Genital herpes

What is genital herpes?

Genital herpes is a sexually transmitted infection (STI) that is caused by herpes simplex viruses (HSV) types 1 and 2. This is the same type of virus that causes cold sores.

Around 1 in every 8 sexually active Australian adults have genital herpes.

Genital herpes can cause outbreaks (flare-ups) of blisters or sores on the genitals and anus. Once infected, you can continue to have outbreaks of symptoms throughout your life.

If you think you have genital herpes, it is important to see a doctor as soon as possible to get a diagnosis, and start treatment.

What are the symptoms of genital herpes?

Most people infected with genital herpes have no symptoms, but some people can experience:

• stinging, itching or tingling in the genital area
• small bumps or blisters around the genitals or mouth
• painful red sores that develop when blisters burst or bleed
• sores that look like a rash or cracked skin on the genitals
• difficulty passing urine

The sores can appear on the parts of the skin that have contact with a partner during sex: the penis in males and the labia, clitoris and vulva in females. You might also see sores in the anus or on the buttocks and inner thighs.

The first episode of infection can also have flu-like symptoms such as:

• fever
• headache
• swollen glands

After the first episode, the virus stays in your body for the rest of your life, which means you can have recurrent outbreaks(flare-ups) of sores and blisters. Recurrent episodes are usually milder, shorter and less frequent over time. They are more likely to happen when your immune system is weak, due to illness, tiredness or stress.

What are the causes of genital herpes?

Genital herpes is spread by skin-to-skin contact with someone who has the herpes simplex virus (HSV), usually during genital or oral sex. It can also be spread through kissing, foreplay or non-penetrative sex.

There are 2 types of HSV, both viruses can affect either the lips, mouth, genital or anal areas, however:

• HSV1 more commonly causes cold sores on the lips or face
• HSV2 causes most genital herpes

The HSV virus is most easily spread when there are blisters or sores, but it can sometimes be passed even if a person has no active blisters, sores or other symptoms.

You cannot get genital herpes from things like hugging, swimming pools or toilet seats.

How is genital herpes diagnosed?

A swab from a blister or sore can be sent to a lab to check if you have herpes simplex virus. It is best if the blister is less than 4 days old. In some cases, you may be able to take your own swab, so you can find out as soon as possible.

How is genital herpes treated?

There is no cure for genital herpes. Your doctor can prescribe an antiviral medicine to reduce your symptoms.

Antiviral medicines are most effective if you start taking them within 2 days of the first symptoms. They can help control outbreaks if they are frequent or severe, and can reduce your risk of passing the virus on to a sexual partner.

You can help manage your symptoms by:

• gently bathing the area with a warm salt solution (1 teaspoon of salt to 2 cups water; or 1 cup of salt in a bath)
• using pain medicine, such as paracetamol or ibuprofen
• applying local anaesthetic (numbing) ointment or cream
• urinating (weeing) while sitting in a warm bath, if urination is painful

Living with genital herpes

Genital herpes is common, but still has a big social stigma. Having a diagnosis of genital herpes may cause you distress. Psychologists and counsellors can help you to work through the distress or anxiety of having genital herpes.

Remember that herpes can be passed on by someone who doesn’t know that they have it, and your first symptoms may appear a long time after you were first infected. This is why it is important to always use condoms and dental dams when having sex, even when you have no symptoms. A dental dam is a square of thin latex that can be placed over the vulva or anal area during oral sex.

It is safest to avoid sex when you have blisters, sores or symptoms.

Herpes is not an infection that needs your doctor to notify the health department or needs you to do contact tracing. Your doctor can help you decide who to tell and how to tell them, to help you reduce the risk of passing on the virus.

What if I am pregnant?

It is important to tell your GP or obstetrician that you or a partner have had genital herpes, so that they can advise you about reducing the risk of infection to your baby. The highest risk to your baby happens if you have your first episode of genital herpes in your third trimester.

If you have ever had genital herpes, your doctor will recommend you take antiviral medicines — even if you don’t have an outbreak. This is to prevent a recurrence towards the end of pregnancy, which would prevent you from having a vaginal birth.

If your doctor is worried about the risks to your baby, they may recommend you have a caesarean birth.

Can genital herpes be prevented?

Practising safe sex is the best way to help prevent genital herpes infection.

It is safest to:

• always use condoms and dental dams, even when you and your partner have no sores or blisters
• avoid kissing and oral sex when there is any sign of a cold sore
• avoid sex when you or your partner have sores or blisters, and for one week until all the sores have healed — this is when you are most infectious
• avoid sex with someone who has any blisters, sores or other symptoms of genital herpes

When should I see my doctor?

If you notice that any of your genital skin looks or feels unusual, see your doctor and ask them to check for herpes. Once your doctor confirms an infection with HSV, they can give you the right treatment. Any time blisters appear you should see your doctor for treatment.

You should also have a review with your doctor a week after starting treatment for the first time, to check your results and make sure the treatment is working.

If you have ever had a diagnosis of genital herpes and are having trouble passing urine (weeing) or opening your bowels (pooing) see your doctor.

Genital herpes in children

If you know a child with genital sores, it is important that they see a doctor for a diagnosis. Sores can be due to many different causes. Genital herpes in children needs careful assessment, as sexual abuse needs to be considered if an obvious source cannot be found.