>Genital herpes

Herpes simplex viruses (HSV)

Genital herpes is caused by infection with herpes simplex virus (HSV). There are two types of HSV, HSV-1 and HSV-2, both of which belong to a wider group called Herpesviridae. Another well-known virus in this group is varicella zoster virus, which causes chicken-pox and shingles.
In general:

• HSV-1 is acquired orally, causing cold sores.
• HSV-2 is acquired during sexual contact and affects the genital area.

Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries.
Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners.

Genital herpes symptoms and signs

If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:

• Itching or tingling sensations in the genital or anal area;
• small fluid-filled blisters that burst leaving small painful sores (see STD pictures);
• pain when passing urine over the open sores (especially in women);
• headaches;
• backache;
• flu-like symptoms, including swollen glands or fever.

Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal.

How is genital herpes is transmitted?

Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sex. The virus affects the areas where it enters the body. This can occur during:

• vaginal sex
• anal sex
• oral sex (HSV-1 or HSV-2)
• kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact.

Where to go for help

If you have any symptoms or you are worried you may have been infected with an STD, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that can help you directly. Check you local telephone directory to see if you have a clinic near you.

Testing for genital herpes

A herpes test will usually involve the following examinations, which are carried out by a doctor or nurse.

• A clinical examination will be done of a patient’s genital area.
• A sample will be taken, using a cotton wool or spongy swab, from any visible sores.
• Women may be given an internal pelvic examination (similar to a smear test).
• A sample of urine may be taken.

If the patient’s symptoms have already disappeared, or if there were no symptoms to begin with, a blood test can be taken to look for the virus. As in HIV testing, the herpes test works by searching for antibodies that the immune system produces to fight the virus. This means that the test is not effective until 3 months after exposure, as the body can take up to 3 months to produce an immune response.
It is possible to have more than one sexually transmitted infection at the same time, so it is advisable to have a full check-up.
Samples taken during an examination are sent to a laboratory for testing, and the result is usually available within 2 weeks, although this varies between countries.

Treatment for genital herpes

There is no cure for the herpes simplex virus and treatment is not essential, as an outbreak of genital herpes will usually clear up by itself. A doctor may however prescribe a course of antiviral tablets to reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes simplex virus from multiplying.
Once the initial outbreak of herpes is over, the virus hides away in the nerve fibres adjacent to the infection site, where it remains dormant, causing no symptoms. It is possible for the dormant virus to be 'reactivated' in some people, in which case it travels back down the nerve to the skin surface.
Recurrences of genital herpes vary from person to person in frequency. Some will never experience an outbreak again, whilst others may have milder recurrences more than 6 times a year. Because these recurrent infections are milder, they often do not require treatment.
When receiving treatment for genital herpes, the doctor or health advisor will discuss the genital herpes infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with within a recent period, as they will also be at risk of having genital herpes and should be tested.

Help during an outbreak

If you are suffering from an outbreak of genital herpes, there are several things you can do that may help make it easier to cope with:

• Take pain-killers (aspirin/paracetamol) for any pain.
• Gently bathe the sore areas with a salt solution (half a teaspoon of salt to half a pint of warm water) twice a day: it is soothing and helps the sores to dry out.
• Wear loose clothing so that the air can get to the sore areas.
• Place an ice-pack wrapped in a clean cloth or towel on the affected area.
• If passing urine is painful, try urinating in a bath of water, or pour water over yourself while urinating.
• Drink plenty of fluids, such as mineral water and soft drinks, to help neutralise the urine (it is important not to hold back from passing urine as this can cause further problems).
• Avoid sunbathing and using sunbeds.
• Get plenty of rest.

Taking care of yourself and your partner

During an outbreak of genital herpes, the sores are highly infectious and the virus can be passed on to others by direct contact. To prevent this from happening, you should avoid:

• Kissing when you or your partner have cold sores around the mouth;
• having oral sex when you or your partner have oral or genital sores;
• having any genital or anal contact, even with a condom or dental dam, when you or your partner has genital sores;
• using saliva to wet contact lenses if you have sores around your mouth.

Remember - wash your hands with soap before and after touching the sores.
Although the likelihood of transmitting genital herpes to your partner between outbreaks is much reduced, there is still some risk. Having genital herpes does not mean the end of your sex life. Ask your doctor or clinical health advisor for advice.
Remember, a condom will only protect against herpes infection if it covers all the sores. Herpes can also be transmitted by non-penetrative sex.

Complications

HIV and genital herpes

Those with suppressed immune systems are likely to have more frequent and severe recurring episodes of genital herpes. They may also have more asymptomatic outbreaks (where the virus travels up the nerve to the surface of the skin but causes no blisters) during which time the virus can be passed on.
A genital herpes infection increases the risk of becoming infected with HIV by up to three times in both men and women. This is due to the breaks in the skin caused by HSV, that facilitate entry of HIV.

Pregnancy and genital herpes

Having herpes does not affect a woman's ability to become pregnant. However, if herpes is transmitted in the first 3 months of pregnancy there is a small risk of a miscarriage. A first episode of herpes during pregnancy carries a greater risk of transmission to the baby. Becoming infected towards the end of pregnancy may cause the baby to be born early.
Though transmission of herpes from a mother to her newborn is rare, if it does occur, it can pose a serious risk to the baby. If left untreated, the infection can cause damage to a newborn's internal organs, skin, and central nervous system and may even prove fatal. Prompt testing and treatment with acyclovir of any baby thought to be at risk is therefore essential.
However, most women who have an outbreak (or even several outbreaks) of genital herpes during pregnancy have a normal delivery and a healthy baby.