Genital herpes

About genital herpes

Genital herpes is a common sexually transmissible infection (STI) caused by the herpes simplex virus (HSV). There are two forms of HSV – HSV1 and HSV2. HSV1 occurs more commonly around the mouth, but it can also occur on the genitals. HSV2 occurs mainly in and around the genital area.

It is estimated that about one in eight people have HSV 2 and about 80% of those infected may be unaware that they have HSV2. It’s often not possible to tell when a person first acquired the HSV infection as the first symptoms may appear weeks to years later, if at all.

There is no cure for genital herpes, but medication can help manage and reduce the severity of symptoms, and also reduce the frequency of recurrences and reduce the risk of spread.

Many people are anxious about herpes, but it’s important to remember that it only affects the skin for relatively short periods of time, and most people only have a few recurrences.

Pregnant women with genital herpes should discuss this with their antenatal care provider, as herpes infection can be transmitted to the baby during pregnancy and delivery, leading to serious illness.

Genital herpes is spread by skin-to-skin contact

The herpes virus is spread by skin-to-skin contact and can be transmitted during vaginal, oral or anal sex. The infection can occur anywhere on the genitals, in areas around the groin or 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 already have the cold sore virus.

The virus can be spread when someone with HSV has an ‘episode’ or an outbreak – characterised by having a sore, blister, ulcer or skin split (this is known as viral shedding). It can also be spread between episodes, when there is no sore, blister, ulcer or skin split present – called asymptomatic viral shedding.

During viral shedding the virus is on the skin surface and can be spread through genital skin-to-skin contact, or from the mouth or face to genital skin during contact.

Symptoms of genital herpes

Many people who have genital herpes may not be aware they have the infection, because they may not have any 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, headaches and pains in the back and legs, with or without enlarged glands in the groin
• small blisters around the genitals – these break open to form shallow, painful ulcers, which scab over and heal after one to two weeks
• small cracks in the skin with or without an itch or tingling
• redness or a distinct rash
• some people also have considerable pain and swelling in the genital area, and hence may have additional pain 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 HSV1 are less likely to recur in the genital area than infections caused by HSV2.

Recurrences may be triggered by:

• stress
• menstruation
• sexual activity
• general illness
• low immunity (such as during cancer treatment)
• no apparent reason noted.

Diagnosis of genital herpes

If you think you have herpes, your doctor will need to take a swab from the affected area to confirm the diagnosis. On rare occasions, your doctor will also do a blood test to help with the diagnosis. Discuss this with your doctor.

Treatment for genital herpes

There is no medication to cure your body of the herpes virus. Treatment is aimed at easing symptoms, reducing the frequency of recurrences and reducing transmission.

Symptoms can be improved by:

• salt baths
• ice packs to the affected area
• pain-relieving medication – such as paracetamol
• antiviral medication – such as acyclovir, famciclovir and valaciclovir. These can reduce the severity of an episode if taken early enough (preferably as soon as you become aware of any symptoms appearing). Topical antivirals usually used for cold sores on the lips or face are not suitable for use on the genitals.

Preventing recurrences of genital herpes

If you have frequent episodes, antiviral medication may be taken daily to reduce the likelihood of symptoms. You will need a prescription from your GP.

Prevention of genital herpes

The best protection against STIs is to always use barrier protection such as condoms, female condoms and dams (a thin piece of latex placed over the anal or vulvar area during oral sex). Because herpes is spread by skin-to-skin contact, condoms will reduce the risk of transmission, but it will not protect sexual partners completely as condoms do not cover the entire genitals.

Using 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 six months of a sexual relationship. Silicone-based lubricants are recommended.

Remember that herpes transmission can occur when symptoms are present (such as a sore or blister), but may also occur even if there are no genital symptoms through asymptomatic viral shedding.

For people who have frequent episodes of genital herpes, antiviral medication, taken daily, helps to reduce transmission of herpes to a sexual partner.

Pregnancy and genital herpes

Herpes infection may be transmitted to the baby during pregnancy and delivery, leading to serious illness. Although this is not common, let your midwife or obstetrician know if you have ever had a diagnosis of genital herpes, in the past or during your pregnancy.

Support and advice for genital herpes

If you have just found out you have genital herpes, you may feel shocked and may have a lot of questions. It may help you to gather as much information as you can about herpes. This can help you to make fully informed decisions about your treatment, safe sex and preventing further recurrences. Talking to a counsellor about your concerns may also help.

Where to get help

• Your GP (doctor)
• 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 or TTY (for the hearing impaired) (03) 9347 8619
• 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 1800657 573
• Sunraysia Community Health Services Tel. (03) 5022 5444
• Barwon Health Sexual Health Clinic Tel. (03) 5226 7489
• 1800MyOptions Tel:1800 696784 is a statewide phone service for information about sexual health as well as contraception and pregnancy options