What is Genital Herpes

Genital herpes is a common infection generally transmitted through sexual contact. It is caused by one of two members of a family of viruses which also include the viruses causing chickenpox and shingles, and glandular fever.

Usually, genital herpes is caused by infection with herpes simplex virus type 2 (HSV-2), and studies suggest that in some countries, one in five people are infected with this virus. Genital herpes can also be caused by HSV-1, the virus which usually causes cold sores on the lips and face, through oral/genital contact.

Genital herpes, for most people, is an occasionally recurrent, sometimes painful condition for which effective treatment is now available. Generally, it is not life-threatening and has no long-term repercussions on one’s general physical health.

Herpes – the key facts

Herpes simplex causes a viral skin condition known as cold sores (on face), whitlows (on fingers) or 'herpes' on genitals or other skin areas.

As many as one in three adults has the virus that causes genital herpes.

Around 80% of people infected with genital herpes don't know they have the virus because they have very mild symptoms or none at all.

Over 50% of people who have genital herpes get it from people who are entirely unaware that they have herpes themselves.

The emotional impact of being diagnosed with genital herpes is often much worse than the condition and it doesn't deserve the upset it causes.

Oral herpes, also known as cold sores, is commonly transmitted to the genitals through oral genital contact. Up to 50% of genital herpes is caused by the oral cold sore type of herpes simplex.

There is effective treatment available if herpes symptoms are problematic.

The symptoms of genital herpes vary enormously. It can show up as blisters or sores, but it can also just produce a mild rash. And whatever symptoms do appear may be on the thighs, back, fingers, and of course the genitals.

The herpes virus can be passed on when there are no symptoms present.

Most people who infect others with herpes don't realise they are even putting their partners at risk.

Using condoms reduces the risk of passing on the herpes virus, but doesn't completely eliminate it.

Daily medication can prevent recurrences of the herpes virus  and reduce the risk of transmission to partners.

Having genital herpes is not associated with causing cervical cancer.

Anyone who is sexually active is at risk of catching genital herpes, regardless of their gender, race or social class.

How has my Partner caught Genital Herpes
Genital herpes can be transmitted through direct contact with an infected blister or sore, usually through sexual contact. It can also be transmitted when there are no symptoms present. HSV-2 infection is usually passed on during vaginal or anal sex. HSV-1 is usually transmitted by oral sex (mouth to genital contact).

If your partner has only just been diagnosed as having genital herpes, this does not necessarily mean that he or she has been unfaithful to you, or sexually promiscuous in the past.

Your partner may have caught genital herpes from you. It is possible that you carry the virus without knowing that you have it, since up to 80% of people who have been infected with HSV-2 have either no herpes symptoms or such mild symptoms they are unaware they have the herpes virus. So it is very easy for you to have unwittingly transmitted the infection to your partner. The symptoms of the infection vary greatly between individuals – it might be totally unnoticeable in you, but cause severe blistering in your partner.

Since the genital herpes virus can be transmitted through oral sex as well as vaginal sex, it is also possible that your partner caught the virus from a cold sore on your mouth or face. Remember, it is possible you can pass the herpes virus on even if you didn’t have a cold sore present at the time of contact.

Genital herpes

Alternatively, your partner may have contracted the herpes virus from a previous sexual partner, perhaps even several years ago. The herpes virus can remain inactive in the body for long periods, so this may be the first time it has caused symptoms.

What are the symptoms of Genital Herpes

If your partner is having a first episode of genital herpes, he or she is likely to feel generally unwell and have fever, headache, and general bone and muscle aches, as well as irritation in the genitals. This may last for several days, during or after which reddened areas may appear on the genitals. These may develop into painful blisters. The blisters then burst, generally to leave sores which gradually heal, usually without scarring.

The severity of this first herpes episode varies between individuals, but for some people it may be severe and last for up to three weeks if not treated.

Genital Herpes

These symptoms should quickly resolve with treatment. The doctor should have given your partner a course of antiviral treatment. This is an effective medicine which, although it does not cure genital herpes, can speed recovery and reduce the severity of the herpes episode. There are also other steps which your partner can take to relieve the pain of genital herpes.

However, for many people who have genital herpes, the physical symptoms are far outweighed by the emotional stress relating to the diagnosis. There are many misconceptions about genital herpes, including the belief that it is associated with promiscuity, and these have given it a reputation which may cause your partner to feel angry and shocked by the diagnosis.

Anxiety, guilt, loss of assertiveness and fear of rejection are also common emotions.

