Genital herpes

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. There may be increased vaginal discharge.

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 (which may swell up), 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. Some recurrent attacks are so minor that they are almost unnoticeable just slight irritation of soreness.

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

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Herpesvirus travels up nerves to the nerve ganglion where it lies low

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At a later date, herpesvirus may travel down nerves to the genital skin, causing a ‘recurrent attack’ of herpes

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Recurrent attack heals, and herpesvirus retreats to the ganglion again

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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 you are female, look at the section on painful vulva.
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).
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 while gently holding the lips of the vagina apart. Take plenty of drinks.
Drying the genital area with a hairdryer on the cool setting may help to ease discomfort.
According to the UK Herpes Viruses Association, applying a cold, wet teabag helps. They say that Earl Grey is best!
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 – 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 Viruses Association has a very helpful booklet called Herpes Simplex - the Guide, which will help you feel better about yourself.

Dr Phil Hammond discusses herpes in rhyme in his Expert Guide to Herpes

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Friday, June 11th 2010

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Comments on this article

Posted by elle on 26/06/2010 at 09:56:20 pm

I was in the emergency room with my first outbreak several years ago with a Pelvic Immflamitory Disease. Now I have only a couple mild outbreaks a year. The first year and a half I had less severe outbreaks about every other month. I think my boyfriend is just now getting it from me. It is not the end of the world. It is hard to date and tell someone about it, but you'll eventually find someone who'll love you anyway and if you don't then that person probably wasn't worth it anyway. I've tackled it and moved on. :-)

Posted by Optional on 04/06/2010 at 05:29:52 am

i just want to ask if it is possible to have genetal herpes if you are just frequently masturbating as in Everyday?

Posted by mize on 25/05/2010 at 06:55:40 pm

I got married for the thired time, and after 3 monthes of my last marriage i found the frist infection my wife does not have any simpthoms of the desease but i have, attacks may be 3 to 4 times every year, the frist one was very bad , but now it's only 3 to 4 days treatment,cold tea bags and bills of aciclovir drinking a lot of water is very helpful

Posted by Optional on 20/04/2010 at 08:04:14 pm

My partner has herpes outbreaks on his scrotum.I don't have herpes. I've searched the internet and can't find any soloutions to protecting myself even when he isn't having an outbreak. The condom doesn't cover his scrotum. Any ideas or insight on what I could do?

Posted by Optional on 10/04/2010 at 06:54:48 pm

I first contracted genital herpes at 30 from a cheating boyfriend who later admitted he'd passed it on to me. I'm now 44 and after a weekend of excessive oral and normal sex with my partner of 2 years I find myself having a 2nd attack. This may be positive feedback to someone who like me at the time with my 1st, thought I would be having attacks several times a year.

Posted by Optional on 13/03/2010 at 07:21:22 am

i am having what i think is a 1st sign of herpes i have finished with my partner so he can go on and find someone decent and will go to the doctors on monday to have it confirmed. a friend thinks i've caught shingles from her but i'm doubting it is so i'm sure its herpes all the signs like nerve pain now blisters everything was going great in my life now its all changed :O(

Posted by Optional on 08/03/2010 at 02:28:03 pm

i had my first outbreak of herpes last may, and my god it was the worst pain i have ever felt!! i think i contracted it after my partner had a coldsore. i started off having bk pain. and i then felt itchy down there thought it was thrust went to the doctors who just diagnosed it as severe thrush, without even looking at me! i knew it was more than this as i was in tears with the pain. everything was swollend down there i could not wee and at one point i thought i would have to go to A+E to be catheterised as i hadnt been able to pass urine for nearly 18hours and i usuallygo evry half hour! i went the GUM clinic just cus i knew they wud no n they gave me antiviral tablets which started to work after 48hrs. ive never felt so bad, i couldnt walk, or sleep or eat, as i felt that bad. i lost half a stone in a week!! and to top it off they gave my co-dydramol for pain as paracetamol was no good and that just made me constipated. i had one more out break about 5 weeks after the first but it was no where near as bad!! i advise any1 to go the gum clinic do not be embarrised!

Posted by k on 22/01/2010 at 09:40:00 pm

i have just been informed a member of staff has genital herpes she has no visible signs on her face but has apparantly had a couple of breakouts in a small amount of time, her job as a beautician involves a lot of skin to skin contact ie when performing facials for example can this be passed on to ,y clients???

Posted by Anonymous on 10/12/2009 at 08:33:00 am

I think that i too have my first outbreak. I am married as well but now have doubts as to where i could have got this from. My husband does get cold sores round his mouth and i am wondering whether this is how i got it but he has not had a cold sore for a while. I just know i feel dreadful

Posted by anonymous on 21/08/2009 at 09:17:00 am

i am having i think my first outbreak of genital herpes, as i am married and have had no other partners, i do not suspect my husband has had any other partner since we got together either, i know it is possible to have the virus and show no symptoms, but if i did not get it from my hudband at th start of our relationship some two and a half years ago, why would i be catching it from him now?

Posted by Nurse on 17/08/2009 at 03:06:00 pm

Lucy, you cannot catch genital herpes from sharing a cup with someone. If they had an active cold sore around the mouth, you would be able to see this so there should be doubt!

Posted by lucy on 25/03/2009 at 07:11:00 pm

i think someone has herpes and i had a bit of his drink after he had already drunk it, i am not with this man but i shared his drink can i catch herpes from this?

Posted by Anonymous on 12/01/2009 at 06:10:00 pm

i am having my first bout of genital herpes but i have severe back pain where i cant even get out of bed is this normal?