Genital herpes

What is it?

A virus that produces a painful rash on the genitals.

What are the main symptoms?

• Often before an attack:
  • Flu-like illness with fever, aches and pains in the lower back, legs and groin.
  • Tingling nerves.
• Painful blisters on the penis or around the anus.
• Pain on intercourse.
• First-episode herpes may take up to 10 days to clear.
• Subsequent outbreaks usually become progressively milder, lasting just a few days and becoming more infrequent. They may stop altogether.
• Some people only ever have one primary attack. 

What's the risk?

• This is a common STI, although the risk of infection is relatively low. Rates are highest among 20—24 year olds.
• Fewer men than women are diagnosed with the infection, but it's thought this is largely because symptoms cause them less discomfort rather than pointing to a lower level of infection among men.
• Transmission rates are greater from men to women than vice versa.

What causes it?

• The herpes simplex virus of which there are two types:
  • HSV1, which causes cold sores on the face and hands.
  • HSV2.
• Both cause genital herpes, although HSV1 produces milder symptoms.
• Infection is lifelong.
• Although the blisters are highly infectious, most transmission occurs when there are no obvious signs of infection but while the virus is silently "shedding". The virus sheds minute quantities of particles through the skin on its way up from the nerve root where it resides in the body. Research shows that shedding is more common in women than first thought and may continue throughout life.
• Previous infection with HSV1 does not provide immunity against HSV2, although it may make the primary attack less severe. 

How can I prevent it?

• Avoid direct intimate contact with anyone who has cold sores or genital blisters.
• Avoid sex if you feel a blister coming on. Safer sex will help reduce your risk of infection. 

Should I see a doctor?

• Yes. Your best bet is to visit a specialist GUM clinic which can provide a confidential service.
• Treatment can reduce the length and severity of first-episode herpes, although it makes little difference in subsequent attacks, but it has to start within five days. To make a diagnosis, a swab will be taken directly from any ulcers.
• A diagnosis can help you to avoid trigger factors (e.g. sunlight and stress) and become sexually responsible towards other partners.

What are the main treatments?

• Antiviral tablets: acyclovir fives times a day, famcyclovir three times a day, or valacyclovir twice a day, for five days — there are very few side-effects.
• "Suppressive therapy" (daily doses of acyclovir) can reduce the frequency of episodes if you have six or more a year.
• There is no cure for genital herpes.

How can I help myself?

• Bathing the blisters in a mild salt-water solution will help them heal. Keep the affected area clean and dry. Aspirin or paracetamol may help reduce the aches and pains.
• Sunlight, physical trauma such as that produced by vigorous sex, and stress can all trigger recurrences.

What's the outlook?

With treatment and care, attacks can be short-lived and less severe. Up to 20% of those affected never have a second attack.