Your support can be very important in helping your partner to deal with these feelings and to minimize the effect of genital herpes on his or her life.

How do I know if I have Genital Herpes?
?Most people who have genital herpes don’t know because they have either no symptoms or such mild infrequent symptoms, it goes unrecognized.

Until recently, diagnosis could only be made by clinical symptoms and swabs from an active herpes episode. However, there are commercially available blood tests becoming available which can distinguish between herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) antibodies. The time taken to develop antibodies is usually two to six weeks after infection, but can be up to six months. It is also important to know that false positives and false negatives are common in these tests.

Because of the limitations of a blood test to diagnose herpes, it is recommended you discuss the implications of the test with someone who has experience with them. It is important that the test can distinguish between HSV-1 and HSV-2 antibodies.

If you think you might be showing signs of the infection, consult your doctor.

Do the symptoms of Genital Herpes return
The symptoms of genital herpes may reappear from time to time. This is because once the herpes virus is acquired, it stays permanently in the body. Most of the time it remains inactive, but every so often it may reactivate and cause another outbreak.

Each individual is different – some people never have a recurrence; others may have recurrences several times a year. However, recurrent outbreaks are usually shorter and less severe than the first herpes episode.

Certain events or situations can trigger recurrences, and you may be able to help your partner avoid or reduce the trigger factors, which may include stress at work or home, fatigue, ill health, loss of sleep, friction due to sexual intercourse, and menstruation in women.

If your partner has frequent or severe episodes of genital herpes, or if the recurrent outbreaks are causing a lot of anxiety for your partner, then he or she may benefit from suppressive therapy (taking oral antiviral tablets continuously), which prevents or reduces recurrences.

What can we do to reduce my chances of getting the Herpes infection
If you take the necessary precautions, the chances of getting the herpes virus from your partner are reduced. Genital herpes does not mean abstinence from sex or a reduced enjoyment of sex.

The risk of transmitting the herpes virus can be reduced about 50% if you use condoms. The continued use of condoms in a long-term relationship is a personal decision that only the couple can make. Most find that as the importance of the HSV infection in their relationship is seen in perspective, that condom use becomes less relevant if this is the only reason condoms are being used.

However, most couples choose to avoid genital skin-to-skin contact during an active episode of herpes because this is when the herpes virus is most readily transmitted. This period includes the time from when your partner first has warning signs of an outbreak, such as a tingling or burning in the genitals, until the last of the sores has healed. Also, sexual activity prolongs the healing of the episode.

Herpes transmission risk is increased if there are any breaks in the skin. For example, if you have thrush or small abrasions from sexual intercourse, often due to insufficient lubrication. It can be helpful to use a lubricant specifically for sexual intercourse and avoid sex if you have thrush. Sexual lubricant is helpful right at the start of sexual activity.

Sores in other areas – such as the buttocks and thighs – can be just as contagious as those in the genital area, and care should be taken to avoid direct contact with such sores during sex.

At other times, there is still a small risk of transmitting the herpes infection through a process known as asymptomatic shedding, even if your partner is showing no signs of genital herpes. This risk can be reduced significantly if a person with herpes takes suppressive oral antiviral treatment.

If you or your partner has a cold sore, it is advisable to avoid oral sex as this can spread the herpes virus to the genitals.

You cannot catch genital herpes by sharing cups, towels or bath water, or from toilet seats. Even during a herpes outbreak, it is only skin to skin contact with the parts of your partner’s body which have the herpes sores which you need to avoid. You can still cuddle, share a bed, or kiss.

Where can I get more information and advice??
After you have read this booklet and discussed genital herpes with your partner, you might have specific questions or concerns about herpes. Your doctor or your partner’s doctor should be able to answer such questions or recommend other experts who can provide advice and support about herpes. Continue to go back to your doctor or counselor until all your queries about genital herpes are answered.

Sexual Health Clinics also provide confidential free treatment, management and information.

In some areas, there are local genital herpes support groups that can be a valuable source of information and support.

Controlling recurrent Genital Herpes: the use of oral antivirals in Herpes management
The following section gives you in-depth information about the use of oral antivirals to treat herpes. Aciclovir has been used for this indication for a number of years now and found to be highly effective in controlling herpes recurrences.

Some people with genital herpes have identified factors which may influence frequency or severity of recurrences. Factors such as stress, diet and lifestyle may be worth considering when looking at ways of managing herpes in your life. Each case is individual and what works for one may not work for another.

