Herpes Screening & Treatment

About Herpes Screening & Treatment

Genital herpes, which is caused by a virus called herpes simplex, is a genital infection (the penis in men and the vulva/vagina in women) and this infection usually also affects the surrounding area of the skin. Your buttocks and/or anus might also be affected, along with other areas, such as your fingers (where the infection is called a whitlow).

There are two types (type 1 and type 2) of the herpes simplex virus. Type 1 often produces cold sores around your mouth and is also responsible for around 50% of all genital herpes cases. The type 2 virus can sometimes lead to cold sores, but usually it only causes genital herpes.

Your IPSA genital herpes consultation

Your IPSA sexual health clinic offers a full genitourinary medicine (GUM) service that is totally confidential. If you suspect or know that you do have a herpes simplex infection, then your IPSA physician will offer a same-day genital herpes consultation where you will receive advice and full investigations in a person-centred, non-judgemental and calm environment. As IPSA has an on-site pharmacy, any of the necessary medications are available immediately.

As with all of IPSA’s services, confidentiality is guaranteed for both your consultation and for any resulting reports or test results. You will always be seen by an experienced IPSA GUM clinician, who is skilled at diagnosing and treating herpes simplex. During your genital herpes consultation, any samples that need to be taken will be taken by your experienced IPSA physician, and your results will be fast, with an option to find them out over the phone from your IPSA doctor. Your consultation will involve a full review of your sexual history so that your IPSA physician can carry out a sexually-transmitted disease risk assessment, and any sores or ulcers you have will be examined. This enables your IPSA doctor to evaluate your risk level and advise you on any other tests that may be necessary.

How do you contract genital herpes?

Genital herpes is mostly passed on through skin-to-skin contact with a person who has already been infected with the herpes simplex virus. The moist skin lining your mouth, anus and genitals is the most susceptible to this type of viral infection, with the herpes simplex virus most commonly being passed on through having anal, oral (mouth-to-genitals), or vaginal sex, or just through close genital contact with a person who is infected. For example, you might pass on the virus for genital herpes if you have oral sex while you have a cold sore.

Herpes simplex virus might also enter your body through cuts or breaks in your skin on other areas of your body (your fingers or hands, knees, and so on) if they come into contact with the other person’s herpes-infected area.

You are unlikely to re-infect yourself with your own herpes virus through any accidental touching, and you are unlikely to catch your own herpes virus from your infected partner on a different area of your body.

The symptoms of genital herpes

When you are infected for the first time with genital herpes simplex, this is called the ‘primary infection’, which might (or which might not) cause symptoms. Following this primary infection, the herpes simplex virus remains in your body in an inactive (dormant) form in a nearby nerve. In some individuals, the herpes simplex virus can occasionally ‘activate’, travelling down the nerve into the skin nearby. If the primary infection was in your genitals, you will get recurrent symptoms of genital herpes, whereas if the primary infection was around your mouth, then you will get recurrent cold sores.

How common is it not to develop any herpes simplex symptoms?

The majority of those who are infected with the herpes simplex virus will never develop any symptoms, with at least 80% of people infected with the genital herpes simplex virus not knowing that they are actually infected. They may have had mild symptoms (such as a small red area that faded rapidly or a slight itch). In these cases, the virus remains dormant (inactive) in the root of a nerve supplying the genitals, and never causes any recurrent episodes with symptoms, but they may sometimes have the herpes simplex virus present in their genital area and are therefore infectious to any of their sexual partners. This is often why many genital herpes simplex infections get passed on.

The first episode of genital herpes symptoms

Initially, you might feel unwell and have a mild fever with aches/pains.
Painful, small blisters then appear in groups around your anus and/or genitals.
These blisters often erupt in ‘crops’ over 1 or 2 weeks.
The blisters then burst, turning into sore and shallow ulcers.
You may experience swelling in the glands in your groin and this can feel like there are ‘lumps’ at the tops of your legs.
Especially in women, passing urine can be painful.
Women can experience a vaginal discharge.

Genital herpes in women: ulcers and blisters might form on your cervix (the neck of your womb, at the top of your vagina) and can last as long as 20 days. These will heal gradually and leave no scarring. The inside of your back passage might also be affected.

Sometimes there are some less typical genital herpes symptoms. You might only have a small, raw area, only a couple of small ulcers, or simply an irritation with nothing visible. The symptoms might last only a couple of days.

The first episode of symptoms can appear months, or even years, after first becoming infected and so your first episode of symptoms might occur in a current and faithful sexual relationship as you could have been infected months/years previously from an earlier sexual partner who was not even aware that they were infectious.

