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What is herpes?

Genital herpes, an infection of the genitals (the male’s penis and the female’s vagina) due to the herpes simplex virus, also usually affects the skin in the surrounding area of the genitals (i.e. buttocks and/or anus) alongside other parts of your body (e.g. fingers, when the herpes infection is termed a ‘whitlow’).

There are two varieties (types 1 and 2) of herpes simplex. Type 1 most often leads to the development of cold sores around the area of your mouth and it also causes about half of the genital herpes cases. Cold sores can be symptomatic of the type 2 virus, but it usually only presents as genital herpes.

Your IPSA Medical genital herpes consultation

Your IPSA Medical sexual health clinic provides a complete and highly confidential genitourinary medicine (GUM) service. If you do know or suspect that you have this type of infection, then your IPSA Medical clinic offers a same-day herpes consultation, where you will be offered advice/full investigations in a non-judgemental, client-focused and calm environment. As IPSA Medical has a state-of-the-art on-site pharmacy, medications are immediately to hand.

As with all of IPSA Medical’s services, both for your herpes consultation and for any of the resulting reports/lab results/test results, we guarantee discretion and confidentiality. You will be seen by a highly experienced IPSA Medical GUM clinician, who is an expert at both diagnosing and treating herpes simplex. During your herpes consultation, any of the required samples will be taken by your IPSA Medical clinician, with fast results and with the option to call your IPSA Medical clinician to hear your results over the phone. Your herpes consultation at your IPSA Medical clinic will involve a full review of your sexual history to enable a sexually transmitted disease (STD) risk assessment, and any of the sores/ulcers that you have will then be examined. This helps your IPSA Medical physician to evaluate your particular risk level and to advise you on possible further tests that might be necessary.

How is genital herpes contracted?

Genital herpes is mainly transmitted via skin-to-skin contact with a herpes-infected individual. The moist skin linings present in your genitals, your mouth and your anus are most susceptible to this kind of viral infection, with the virus usually being transmitted through anal sex, oral sex (mouth-to-genital sex), or through vaginal sex, and it can also be passed on via close genital contact with a herpes-infected partner (e.g. if you have a cold sore, you might transmit the genital herpes virus when having oral sex). The virus can be transmitted through skin cuts/breaks (e.g. if you have cuts/skin breaks on your hands, knees, or fingers etc.) if these areas are exposed to your partner’s herpes-infected area.

The chances are slim of you re-infecting yourself with your herpes virus via accidental touching, and of you catching your herpes virus in a different part of your body from an infected partner.

What are the common symptoms of genital herpes?

When you are first infected with genital herpes (the ‘primary infection’), you might or might not develop herpes symptoms. Once you have been infected, the herpes virus remains inactive (dormant) in your body in a nearby nerve. In some infected individuals, the virus occasionally ‘activates’ and travels along the nerve, entering into your skin. If your primary infection was in your genital region, then you will experience recurrent genital herpes symptoms; if it was around your mouth, then this results in recurrent cold sores.

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

The majority of herpes-infected individuals never develop any herpes symptoms; at least 80% of those infected with genital herpes simplex don’t know they are actually infected. They might have experienced only mild symptoms (e.g. a small, red, rapidly fading area or just a slight itch). For these infected individuals, the herpes virus stays in a dormant (inactive) form in the nerve root supplying their genitals, never producing recurrent episodes with herpes symptoms, but the virus might sometimes be present in their genital region and, at these times, they are infectious; this is often how genital herpes simplex infections are transmitted.

Symptoms of a first episode of genital herpes

  • At first, you might feel slightly unwell with a mild fever and aches/pains
  • Groups of small and painful blisters form around your genitals and/or your anus
  • Over 1–2 weeks, the blisters can erupt into ‘crops’, which burst and turn into sore/shallow ulcers
  • The glands might swell in your groin (and this might feel like ‘lumps’ are present at the tops of your legs)
  • Painful urination is possible, particularly for women
  • A vaginal discharge is also a possible symptom in women

Women with genital herpes: ulcers/blisters may develop on your cervix (this is at the top of your vagina: the neck of the womb) and these can last for up to twenty days, healing gradually and leaving no scarring. The inside area of your anus/back passage can also be affected.

The less typical symptoms (which might only last a few days) experienced with genital herpes are a small, raw area developing, only a few small ulcers developing, or simply having some irritation with no blister/ulcers or visible red areas.