Frequent or severe recurrences of genital herpes infection may interfere with normal work and social activities, and cause disruption to your sex life. However, there are steps which you can take to reduce outbreaks and help bring the herpes virus under control. This section explains what you can do and answers some other questions which you may have about living with genital herpes.

Recurrences
Once you have acquired the herpes simplex virus (HSV-2) it remains permanently resident in your body, living in a structure called the dorsal root ganglion, which is part of the nervous tissue located near to the base of the spinal column. It spreads down the nerve to break out on the skin from time to time. Most of the time it is inactive, but every so often something happens to reactivate it, which causes the symptoms you recognize. Sometimes the herpes virus can reactivate and be shed without recognizable herpes symptoms (asymptomatic shedding).

It is not known exactly why the herpes virus becomes active again. Some people recognize certain trigger factors which contribute to an outbreak. These may include friction due to sexual intercourse, ill health, stress, fatigue, depression, loss of sleep, direct sunlight and menstruation.

Many people find that as the years go by the number and severity of their herpes recurrences naturally diminish. There may be several reasons for this, for example, changes in lifestyle, in the body’s immune system, in the herpes virus itself, or in your ability to cope with the trigger factors.

Education and counseling will often help an individual cope with recurrences. People who make contact with a support group for people with genital herpes often describe this as being a turning point in their coping with genital herpes in their life.

What is ‘suppressive therapy’
Suppressive therapy involves taking an oral antiviral drug every day for prolonged periods. It interferes with the herpes virus’ reproductive cycle and so prevents or dramatically reduces the number of recurrences. When recurrences do occur, they are usually less severe and shorter lasting.

If you find the frequency of your outbreaks unacceptable, or if you are finding it difficult to cope emotionally with having recurrences of genital herpes, tell your doctor and discuss the use of suppressive therapy.

How effective is suppressive therapy
Studies have proven that continuous suppressive antiviral therapy for herpes can dramatically reduce the frequency of herpes outbreaks or prevent them altogether and reduces the risk of transmission by 50%.

For example, a very large study found that people who had an average of over 12 herpes occurrences a year, could reduce the frequency of their herpes outbreaks to less than two a year after one year of continuous suppressive therapy.

The study also showed that if recurrences do occur during suppressive therapy, they are usually less severe and shorter lasting.

“I didn’t want to take any drugs, so I tried natural therapies. These didn’t work. I now take Aciclovir 400mg twice a day and have not had any outbreaks since. If your outbreaks are frequent, I really recommend it.”

Who is suppressive therapy suitable for
Your doctor may agree that suppressive antiviral therapy is suitable for you if one of the following applies to you:

You are having frequent herpes recurrences.
You have less frequent but particularly severe or long lasting herpes outbreaks.
You find recurrences of genital herpes are making you depressed, anxious or withdrawn, or the emotional upset caused to you by genital herpes is disrupting your social activities or sex life. Such feelings can themselves bring on a recurrence and so you can easily get into a vicious cycle. Taking suppressive therapy, perhaps only for a short time, can help you break the cycle and give you a sense of control over the infection.
You experience severe pain (neuralgia) due to recurrent herpes episodes.
You have only a few herpes recurrences but they always occur during specific situations, for example, when you have exams or go on holiday. You may wish to start suppressive therapy before you go on holiday and continue on it until you return, thereby reducing the chance of a recurrence.
You have recurrences when you are starting a new relationship – suppressive therapy may decrease the risk of herpes transmission to your partner.
You know that stress is a trigger factor for your herpes recurrences, and you are going through a stressful period, for example a new job or a recent death in the family.
You want to avoid a situation which would be spoilt by a herpes recurrence, for example if you are going on your honeymoon.
You have another illness which triggers a recurrence of herpes – a course of suppressive therapy may be appropriate until the condition triggering the outbreak has resolved.
How do I take suppressive therapy??
There are two oral antivirals available for suppressive treatment.

Aciclovir tablets 400mg taken twice daily, morning and night. If you start suppressive therapy, it is important not to miss any doses and to take it regularly at approximately 12 hourly intervals. If your recurrences are not suppressed by this dose, you should discuss this with your doctor as taking 200mg four times a day may be more effective. Aciclovir is also available in a soluble form if you are unable to swallow tablets.

Valtrex tablets 500mg taken once a day. People who find Aciclovir isn’t working in treating problematic recurrent herpes, can now access Valtrex by fully subsidized prescription from their doctor through a Special Authority application. This is a new generation antiviral with better absorption.

