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Genital
herpes
- In
the UK in 2003, more than 18 000 people visited a clinic
for a first attack of genital herpes
- In
the UK, genital herpes has increased by 19% in men
and 9% in
women since 1996
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Genital
herpes is an infection with the herpesvirus, called herpes
simplex.
Herpes simplex virus is also responsible for ‘cold
sores’ that occur on
the face.
How you
catch genital herpes
You catch genital herpes during sex, by contact with someone
who has the infection on their skin. You are most likely
to catch it if your partner has herpes blisters or moist
herpes sores.
You can also catch
herpes from someone who has no visible herpes sores. About
3% of people carry the virus on their skin
without knowing that they have it (because it has never given
them any symptoms), but they can pass it on to other people.
This is one of the reasons it is important to use a condom
with a new partner. Condoms give significant protection against
genital herpes (Journal of the American Medical Association 2001;285:3100–6).
Because cold
sores are also
caused by herpes simplex virus, you can catch herpes if your
partner gives you oral sex when they have a cold sore.
The herpesvirus cannot survive for long outside the body,
so it is unlikely (but not impossible) that you will catch
it from towels.
How do I know if I have herpes?
With herpes, you do not usually have symptoms all the time.
The symptoms usually come and go in ‘attacks’ (also
called ‘episodes’).
-
The
first attack is the worst, and starts between 2 and 12
days after
you caught the infection (usually about
4 days).
-
Later
attacks (‘recurrences’)
are less severe.
-
Some people
never get recurrences, some people get them occasionally
and a few people get them regularly.
-
The severity
of the attacks varies a lot between individuals. At one end
of the
spectrum, some people have really troublesome
attacks. At the other end of the spectrum, the attack
may be so mild that the person does not notice any symptoms, which
is how people end up carrying the herpesvirus unknowingly.
First herpes attack
Women. The first time you get herpes can be very unpleasant.
First of all, you may feel as if you have flu – muscle
aches, feverishness, tiredness and headache. Then small blisters
appear on the labia (the ‘lips’ that surround
the opening of the vagina). After 3 or 4 days, they burst
to leave small, painful sores. Passing urine may be very
painful indeed, and you will probably feel completely miserable
and tearful. You may notice that the glands in your groins
are swollen and tender.
After 6 or 7 days, the sores start to scab over and slowly
heal. So it can be 3 weeks from when you first started to feel
unwell to complete healing.
Men. In men, a first attack of herpes is usually less severe
than in women. The blisters and sores may be on the glans (head)
of the penis, the foreskin, the scrotum, the thighs, the buttocks
or near the anus. Passing urine may be uncomfortable, and there
may be discomfort or pain around the anus (back passage). You
may feel feverish and generally unwell. The ulcers on the glans
or the foreskin heal softly, but those on the shaft or scrotum
form scabs as they heal.
Later attacks (recurrences)
Do not assume that you will get more attacks of herpes – some
people do not. The number and severity of recurrent attacks
varies enormously between individuals, but the average number
is about five a year in men and four a year in women. Although
this sounds bad, recurrent attacks are often very mild. Many
people find that recurrences become less frequent and even
milder with time.
You will probably not have the flu-like feeling, nor the swollen
glands in the groin, that you may have had with the first attack.
An uncomfortable tingling feeling in the genital area and buttocks
often warns that an attack is about to occur. Some people experience
shooting pains in the buttocks, legs or hips. The stage with
painful sores will usually last about 4 days, and it will all
be over in about 10 days.
Why recurrences occur
After the first attack, herpesvirus often remains because the
body has difficulty in getting rid of it completely. The
virus travels away from the genitals using the nerves in
the pelvic area as a pathway. When it reaches the clusters
of cells at the end of the nerves (called ganglia), it stops
travelling. The herpesvirus DNA then remains quietly in the
ganglia. Fortunately, it does not damage the nerves or interfere
with their function.
In some people, from time to time, the herpesvirus travels
back the way it came, along the nerve towards the genitals.
This is called activation. When it arrives in the skin, it
causes blisters and sores.
After theses sores heal, the virus goes back up the nerve
to the ganglion again, where it lies low again. But it can
become activated again at any time, and travel down the nerves
to the skin to cause another sore. The virus always travels
up and down the same or nearby nerve pathways, which explains
why herpes sores always recur in roughly the same place.