As your first symptomatic episode can arise months or years after you first pick up the infection, your first episode with herpes symptoms can occur when you are in a faithful, current sexual relationship, because you could have picked up the herpes infection months/years before from a previous sexual partner who was perhaps not aware of being infectious.

We still don’t know why some herpes-infected individuals develop symptoms, others don’t, and why others don’t have their first episode with symptoms for months/years after first picking up the infection. It might be because the immune system reacts differently to the herpes virus in different people.

Genital herpes symptoms: Recurring episodes

Following a first episode with herpes symptoms, further episodes (recurrences) can occur. It is unclear as to why the dormant virus erupts. These recurrences are mostly less severe and briefer than your first episode with symptoms for only 7–10 days instead of the 10–20 days you might have experienced with your first episode, and with the time varying between each recurrence, generally becoming less frequent over the years. Some infected individuals have more than six recurrences each year, while others have none. There is usually no fever and you usually don’t feel unwell with recurrences; however, 12–24 hours prior to recurrences, itching/tingling in the genitals is a fairly common sign of the onset. Some herpes-infected individuals can identify triggers for these recurrences (e.g. stress, sunlight, physical illness, excess alcohol). If you do know your recurrence triggers, try to avoid them.

What tests are undertaken at my IPSA Medical consultation?

Your IPSA Medical clinician will use a swab to sample one of your herpetic blisters, if present, for laboratory testing. This confirms if your current infection is due to the herpes simplex virus. Treating and diagnosing you holistically, and having run through your sexual history with you, your IPSA Medical specialist might recommend you are tested at the same time for other possible sexually transmitted infections, with these additional tests being undertaken in the comfort of your IPSA Medical GUM clinic during your genital herpes consultation. If your IPSA Medical specialist diagnoses herpes simplex, then she/he will discuss the possible herpes treatment methods and the general protocol for easing your herpes symptoms during a recurrence.

What treatments are available for genital herpes?

You can take some general measures that will ease your genital herpes symptoms:

  • Painkillers (e.g. paracetamol) can help with the pain.
  • Homemade ice packs (ice wrapped in a tea towel) can be placed for 5–10 minutes over your sores: don’t put the ice in direct contact with your skin or you could risk ice burns.
  • Used tea bags can give relief if placed over your herpetic sores.
  • Pass water over your genital area or sit in a warm bath to urinate if urination causes pain.
  • Dilute your urine to reduce the pain of urination by drinking lots of fluids.
  • Avoid sexual intercourse until your sores/ulcers have cleared or you have visited your IPSA Medical GUM clinic.
  • Use anaesthetic ointment (e.g. 5% lidocaine) to relieve pain/itching. Apply it 5 minutes prior to urinating if urinating causes pain. Bear in mind that some individuals are allergic to these ointments, so using Vaseline® is an alternative.
  • Avoid scented soap, bubble bath etc. because they can irritate your herpes symptoms. Clean your genital area gently with salt/plain water and cotton wool and use a low setting on your hairdryer to dry your genital region (as towels can cause further discomfort).

The herpes simplex virus is not transmitted from using towels, toilets and facecloths or from swimming pools.

After your herpetic episode has cleared up, you can recommence with sexual intercourse. Using a lubricant during sex can help to prevent recurrences, because the friction created during sexual intercourse can trigger some recurrences.

Genital herpes: What are the anti-viral medications?

Taking anti-viral medication (i.e. aciclovir, famciclovir, valaciclovir) does not kill the herpes virus. They work by stopping the replication of the virus and are at their most useful when you have your first episode with symptoms. They work by reducing both the symptom severity and episode duration if you start the treatment protocol within 5 days of your symptoms starting up. A 5-day treatment is standard, but your IPSA Medical specialist might extend this slightly if your blisters have not stopped forming.

Anti-viral medications might not be appropriate for recurrences because of the mildness of the symptoms and the brief duration. If your recurrence symptoms are severe, then this type of anti-viral medication might help but you must start the treatment at the onset of the recurrence to reduce both its duration and severity. Your IPSA Medical clinician might prescribe an anti-viral medication for you to keep in your home so you can initiate your own treatment when you get the warning signs of a recurrence.

If you have quite frequent recurrences, your IPSA Medical specialist might discuss taking anti-viral medication daily, because your recurrences can stop entirely with this protocol, or their frequency and severity reduce substantially.

Can I have sexual intercourse when I have genital herpes?

