What is herpes?
Herpes simplex is a virus. It is the most common infection there is that causes vulval blisters and ulcers. There are two types of HSV: HSV1 and HSV2. HSV 2 used to be responsible for most cases of genital herpes and HSV1 for cold sores, but this is changing and HSV1 is becoming more common as a cause of genital herpes.
How do you catch genital herpes?
HSV is caught by making contact with another infected person through vaginal , oral or anal sex or by genital to genital skin contact.
Unlike cold sores, which are usually caught during childhood, HSV of the vulva is a sexually transmitted disease. It is therefore rarely seen in children. Not every case of herpes of the genital area in children is sexually acquired however, particularly where the child has an underlying skin disorder such as eczema. The occurrence of genital herpes in a child with no predisposing factors does raise the question of child sexual abuse.
If you have caught herpes you can infect another person, even when you are not having an attack. This is what is known as viral shedding.
What are the symptoms?
Herpes doesn’t always cause symptoms and many people don’t therefore know they have it.
For those who do get symptoms, the first, also known as the primary, attack is always the most severe. Painful blisters are found on any part of the genital and perianal skin and mucosa(moist inner surface of the vagina and anus). They range in size from about 3 – 6mm and rapidly erode leaving ulcers. Ulcers may join up to cause larger ulcerated areas. Lesions may extend to the inner thighs and buttocks, around the anus, in the pubic hair. They may just occur on one side of the genital area. Lesions may be numerous or few in number. Lymph glands in the groin are swollen and tender and you may feel unwell with headache, fever and aches and pains. It may be difficult to pass urine. If you don’t have treatment the attack usually lasts up to two weeks.
Most patient only ever experience one attack of genital herpes, however it may recur at any stage of life and recurrences may be frequent or infrequent.No one knows why healthy patients may or may not get recurrences. Patients with HIV disease may experience severe genital ulceration due to HSV.
Second and subsequent attacks are much less severe. People complain of tingling and itching, often starting before the first blister. Attacks last 1-2 weeks.
How is genital herpes diagnosed?
Diagnosis of HSV is made by a viral swab test called PCR, sampled by swabbing a new blister. This technique is accurate and identifies whether you have HSV 1 and 2. The sooner you come in for the test after you get a new blister the more accurate it will be.
There is also a blood test but this is much less accurate and can be misleading. The best test is a positive swab.
How is genital herpes treated?
If you have mild or infrequent attacks, you may not need treatment. However antiviral drugs are available. These act directly against HSV virus to stop it from multiplying. These drugs cannot remove the virus from the body, but by stopping it multiplying they can relieve outbreaks. Taken continuously, they can prevent most outbreaks altogether.
Three antiviral medications are available: aciclovir, valaciclovir and famciclovir. All three reduce the symptoms and duration of acute attacks.
If you experience recurrent herpes, all antiviral agents may be used intermittently or continuously depending on the frequency of attacks. These medications are well tolerated and long term have an excellent safety record.
So you can either:
- Take medication at the first sign of an attack (episodic therapy) – dosage and duration of treatment depends on the specific medication. Newer short course 2 day treatments are as effective as longer 5 day treatments.
- Take medication everyday to prevent attacks (suppressive therapy).
I am scared to have sex with a new partner. Will I infect him or her?
The only way to be absolutely sure you will not transmit infection is to avoid having sex. However you can reduce (but not eliminate) the risk of transmission by Safe sex practices. Continuous antiviral medication will also reduce the risk of transmission to a susceptible partner.
If your partner has had cold sores, they will generally be immune to genital HSV1 and will have less risk of catching HSV2. This is why it is important for you to know which sort of herpes you have. If you partner has already had HSV2 genital herpes themselves, you cannot transmit it to them any further: they already have it. If they get an attack, it will be a reactivation of their previous herpes, not a new infection.
If your partner has never had herpes, it is usually easier to honestly discuss the risks with them than admitting to having herpes if they develop symptoms. Whilst herpes can cause a lot of anxiety, most strong relationships survive and herpes eventually becomes much less of an issue.
Women have twice the risk of males of catching HSV from their partner.
I am pregnant. Can my baby catch herpes?
If you have a vaginal delivery, there is a very small chance of your baby catching herpes. This can be serious. This is most likely to happen if you catch herpes for the first time in the last 3 months of pregnancy or if you have an active herpes blister at the time you go into labour. It can rarely happen to babies where the mother didn't even know she had herpes.
If you know you have genital herpes and are pregnant you should discuss this with your obstetrician or midwife.
Can herpes cause vulval pain or vulvodynia?
HSV is never fully eradicated from the body and lives in your nerves that record pain and other sensations. This is very rare but some patients with chronic vulval pain do appear to get better on antiviral medications. However it is much more likely that chronic pain of the vulva is caused by something else.
I feel really shattered by a diagnosis of genital herpes.
A diagnosis of genital herpes is emotionally devastating for most women. So it is really important to make sure this is really what you have. There are several conditions of the vulva that blister and not every blistering condition is genital herpes. So if you suspect you have it, go straight to your doctor as soon as you have an attack and have a swab test.
If you do have genital herpes you will have many questions. Speak to your doctor and if necessary see a counsellor to discuss your feelings and how you will manage to come to terms with it.