the uterus (womb) or cause infertility. Nor does it cause cancer of the cervix.

Do I need any tests?

Yes. A blister can be swabbed by a doctor or nurse to obtain a small sample to send to the laboratory. This can confirm the infection is due to the herpes simplex virus. Tests to look for other infections may also be done at the same time.

Exams & Tests

Many doctors will start treatment based only on the appearance of the sores, if the sores seem typical of herpes. Doctors may also take a swab of the sore and send the swab to the laboratory to see if the virus is present. This test generally takes a few days.

What is the treatment for genital herpes?

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Can genital herpes be passed on to others?

Yes. Herpes simplex virus is very contagious when blisters are present. Genital herpes is usually passed on by vaginal or anal sex. However, if you have a cold sore you may also pass on the virus to cause genital herpes by having oral sex ('mouth to genital sex').

  • When you have symptoms (during a primary episode or recurrence)

There is a high chance of passing on the virus if you have sex. It is best not to have sex from the time symptoms first start until they are fully over. If you do have sex, using a condom may not fully protect against passing on the virus as the condom only protects the area that is covered.

  • When you do not have symptoms (which is most of the time)

It is very unlikely that you will pass the virus on when you have sex. However, some virus will be present on the genital skin surface from time to time, although infrequently. So, there is still a small chance that you may pass on the virus when you have sex when you do not have symptoms. It is best to discuss things over with your sexual partner. Using a condom each time you have sex is thought to reduce the chance much further. Also, people who take antiviral medication long-term to prevent recurring symptoms have a reduced risk of passing on the virus.

Note: If your sexual partner already has the same virus then you cannot re-infect each other.

What can Happen?

After the herpes blisters disappear, a person may think the virus has gone away — but it's actually hiding in the body. Both HSV-1 and HSV-2 can stay hidden away in the body until the next herpes outbreak, when the virus reactivates itself and the painful sores return.

Over time, the herpes virus can reactivate itself again and again, causing discomfort and episodes of sores each time. Usually a person has about four to five herpes outbreaks each year — but in some people, the number of outbreaks will lessen over time.

There is no cure for herpes; it will always remain in the body and can always be passed to another person with any form of unprotected sex. This is the case even if blisters aren't present on the genitals. Many cases of genital herpes are transmitted when symptoms are not present.

Genital herpes also increases the risk of HIV infection. This is because HIV can enter the body more easily whenever there's a break in the skin (such as a sore) during unprotected sexual contact. In addition, if a pregnant woman with genital herpes has an active infection during childbirth, the newborn baby is at risk for getting herpes infection. Herpes infection in a newborn can cause meningitis (an inflammation of the membranes that surround the brain and spinal cord), seizures, and brain damage.

How is it Prevented?

 

The only surefire way to prevent genital herpes is abstinence. Teens who do have sex must properly use a latex condom every time they have any form of sexual intercourse. If one partner has a herpes outbreak, avoid sex — even with a condom or dental dam — until all sores have healed. Herpes can be passed sexually even if a partner has no sores or other signs and symptoms of an outbreak.

People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any sexual contact when sores are present. Even the use of a condom does not prevent the spread of disease because not all sores are covered by the condom.

Although the chance of spreading disease is greatest when sores are present, people who have had genital herpes may always be contagious to some degree, even if they have received medical treatment. The virus can become active and be transmitted to a sexual partner even when the skin appears completely normal. For this reason, safe sex practices (use of a condom) should be used between disease outbreaks to lessen the chance of spreading disease to a sexual partner.

Facts About Genital Herps:

  • Transmission is caused by close oral, anal, or genital contact, including intercourse, masturbation, kissing, or any direct skin-to-skin contact which allows for the transfer of bodily fluids.
  • A person is considered contagious when prodromal symptoms, active sores, and healing lesions are present.
  • Herpes is potentially contagious when no symptoms are present. That is, a person who has genital herpes is potentially always shedding active virus.
  • Approximately 1 in 6 members of the general infected population is thought to shed active virus occasionally without symptoms.
  • Some people do not get typical blister-like sores but harbor active virus in their saliva, vaginal, or penile secretions, and can shed the virus without knowing they have herpes.
  • Lesions can occur deep inside the vagina where they cannot be seen or felt, but can readily transmit the virus.
  • An uninfected individual has about a 75% chance of contracting herpes during intimate contact with someone actively shedding virus.
  • Oral herpes can be transmitted to the genitals, and vice versa. Symptoms are similar.
  • Auto-inoculation: An infected individual can spread the virus to other parts of his or her body by touching an area shedding virus and then touching, scratching, or rubbing another susceptible part of the body. Towels are especially conducive to this.
  • It is possible for a person to contract genital herpes if the partner with oral herpes performs oral sex. Oral herpes can be transmitted to the genitals, and vice versa. Symptoms are similar.
  • Environmental surfaces like toilet seats may be a source of contagion, but there is no evidence that this poses a real threat to the general population. Experts differ as to how long the virus can survive on its own. The primary cause of infection remains intimate contact.

Self-Care at Home

·         Avoid excessive heat or sunlight, which makes the irritation more uncomfortable.

·         Do not use perfumed or antibacterial soaps, feminine deodorant, or douches.

·         Wear more comfortable, loose cotton clothing.

·         For pain, you may take aspirin, acetaminophen (Tylenol), or ibuprofen (Advil).

·         Cool cloths on the affected area may soothe the pain.

Treatment

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