What is herpes and how common is it?
Herpes is caused by a virus called Herpes Simplex Virus (HSV). There are two types, type 1 and type 2. These viruses can also cause cold sores around the mouth.
Herpes is very common. Seven out of ten people aged over 25 have either herpes type 1 or 2.
Both types of herpes can cause oral or genital symptoms. It is also possible to have the virus without any symptoms. Only about one in four people know they have it, which means it is easy to pass on without realising.
A sexual health clinic or GP can confirm the diagnosis with a swab (a small cotton bud), but most people have such mild symptoms they do not seek medical advice. Herpes symptoms can be recurrent, which means that the symptoms may come and go. The virus will always stay with you although your immune system will learn to control it over time.
Herpes is usually limited to one area of the body, for example the genital area, or the mouth and face called a cold sore, or on the fingers, called a whitlow. Sexual health services manage genital herpes. For herpes in other areas speak to your GP or local pharmacy if you need to.
Genital herpes is different to chicken pox or shingles, which are caused by the varicella zoster virus, or glandular fever which is caused by the Epstein-Barr Virus. If you are worried about shingles, chicken pox or glandular fever please talk to your GP.
What are the symptoms of genital herpes?
The symptoms of genital herpes may appear between two to fourteen days after contact and include:
- tingling, burning or itching sensation in the genital area before the sores appear. This is sometimes called a prodrome which can be a sign that genital symptoms are on the way
- small blisters which become painful sores in the genital area (vulva, penis, anus, bottom or thighs)
- swollen painful glands in the skin crease at the top of the legs
- pain when urine touches the sores – if you are not able to pee (urinary retention) speak to a doctor as soon as possible
- new discharge (anything that is not normal for you)
When people have herpes for the first time they can have ‘flu-like’ symptoms including body aches, a temperature and feeling tired. This is partly caused by the immune system producing antibodies and starting to control the virus. The first episode often has the most symptoms, and it may last for one to two weeks. As the immune system forms antibodies, recurrences become less frequent, shorter and less painful.
It is possible to have a recurrence at any time, but some people notice triggers such as missing out on sleep, sun exposure or stress. If you have HSV type 1 in the genital area, you are less likely to have recurrences than if you have HSV type 2.
How is herpes transmitted?
Herpes is passed on from skin-to-skin contact with someone who has herpes. This is more likely to happen when someone has tingling, blisters or sores, but it can be passed on when the skin looks and feels normal. This is called asymptomatic shedding. This is when the virus comes to the skin surface without causing any symptoms. This happens more frequently in the first six to twelve months after initial infection but will reduce as the immune system forms antibodies and controls the virus.
If you have symptoms we advise you not to have sexual contact or use a barrier, such as condoms for oral, anal or vaginal sex, to reduce the chance of passing it on.
Oral herpes, usually type 1, can be passed on through kissing and can cause genital herpes following oral sex with someone with a cold sore.
You cannot pass on herpes from household objects such as sharing cutlery, crockery or bathrooms. The virus is killed by soap and water.
If you have herpes during pregnancy, it is possible to pass the virus on during delivery of your baby which can cause serious complications. You will be offered anti-viral tablets to take for the last few weeks of your pregnancy to reduce any risks. You must discuss this with a sexual health doctor and your midwife.
How is herpes diagnosed?
Herpes can be diagnosed at a sexual health clinic or by your GP if you have symptoms of blisters or sores. If you have symptoms, please come to see us.
You will be examined and a swab will be taken for laboratory testing. The swab test involves a clinician running a cotton bud over the blister or sore. If the skin is dry or blisters have healed, this test can miss herpes. Usually we can make a provisional diagnosis based on your examination and start you on treatment straight away. You should also have a sexual health screen (swabs/urine/blood tests) to look for any other sexually transmitted infections.
Sexual health clinics do not offer a test for people who have come into contact with herpes (except in very specific circumstances, like pregnancy) unless they have symptoms.
We do not routinely offer a herpes blood test, they are not very accurate and even when antibodies are detected, we cannot say whether this is oral or genital infection or when the virus was picked up. Remember that most adults have either HSV 1 or 2. We don’t advise paying for a herpes blood test.
How is herpes treated?
The first time you have herpes you will be given a five day course of anti-viral tablets called aciclovir and pain relief to apply to the skin to help manage your symptoms if you need it.
For recurrences when your immune system has formed antibodies, herpes symptoms will be milder and go away on their own. Often tablets are not required. If your recurrences start with a tingling, burning or itching sensation in the genital area we sometimes provide you with two-day treatment courses to take as soon as you realise the virus is on the way to the skin. This can stop a recurrence altogether if taken promptly. Once the skin breaks down though anti-viral tablets do not offer much benefit.
There are lots of things you can try at home to make yourself more comfortable:
- keep the area clean – you could use salt water (1 teaspoon in one pint of water) to bathe the area, which will reduce the chance of the sores becoming infected. Wash your hands afterwards.
- take simple pain relief like paracetamol or ibuprofen, or pain relief gel or cream
- if it is too painful to pee try peeing in the bath or using a jug to pour water over your genitals whilst you pee. Drink plenty of water to keep your pee diluted
- use a soothing compress like a cool flannel – do not apply ice directly to your skin
- avoid irritating the area, avoid tight clothes, tight underwear or excessive washing/wiping
- refrain from sexual contact whilst you have symptoms (and until it is comfortable again)
If you are struggling with recurrent symptoms of herpes every month or so we can discuss ‘suppressive’ treatment where you take a smaller daily dose of anti-viral tablets.
Treatment for genital herpes is free from sexual health clinics.
Herpes in pregnancy
If you know you or your partner have herpes and you are pregnant you should discuss this with your midwife.
It is important to remember that herpes can be passed on during childbirth. Neo-natal (newborn) herpes is uncommon but can be very serious, your doctor or midwife might give extra advice about your birth plans, including taking anti-viral medication near to the time you are due to deliver.
The chances of neo-natal transmission of herpes are highest if you have your first episode of herpes whilst you are pregnant.