When experiencing symptoms (during your primary episode or recurrences)

Herpes simplex is highly contagious when you have the herpetic blisters, with a high chance of you transmitting the virus during sex. Avoid sex altogether from your symptoms first starting up until they have completely cleared. If you do have sex, condoms won’t fully protect your sexual partner, because they only protect the shaft of the penis that is inside the condom.

When not experiencing symptoms

When you are asymptomatic (you have no symptoms), the chance of you transmitting herpes during sex reduces, but some of the virus will be present intermittently on the skin around your genital region. This means you can still transmit the genital herpes virus when having sexual intercourse when you are asymptomatic, although the risk is reduced, so discuss this with your current sexual partner. Using condoms does reduce the chance of transmission, but they cannot completely prevent herpes from being passed on. If you are on the long-term anti-viral treatment to prevent recurrence, then your risk of transmitting the herpes virus is also reduced.

If your current sexual partner also has the herpes virus, you can’t then re-infect each other. Your partner might also be infected but might be asymptomatic. You can discuss these aspects with your IPSA Medical practitioner during your genital herpes consultation.

Are there complications from having genital herpes?

Genital herpes does not cause cervical cancer, infertility or damage to your womb. On rare occasions, the infection can spread out across other areas of your skin because sometimes, your herpetic blisters can get infected by bacteria, resulting in a spreading infection across your skin.

Genital herpes and pregnancy

Your IPSA Medical clinician will advise you regarding the steps to take if you have contracted genital herpes when pregnant, or if you have recurrent herpes and fall pregnant, as there is a chance of you transmitting the viral infection on to your baby.

What if I get my first episode of genital herpes when I am pregnant?

If your first genital herpes episode takes place during the final six weeks of your pregnancy, or if it happens near to the time of birth, the risk is at its peak (about 40%) for herpes transmitting to your baby, and for your baby developing a serious herpetic infection if you opt for vaginal delivery.

Your IPSA Medical clinician is likely to recommend a caesarean section because this type of delivery greatly reduces the chances of your baby physically being exposed to the virus that is mainly in the blisters/sores in your genital region. This greatly reduces (but not totally) the risk of infection transmission to your baby.

If you do want a vaginal birth rather than a caesarean section, then your IPSA Medical clinician will probably recommend having intravenous anti-viral medication injected, most notably, acyclovir, during labour and birth, alongside anti-viral medication for your baby after he/she has been born.

There is a miscarriage risk if you have your first herpetic episode during the initial pregnancy stages; if you do not miscarry, then your baby is not affected by the virus.

As long as a 2-month gap exists between you contracting genital herpes and the birth, then a vaginal delivery is usually safe, as there is time for antibodies to develop and be transmitted to your baby so that he/she is protected. Your IPSA Medical GUM specialist may advise anti-viral medication at the time of the initial infection to help your sores/blisters clear up more quickly and for the final 4 weeks of pregnancy to prevent a recurrence at the time of delivery. This is not the usual treatment regime; thus, the positives and negatives of anti-viral medication being taken in the 4 weeks preceding delivery will be discussed during your IPSA Medical genital herpes consultation.

What if I have recurrent genital herpes and fall pregnant?

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

There is an ongoing debate regarding the best protocol if, during childbirth, you have a recurrent herpetic episode with sores/blisters. Some doctors recommend having a caesarean section, but neither the National Institute for Health and Clinical Excellence (NICE) nor the Royal College of Obstetricians and Gynaecologists routinely recommend having caesarean sections during childbirth when blisters/sores are present from a recurrent herpetic episode because your baby has probably developed some immunity and the chances are fairly low of him/her developing a more serious herpetic infection. If you experience a recurrence when going into labour, discuss your options with your IPSA Medical specialist so as to decide on the best delivery method for your baby.

Another debatable issue relates to whether or not anti-viral medication should be given at all in the 4 weeks prior to the birth. However, it might help prevent blisters/sores recurring during childbirth. Your IPSA Medical clinician will advise you about the pros/cons of this protocol.

Summary: Pregnancy and genital herpes

Having your first herpes episode close to the time of birth could be serious for your baby. Caesarean sections are often advised. Any other situation like the earlier onset of the primary infection or recurrences means that the risk of a serious herpetic infection to your baby is fairly low; your IPSA Medical practitioner will advise you on the options during your IPSA Medical genital herpes consultation.

If you do suspect you have genital herpes (or any other kind of STD), then book your IPSA Medical genital herpes consultation today for your same-day appointment or book online through IPSA Medical’s website.

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