Genital herpes

Genital herpes and its causes

Genital herpes (also known as herpes) is a common sexually transmitted infection (STI) caused by the herpes simplex virus (HSV).

There are 2 forms of HSV:

• HSV-1 – occurs more commonly around the mouth (as a cold sore), but it can also occur on the genitals. Usually if this happens, a person with the cold sore virus performs oral sex on someone with no previous exposure to the virus.
• HSV-2 – occurs mainly in and around the genital area. It may also occur on the mouth of someone who has not previously been exposed to the virus performs oral sex on someone who has HSV-2. (However, this is uncommon and recurrence almost never happens in healthy people.)

Image of genital herpes - blisters and ulcer, courtesy DermNet

Genital herpes is common

Around 75% of the Australian population have been exposed to the HSV-1 virus and about one in 8 people have HSV-2. It is difficult to be certain as many people do not experience symptoms.

Also, it’s often not possible to tell when a person first acquired the HSV infection as symptoms may appear weeks to years later, if at all.

Many people are anxious about genital herpes. It’s important to remember that it only affects the skin for short periods of time. Most people only have a few recurrences.

How genital herpes spreads

The herpes virus spreads by skin-to-skin contact and can be transmitted during:

• vaginal, oral or anal sex
• genital rubbing
• mouth to anus sex.

The infection can occur anywhere on the genitals (including the groin and pubic area) and in or around the anus.

Cold sores on the mouth can cause genital infection during oral sex for those who do not have the cold sore virus.

When genital herpes is most contagious

The virus is most contagious when someone with HSV has an ‘episode’ or an outbreak. This occurs by having a sore, blister, ulcer or skin split (known as viral shedding).

During viral shedding, the virus is on the skin surface and can spread through:

• genital skin-to-skin contact
• from the mouth or face to genital skin during contact.

Genital herpes can also spread between episodes – when there is no sore, blister, ulcer or skin split present (known as asymptomatic viral shedding).

Genital herpes symptoms

Many people who have genital herpes may not be aware they have the infection, because they have no symptoms.

The first episode of herpes can cause considerable pain and distress. Symptoms of the first episode may include:

• Flu-like symptoms (such as feeling unwell, headache, pain in the back and legs, enlarged glands in the groin).
• Small blisters around the genitals – these break open to form shallow, painful ulcers, which scab over and heal after 1 to 2 weeks.
• Small cracks in the skin (with or without an itch or tingling).
• Skin redness or a distinct rash.
• Considerable pain and swelling in the genital area – that may cause discomfort and difficulty passing urine.

Recurrent episodes of genital herpes

Recurrences are usually less painful and shorter in duration than the first episode of genital herpes. Over time, episodes usually become less frequent and may eventually stop altogether.

Infections caused by HSV-1 are less likely to recur in the genital area than infections caused by HSV-2.

Recurrences may be triggered by:

• stress
• menstruation
• sexual activity
• general illness
• low immunity (such as during cancer treatment)

In some, there may be no apparent reason.

Diagnosing genital herpes

If you think you have genital herpes, your doctor will take a swab to confirm the diagnosis.

Sometimes a blood test for HSV may be offered. This method is not very reliable for people without symptoms. If you have any concerns, discuss them with your doctor.

Genital herpes treatment

Although there is no cure for genital herpes, medication can help manage and reduce the severity of symptoms.

Medication can also reduce the frequency of further infections and spreading the virus.

Genital herpes symptoms can be improved by:

• salt baths
• ice packs to the affected area
• pain-relieving medication (such as paracetamol)
• antiviral medications (such as acyclovir, famciclovir and valaciclovir). These reduce the severity of an episode if taken early (as soon as any symptoms appear).

Topical antivirals used for cold sores on the lips or face are not suitable for use on the genitals.

Preventing recurrences of genital herpes

If you get herpes frequently, taking a daily antiviral medication can reduce the likelihood of symptoms recurring. This is called suppressive therapy. It has the added advantage of reducing the risk of spreading the virus to your sexual partners.

You will need a prescription from your GP.

Preventing genital herpes

The best protection against STIs is to use barrier methods. This includes external condoms, internal condoms and dams (a thin piece of latex placed over the anal or vulvar area during oral sex).

Keep in mind that condoms do not cover the entire genital skin area, so there is a chance you can catch the virus.

It's a good idea to use lubricant with a condom during sex will also reduce the risk of trauma to the genital skin. This has been shown to reduce HSV transmission, especially in the first 6 months of a sexual relationship. Silicone-based lubricants are recommended.

Herpes transmission can occur when symptoms are present (such as a sore or blister). Transmission may also occur without genital symptoms through asymptomatic viral shedding.

For those who have frequent episodes of genital herpes, antiviral medicines (taken as prescribed) will help to reduce transmission to sexual partners.

Pregnancy and genital herpes

Herpes infection can pass on to a baby during pregnancy and labour and may cause serious illness. This is not common.

Let your midwife or obstetrician know if you have ever been diagnosed with genital herpes (in the past or during your pregnancy). They may support you to take suppressive therapy through the last weeks of pregnancy to prevent recurrence.

Ways to reduce the risk of herpes infection during your partner's pregnancy include:

• Don't perform oral sex on your pregnant partner if you have a cold sore. Unless the pregnant partner has had a known HSV-1 infection.
• Taking suppressive antivirals
• Use barrier protection during sex.

Support and advice for genital herpes

If you have found out you have genital herpes, you may feel shocked and may have a lot of questions.

Try to gather as much information as you can about herpes. This can help you to make an informed decision about treatment, sex and preventing further recurrences.

Talking to a counsellor about your concerns may also help.

Where to get help

• Your GP (doctor)
• Your school nurse or school welfare coordinator (Some secondary schools provide access to an adolescent health trained GP on site)
• Your pharmacist
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call) 1800 013 952. These services are youth friendly.
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017
• Victorian Sexual Health Network – where to get tested – visit Melbourne Sexual Health Centre's GP partner clinics for STI check-ups and treatment
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
• Ballarat Community Health Sexual Health Clinic Tel. (03) 5338 4500
• Bendigo Community Health Sexual Health Clinic Tel. (03) 5434 4300 Or (03) 5448 1600
• Gateway Health Clinic 35, Wodonga Tel. (02) 6022 8888 or 1800 657 573
• Sunraysia Community Health Services Tel. (03) 5022 5444
• Barwon Health Sexual Health Clinic Tel. (03) 5226 7489
• Victorian Aboriginal Health Service Tel. (03) 9419 3000
• Women's sexual and reproductive health hubs (throughout Victoria)
• 1800MyOptions Tel.1800 696 784 is a statewide phone service for information about sexual health as well as contraception and pregnancy options