Genital herpes
Herpes is a sexually transmitted virus that usually affects the mouth and or genitals. Once you are infected the virus remains in you for life. In most people the infection is subclinical, in other words you might not know that you have been exposed.
Genital herpes can be caused by either Herpes Simplex Virus 1 or 2 (HSV1 or HSV2).
After the initial attack there will be periodic reactivation of the virus causing symptoms, and there can be asymptomatic shedding of the virus which means you can pass on the virus even when you do not have herpes symptoms of an acute attack.
If you are HIV positive the risk of passing on both the herpes and the HIV infection is increased.
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Symptoms
In some patients HSV infection may be asymptomatic, i.e. no specific genital herpes symptoms and the attack can pass unnoticed. Most people will develop symptoms though and these include:
- Painful ulceration and/or blisters on the genitals
- Painful urination
- Vaginal or urethral discharge
- Enlarged and tender local lymph nodes with or without a flu like illness
Most outbreaks tend to affect the same area every time but you can spread the infection to fingers and adjacent sites.
Diagnosis
We can do a simple blood test to check for HSV1 and HSV2 antibodies. It is difficult to determine how recent the herpes infection is although we can perform serial samples to see if someone who was HSV negative becomes positive after a contact.
If you get a positive antibody test showing HSV1 this only means you have been in contact with the virus at some time and cannot differentiate between oral and genital herpes. HSV2 antibodies are usually indicative of genital herpes.
We recommend this type of herpes testing in people who have symptoms suggesting herpes, especially if the attacks are recurrent and in investigating asymptomatic partners of patients with genital herpes, including pregnant women.
If you do develop some suspicious lesions it is often better to come in right away so that we can do a swab test from the affected area. This is a much more effective way of diagnosing or excluding herpes. If it is herpes it will also tell us which type it is.
Treatment
If you are diagnosed with genital herpes it is important to realise it is not the end of the road when it comes to your sex life. There are many people out there with herpes who have a very normal and active sex life.
Even though at present time there is no vaccine or cure, there are certainly effective treatments that can help limit the extent of an attack or shorten the duration of an attack. The most important thing is to be treated as soon as possible, as we know that treatments work best if taken within 2-3 days of developing lesions. It is therefore essential to get an early diagnosis where possible.
If you get very frequent attacks we can also try suppressive antiviral therapy for a few months to see if it keeps the virus at bay.
There are certain things you can do to try and limit the frequency of attacks, such as getting enough sleep, avoiding getting too stressed or run down, as we know that these factors can influence the frequency of attacks.
Prevention
Unfortunately there are no ways of completely protecting against transmitting the genital herpes virus to sexual partners. Abstaining during outbreaks, using condoms and taking suppressive anti viral therapy can reduce the risk.