Genital herpes is a common sexually transmitted infection which can cause blisters or ulcers on the genital skin. It is caused by a virus called herpes simplex virus (HSV). Genital herpes is similar to cold sores found on the mouth: they are both caused by the HSV virus, just different types. Genital herpes can be due to either type 1 or 2 and cold sores are usually due to type 1.
What causes the disease?
Genital herpes is caused by herpes simplex virus (HSV), either HSV-1 or HSV-2. HSV gains entry to the body through the delicate membranes of the genital tract, mouth, and anus, or through tiny abrasions in the skin (initial infection.)
The virus then enters adjacent nerve tissue, where it persists but is generally kept under control by immune cells in healthy skin. However, certain factors, especially trauma to the skin, result in weakening of the skin’s protective immunity and release of virus particles onto the skin surface (recurrent infection.)
What is oral herpes?
Oral herpes is usually caused by HSV-1 and can result in cold sores or fever blisters on or around the mouth. However, most people do not have any symptoms. Most people with oral herpes were infected during childhood or young adulthood from non-sexual contact with saliva.
Is there a link between genital herpes and oral herpes?
Oral herpes caused by HSV-1 can be spread from the mouth to the genitals through oral sex. This is why some cases of genital herpes are caused by HSV-1.
How is genital herpes passed on?
Genital herpes can be passed from one person to another during sexual contact. Anyone who’s sexually active can get the virus and pass it on. Herpes simplex is most likely to be passed on just before, during or straight after an outbreak.
Genital herpes can be passed on: O from one person to another during vaginal or anal sex, or by sharing sex toys O by direct genital contact – you don’t need to have penetrative sex (vaginal or anal) O by skin to skin contact with the affected area during sex, if the virus is active on the skin outside of the area protected by a condom or dam (a latex or soft plastic square) O if you receive oral sex (going down, giving head) from someone who has a cold sore or is just about to get one O if a person with an active herpes sore on the hand or finger touches a partner’s vagina, genitals or anal area.
If you’re pregnant it’s possible to pass the virus to the baby if you’re having your first outbreak at the time of giving birth. If you already have one type of herpes simplex virus it’s still possible for you to get the other type although you may not notice symptoms. You can’t get genital herpes from hugging, sharing baths or towels, from clothing, from swimming pools, toilet seats or from sharing cups, plates or cutlery.
What are the signs and symptoms of genital herpes?
Many people won’t have any visible signs or symptoms at all, or won’t be aware of them. Some people will get symptoms within 2-14 days of coming into contact with the virus. In others, the virus may be in the body for weeks, months or years before signs or symptoms appear. So if you get symptoms it doesn’t necessarily mean you’ve only just become infected. If you do get signs or symptoms, they usually follow a pattern.
You may feel generally unwell with flu-like symptoms, which might include fever, tiredness, headache, swollen glands, aches and pains in the lower back and down the legs or in the groin. This may be followed by: O stinging, tingling or itching in the genital or anal area O discharge from the vagina O discharge from the urethra (tube where urine comes out) O small, fluid-filled blisters which could be in the genital or anal area, on the buttocks, or at the top of your thighs; these burst within a day or two, leaving small, red sores which can be very painful O pain when passing urine (peeing) caused by urine flowing over the sores.
Both virus types can cause genital herpes but with different outcomes. HSV-1 is the cause of oral cold sores and genital HSV-1 infection occurs when someone with the cold sore virus (who may or may not have symptoms) performs oral sex on someone who has had no previous exposure to HSV-1. Initial genital HSV-1 infection may be quite painful, but recurrences and viral shedding without symptoms occur much less frequently than with genital HSV-2 infection. People with genital HSV-1 infection rarely need to use antiviral treatment after the initial episode and rarely transmit the infection to sexual partners.
Genital HSV-2 infection, on the other hand, is associated with frequent symptomatic recurrences as well as atypical and asymptomatic viral shedding episodes, and a risk of transmission to sexual partners.
Most people with genital HSV-2 will, at some time, require treatment with antiviral medications for control of recurrences or relief from symptoms. Initial oral HSV-2 infections are uncommon and almost never recur in healthy people. Oral cold sores are virtually always caused by HSV-1 infection
Antiviral medications (Valtrex®, Famvir®, Zovirax®) help manage the symptoms of herpes. They are very effective and very safe, even when taken for prolonged periods. Initial HSV infections should be treated for up to 14 days to reduce the severity and duration of the initial episode. Mild and infrequent recurrences can be treated with short (e.g. 2-day) courses, i.e. episodic therapy.
Treatment should be started at the first sign of symptoms and, if taken early enough, e.g. at the stage of itching or redness, can sometimes prevent the full development of herpes lesions. Frequent recurrences can be suppressed by taking a continuous daily dose of as little as 1 tablet daily. This suppressive therapy also has the advantage of reducing transmission to sexual partners. People with herpes frequently switch between episodic and suppressive therapies according to their needs and circumstances.