Introduction

Genital herpes is a common sexually transmitted infection (STI). It is caused by the virus herpes simplex (HSV). There are two types, HSV l and HSV ll. Both types can infect the genital and anal area (genital herpes) and also the mouth and nose (cold sores) and fingers and hand (whitlows). The virus enters the body through small cracks in the skin or through the moist soft lining (mucous membranes) of the mouth, vagina, rectum, urethra (tube where urine comes out) and under the foreskin. Following an infection by the herpes simplex virus, some people will experience an outbreak of genital herpes.

The virus then becomes dormant (inactive) and remains in the body where you were infected. During this time it is not infectious and does not cause signs or symptoms. In some people, the virus can become active again from time to time and cause further outbreaks of genital herpes – known as recurrent outbreaks.

Symptoms

The incubation period for genital herpes is normally 14 days or within 14 days.

First outbreak

Many people will not have any visible signs or symptoms at all, or not be aware of them. Some people will get symptoms within 4-5 days of coming into contact with the virus. In other people, the virus may be in the body for several weeks, months or possibly years before any signs or symptoms appear. Therefore, when you get symptoms, it doesn’t necessarily mean you’ve only just come into contact with the virus. If you do get signs or symptoms, they usually follow a pattern. You may have some or all of the following:

• Feeling generally unwell with flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back and down the legs or in the groin. This will be followed by:

• Stinging, tingling or itching in the genital or anal area

• Small, fluid-filled blisters anywhere in the genital or anal area, on the buttocks and the tops of the thighs. These quickly burst within a day or two leaving small red sores which can be very painful

• Pain when passing urine (peeing) caused by the urine flowing over the sores

Recurrent genital herpes

Signs and symptoms of recurrent outbreaks are usually milder than with the first outbreak and clear up more quickly (in about a week). There is often an early warning tingling sensation and you may get a flu-like illness before an outbreak. The blisters and sores are usually fewer, smaller, and less painful and heal more quickly. They normally appear in the same part of the body as in previous outbreaks but in some people, they may appear nearby.

How is Genital herpes passed on

Genital herpes can be passed from one person to another during sexual contact. Anyone who is sexually active can get the virus. Both men and women can have genital herpes, and pass it on. The herpes simplex virus is most likely to be passed on just before, during or straight after an outbreak.

Genital herpes can be passed on:

• From one person to another during vaginal or anal sex, or by sharing sex toys

• During skin to skin contact. It can be passed on by close genital contact – you don’t need to have penetrative sex (vaginal or anal) to pass it on

• During skin to skin contact if the virus is active on the skin areas not protected by a condom or latex square

• If you receive oral sex from someone who has a cold sore or is just about to get one

• If a person with herpes on the hand or finger touches a partner’s vagina, genitals or anal area

If you already have one type of Herpes simplex virus, it is still possible for you to get the other type although you may not notice symptoms. You cannot get genital herpes from kissing, hugging, sharing baths or towels, toilet seats, swimming pools or from sharing cups, plates or cutlery.

Can I pass the virus to a partner when I have no signs or symptoms?

In some people, the body can shed the virus from the skin or mucous membranes without there being any signs or symptoms of genital herpes. This is called asymptomatic shedding or viral shedding. It is possible to pass the virus on during periods of asymptomatic shedding but for most people the risk is low. Shedding is higher in the first year after infection and if you have frequent outbreaks. The longer the time between outbreaks the less likely you are to have any asymptomatic shedding.

Genital herpes tests

In many cases, our doctor may diagnose genital herpes by taking a swab of fluid from the infected area. They may gently break a blister to get a sample of the fluid inside. The swab will then be sent to the laboratory and the result will be known within a few days. If the patient does not have any symptoms, a blood test will then be required. It is easier to diagnose genital herpes at the beginning of an outbreak when it is possible to take a swab sample of fluid from a blister or sore before it starts to heal.

How soon can I have a check-up after sex?

You can have a check-up as soon as you have signs or symptoms. There is no routine test for genital herpes if you do not have signs or symptoms.

Reference
http://www.fpa.org.uk/helpandadvice/sexuallytransmittedinfectionsstis/genitalherpes

Treatment

The aim of the treatment is to relieve the pain, and to prevent the virus from multiplying.

• Treatment is recommended when you have the first outbreak as this may provide some relief.
• Treatment is usually started within five days of the commencement of the first outbreak and while new blisters or sores are still forming. It involves taking antiviral tablets daily (sometimes up to five times a day) for five days. There are several different antiviral tablets that can be used.
• Some people find it helpful to take antiviral treatment when they get another outbreak of genital herpes. You may be given some tablets to take at home. These need to be started as soon as the outbreak begins.
• People who have repeated outbreaks (usually more than six in a year) may be given longer courses of the tablets to try to reduce the number of outbreaks.
• As genital herpes is caused by a virus and not bacteria, antibiotics will not help.

What happens if genital herpes is not treated?

It is not essential to have treatment as genital herpes will clear up by itself. However, prompt treatment at the start of an outbreak can be a great help – it can reduce the time the outbreak lasts, help the healing process and can reduce the risk of you passing the virus on to someone else.

Reference

Reil H et al. Clinical Validation of a new triplex real-time polymerase chain reaction assay for the detection and discrimination of Herpes simplex virus types 1 and 2. J Mol Diagn. 2008 Jul;10(4):361-7

Groen J et al. Evaluation of a fully automated glycoprotein G-2 based assay for the detection of HSV-2 specific IgG antibodies in serum and plasma. J Clin Virol. 1999 May;12(3):193-200