It is still not clear as to why some people will develop symptoms, while others won’t, and why some people only have their first episode of symptoms months or even years after first becoming infected. This may be because of the way each person’s immune system reacts to the virus in slightly different ways.

Recurring episodes of genital herpes symptoms

Following your first episode, further episodes of symptoms, called recurrences, may occur in some people, and it is unclear why the dormant herpes simplex virus erupts. Theses recurrences are often shorter in duration and less severe than the first episode, with only 7 to 10 days of symptoms, unlike the 10 to 20 days of symptoms experienced during your first episode, and with a variable time between each recurrence.

Most people do not feel particularly unwell with a recurrence.
Most people do not develop a fever during a recurrence.
12 to 24 hours before a recurrence, you might feel an itch or tingling sensation in your genital region.
Recurrences often become less frequent over time.
The frequency of recurrences can vary from six or more recurrences each year to none.
4 to 5 recurrences are usual in the first two years following a first episode.

Some people are able to identify triggers for their recurrences, such as sunlight, stress, physical illness or excess alcohol. If you are able to identify your triggers, then try to avoid them, if possible.

What tests will be carried out during my IPSA consultation?

Your IPSA physician will take a swab of one of your blisters, if these are present, to send a sample to the laboratory for testing. This will then confirm if your infection is caused by the herpes simplex virus. Treating you holistically and working with you to examine your sexual history, your IPSA physician may recommend that tests for other possible sexually-transmitted infections be carried out at the same time, and these can be done in the comfort of the IPSA GUM clinic during your genital herpes simplex consultation. If herpes simplex is confirmed, then your IPSA doctor will discuss the possible treatment methods with you and also the general methods to help in easing any herpes simplex symptoms during an episode.

What is the treatment for genital herpes?

General measures to ease genital herpes symptoms:

Painkillers (like paracetamol) might help to ease any pain.
Place a home-made ice pack (wrap up some ice in a tea towel) over your sores for 5 or 10 minutes to soothe them. Do not put ice directly on your skin or it could lead to ‘ice burns’.
Some people gain relief from placing cold used tea bags on their sores.
If passing urine is painful, this can be eased by passing urine with water flowing over the area or while sitting in a warm bath.
Drink plenty of fluids to dilute your urine and make it less painful when passing urine.
Avoid sex until you have seen your IPSA physician or your blisters/ulcers have cleared up.
Anaesthetic ointment (such as lidocaine 5%) might relieve your itching or pain, and you can apply the ointment about five minutes before you pass urine, if this is painful. Your IPSA physician will discuss this with you, as some people are allergic to these anaesthetic ointments, and using the ointment makes the symptoms worse. Applying Vaseline® prior to passing any urine might be a suitable alternative to the anaesthetic ointment.
Avoid using bubble baths, scented soaps, and so on, as these might irritate the condition. Gently cleaning your sores with cotton wool and salt or plain water is advised. Gently dry the area with a hairdryer on the lowest setting, as this can be more comfortable than drying with a towel.
The herpes virus cannot be passed on by using toilets, towels, facecloths, or swimming pools.
After your episode has cleared, you can resume sex. A lubricant might help, as the friction from having sex can sometimes trigger recurrences.

Antiviral medication

Antiviral medications like aciclovir, famciclovir and valaciclovir do not rid the herpes simplex virus from your body. These medications work by stopping the herpes simplex virus from being able to multiply and are most useful during your first episode of symptoms. They reduce both the duration and the severity of symptoms if started within five days of the start of your symptoms. A five-day treatment course is usual, but your IPSA physician may extend this for a couple of days if you still have blisters forming.

Antiviral medication might not be required to treat recurrences as the symptoms are usually much milder than during your first episode, and only usually last for a few days. If you do tend to get bad recurrence symptoms, then a course of medication might be useful. Starting the medication as soon as you notice the symptoms can reduce both the recurrence’s duration and severity. Your IPSA specialist may prescribe this type of antiviral medication for you to keep at home so that you can start treatment when you experience the first signs of a recurrence.

If your recurrences are frequent, your IPSA physician may discuss the option of taking the antiviral medication every day, as the recurrences either stop completely, or their frequency/severity are substantially reduced.

Can I have sex if I have genital herpes?