How long will I need to take the treatment??
Many people who use suppressive therapy say that they get so used to taking the tablets or capsules they are happy to continue with the treatment.

If you choose suppressive therapy, you do not have to stay on it permanently. If you prefer, you can take it until you feel in control of the herpes infection, but this is usually a period of 6-12 months initially. Your doctor may suggest you stop the suppressive therapy for several months after you have taken suppressive therapy for some time, in order to assess how active your genital herpes remains. If you are still having problems with herpes recurrences, you and your doctor may then decide that you should start suppressive therapy again.

Is it safe to take the treatment for a long time??
Aciclovir has been reported to cause no serious side-effects, even after years of use. A few people taking suppressive therapy do experience minor side-effects such as headache, nausea and diarrhea. If you have a problem, discuss this with your doctor.

Research to date shows that people with normal immune systems who are on oral antivirals for a long period do not develop virus resistance or clinical breakthrough. Also, there is little interaction with other drugs, e.g. the contraceptive pill is unaffected by Aciclovir.

Will suppressive therapy make it easier to live with Genital Herpes
Suppressive herpes therapy may give marked improvement to your emotional well-being. Many people find the fact that they can control the infection gives a boost to their sense of well-being and self-confidence. Even if only taken for a few months, suppressive therapy can help you to come to terms with emotions caused by recurrent genital herpes, including depression and anxiety.

However, suppressive therapy is only part of it. There are benefits gained from expert counseling from your doctor or nurse, or by speaking to a counselor. Make sure that you continue to talk to a health professional you are comfortable with, at least until you feel completely at ease with having genital herpes and in command of the infection.

Are any other treatments effective against Genital Herpes
The antiviral drug Aciclovir was the first therapy which had been shown conclusively to be effective in treating genital herpes. New antiviral drugs have become available which work in a similar way to Aciclovir, are more effective and require less frequent dosing to treat or suppress the recurrence.

Recent studies using an HSV-2 vaccine are showing some promise in both prevention and transmission of HSV-2. However, these are still in the developmental research stage and will not be available commercially for some years.

Many people find that having a healthy diet, eating regularly and getting enough sleep are helpful in preventing recurrences.

Can Genital Herpes harm babies, either during or after pregnancy??
Having genital herpes does not affect your ability to have a baby. Overall, the incidence of neonatal herpes (babies up to 28 days old infected by herpes) is very rare. However, when it does occur it is potentially very harmful to the baby. It is therefore important to tell your doctor or midwife if you or your partner have had a history of genital herpes. They will then be able to provide information, reassurance and optimal management.

Recurrent episodes of genital herpes during pregnancy are not harmful to the fetus. If you have genital herpes at the time when your baby is due, there is a small risk that the baby could become infected at delivery as it passes down the birth canal. This risk is most substantial for mothers who are having their first ever episode of genital herpes near to or during delivery. However, if you are simply having a recurrence of genital herpes, then the chances of your baby becoming infected with herpes at delivery are low as the baby is protected by antibodies circulating in the mother’s blood.

Is it safe to take drug treatment for Genital Herpes during pregnancy?
As with any drug therapies, oral antiviral tablets are not routinely recommended for use during pregnancy. Aciclovir has been used for treating genital herpes for over 15 years and as with any drug, a register has been kept to report any adverse side effects for women who have taken it during pregnancy. To date there have been no adverse side effects reported for either the baby or the mother.

Due to the potential seriousness of a primary episode of genital herpes for the baby and the relative safety of Aciclovir, it is now recommended that Aciclovir is used for treating a first episode of genital herpes or severe recurrent herpes in the last trimester of pregnancy. It is believed that the benefit of using Aciclovir, by reducing the risk of transmission of herpes to the baby, outweighs the risk of not using it.

Episodic treatment
Episodic treatment is taking a short course of Aciclovir at the onset of a recurrence. Those who have less frequent recurrences may find episodic herpes treatment useful. It works best if treatment is taken as soon as warning signs of an impending herpes recurrence (such as neuralgic pain and/or tingling or buzzing sensation in the skin), occur. If taken soon enough, it may stop ulcers developing (known as aborting the lesion). It helps to have Aciclovir available beforehand. If you want to use episodic treatment, ask your doctor to prescribe a supply for you.

This approach will not have any effect on asymptomatic viral shedding and hence its effect on reducing herpes transmission is unclear and not likely to be very significant.

This approach is useful, however, for persons who have infrequent attacks or for when persons are stopping continuous suppressive therapy.

 

 

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