How
recurrences of herpesvirus happen
First
genital infection with herpes simplex virus causes
sores
↓
Herpesvirus
travels
up nerves to the nerve ganglion where it lies low
↓
At
a later date, herpesvirus may travel down nerves
to the genital skin, causing a ‘recurrent attack’ of
herpes
↓
Recurrent attack heals, and herpesvirus
retreats to the ganglion again
↓
At a later date,
herpesvirus
may travel down to the genital skin again, causing
another
recurrent attack. This may happen several times |
No one really understands why the virus in the ganglion suddenly
wakes up from time to time, and decides to go to the skin and
cause recurrent attack. But in some people, there are some
definite triggers that make this happen, such as:
-
emotional
stress
-
physical
stress – for example, having another illness
-
damage
to the genital skin
-
menstruation.
There are two types of herpes simplex virus; recurrences are
more likely if you have type 2 than type 1. Recurrences are
slightly more likely in men than in women.
What
to do if you have an attack of herpes
-
-
If
this is your first attack, go at once to your nearest genitourinary
medicine clinic
to check that you really do have herpes. There are
many other causes of rash
or discomfort in the genital area.
For example, people sometimes mistake herpes for
jock itch or conditions
causing anal pain.You
do not need a doctor’s
letter to go to the clinic. If you are anxious about
going to the
clinic, look
at the section on Visiting
the clinic.
The advantage of
the clinic
is that
they will test you for other genital
infections, they may also be able to give you some
treatment to take
away with you and
they have counsellors (‘health
advisors’)
who can talk to you about the whole
subject. However, if you prefer,
you could see your family doctor instead.
-
There
is no cure for herpes, but if this is your
first attack your doctor will probably prescribe
medication
to reduce symptoms and speed healing (such as aciclovir, famciclovir or valaciclovir).
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If this
is your first attack, recognize that you will be feeling
excessively miserable (which is part of the
viral illness). Do not force yourself to go to work - stay
home until the worst has passed and pamper
yourself as much as possible.
-
Do not
share your towel or flannel with anyone – there
is no strong evidence that herpes is
transmitted this way, but better to be on the safe side.
-
Put two
handfuls of ordinary salt into a bath of warm water and sit
in it for a while.
-
If passing
urine is painful, do it into the warm bath. Take plenty of
drinks.
-
Drying
the genital area with a hairdryer on the cool setting may
help to ease discomfort.
-
-
Paracetamol
(acetaminophen) will help to relieve pain.
-
If appropriate
(for example, you are home alone), leave the sores exposed
to the air to
prevent irritation from knickers or underpants.
-
You could
try a herbal cream, such as aloe vera, melissa (a type of
mint) or propolis
(made by bees from the resin of Canadian poplar trees). These remedies are
available from health
food
stores. But remember that
there is very little scientific evidence to back the use of these remedies,
their quality is not always
controlled and some people
may react badly to herbal creams.
-
Do not
have sex until the sores have completely healed – if
this is your first attack,
this could be about 3 weeks. One reason is that you are
most likely to pass the infection on
when you have the sores.
Another reason is to protect yourself – open
sores give other infections
(such as HIV) easy access to your bloodstream.
-
After
the sores have healed and you start having sex again,
use plenty
of lubrication
to protect your skin from too much friction. Look at the section on Vaginal
dryness for advice
on lubricants.
What to do if you keep getting recurrences
It is common to get four or five recurrences a year, but these
are usually not very troublesome. You just wait for them
to go and avoid sex until the sores have healed. But a few
unlucky people have lots of recurrences, which can make their
life a misery. Here is some advice for this situation.
-
Talk
to your doctor about some anti-herpes drug therapy. This
medication
is most effective if you take it as soon as
the attack starts, so your doctor may give you
some to keep at home in readiness. For a really severe
problem, your doctor
might suggest that you take the anti-herpes medication
continuously, and will discuss the pros and cons with you.
-
Look
after your genital skin between recurrences. For
sex, use plenty of lubrication to protect your skin
from too much friction; look at the section on Vaginal
dryness for advice on lubricants.
Try to avoid
over-vigorous sex or over-vigorous
masturbation. There is general advice for women in the section on Vaginal
and vulval problems – commonsense
dos and don’ts’.
-
Keep your
immune system in good shape by eating plenty of fresh fruit
and vegetables, taking
plenty of rest
and not smoking.
-
Try to
keep the problem in proportion. The
UK Herpes Association has
a very helpful booklet called Herpes simplex: a guide,
which will help you feel
better
about yourself.
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