When you have symptoms (during a primary episode or a recurrence)

Herpes simplex virus is highly contagious when the blisters are present with a high chance of passing on the herpes simplex virus if you do have sex. You should avoid sex from the time your symptoms first begin until they are completely over. If you have sex, a condom might not fully protect your partner from the virus, because condoms only protect the area that is actually covered by the condom.

When you do not have symptoms (which is the majority of the time)

When you have no symptoms, there is less chance of you passing on the virus during sex, but some of the genital herpes virus will occasionally be present on your genital skin surface, if infrequently. This means that there is a small chance of you passing the genital herpes virus on when you do have sex when experiencing no symptoms, so discuss this with your sexual partner. Using a condom every time you have sex can reduce the chance of passing on genital herpes further, but it cannot completely prevent passing the virus on. If you are taking the long-term antiviral medication to prevent recurrences, then you also reduce the risk of passing the virus on.

If your sexual partner has already got the same genital herpes virus, then you can’t re-infect each other. Your partner might be infected but he/she might not have any symptoms. You can discuss these things with your IPSA physician during your genital herpes consultation.

Are there any complications from genital herpes?

Rarely, the genital herpes infection spreads to other skin areas on the body.
Sometimes the blisters can become infected with bacteria (other germs), causing a spreading skin infection.
Genital herpes does not damage your uterus (womb).
Genital herpes does not cause infertility.
Genital herpes does not cause cancer of your cervix.

Genital herpes and pregnancy

Your IPSA specialist will advise you about what to do if you contract genital herpes while pregnant, or if you do have recurrent genital herpes and then fall pregnant, as there might be a chance of passing the infection on to your baby.

A first episode of genital herpes while pregnant

If you do develop your first genital herpes episode within the final six weeks of pregnancy, or near the time of the birth, the risk is the highest (about 40%) that herpes will be passed on to your baby, and that your baby might develop a serious herpes infection if born via a vaginal delivery.

Your IPSA specialist is thus likely to recommend a caesarean section delivery, as this greatly reduces the chance of your baby coming into contact with the herpes virus (mainly present in the blisters/sores around your genitals). Infection of your baby is then mostly, but not always, prevented.

However, if you do decide against a caesarean and want a vaginal birth, your IPSA specialist will probably recommend that you are given antiviral medication, usually acyclovir, intravenously (into the veins) during both your labour and birth and might also suggest antiviral medication for your baby, after he/she is born.

There is a miscarriage risk if you develop your first episode of genital herpes during the initial stages of your pregnancy, but, if you don’t miscarry, then your baby will not be damaged.

As long as there is a two-month gap between you catching the genital herpes virus and the birth of your child, then a normal vaginal delivery is probably safe, as there is enough time for the antibodies to form and for them to be passed on to your baby so she/he is protected when being born. Your IPSA GUM clinician might advise you to take antiviral medication at the time of the herpes infection to help the sores to clear up quickly. Additionally, your IPSA specialist might advise you to take the antiviral medication for the final four weeks of your pregnancy to help to prevent a herpes recurrence at the time of the birth. This is not a routine practice and the advantages/disadvantages of taking this antiviral medication for the final four weeks of your pregnancy will be discussed with you during your genital herpes consultation.

If you have recurrent genital herpes and then become pregnant

If you have recurring genital herpes episodes, the risk to your baby of developing a serious herpes infection is actually quite low, even if you have blisters or sores during childbirth, because you pass on to your baby some antibodies (and thus immunity) during the final two months of your pregnancy.

There is some debate regarding what is best if you do experience a recurrent episode of sores/blisters during childbirth. Some doctors might recommend having a caesarean section. Both the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists do not routinely recommend caesarean sections if there are blisters/sores from a recurrent herpes episode during childbirth, as your baby is likely to have some immunity to the herpes virus and the chances are low of your baby developing a serious herpes infection. If you experience a recurrent genital herpes episode when you are going into labour, then discuss your options with your IPSA specialist to decide on the best route for your baby to be delivered.

Another debatable point concerns whether antiviral medication should be given in the four weeks prior to giving birth. It might help to prevent blisters recurring during childbirth. Your IPSA specialist will advise you on the pros and cons of this approach.

Pregnancy and genital herpes: A summary

Having your first episode of genital herpes near the time of birth may be serious for your baby. A caesarean section is often advised. Any other situation, such as an earlier primary infection or recurrent episodes, means that the risk to your baby is low, and your IPSA clinician will advise you about the possible options during your genital herpes consultation.

If you do suspect that you have genital herpes (or any other type of sexually-transmitted disease), then book your IPSA genital herpes consultation today for a same-day appointment, or book online through IPSA’s website.