Genital herpes is a common sexually transmissible infection (STI) caused by the herpes simplex virus (HSV). There are two types of HSV: HSV1 and HSV2. HSV1 is usually found around the lips and mouth and is often referred to as cold sores. HSV2 commonly infects the genital and anal areas. Both HSV1 and HSV2 can occur on the lips, mouth, genital or anal areas. It is possible for a person to be infected with both HSV1 and HSV2.
In Australia it is estimated that three-quarters of Australian adults are infected with HSV1, and one in ten adults with HSV2. Women are more likely to be infected with HSV2 than men.
HSV enters the body through the skin on the mouth, genitals and anus or small cuts in the skin elsewhere on the body. The virus lives in the nerves beneath the skin and may remain inactive and unnoticed for many years.
It is not completely understood what causes the virus to activate and cause blisters. Isolated factors such as, menstruation (periods), emotional upset and sexual activity have been known to trigger an episode. Sunburn can also trigger a herpes episode (or cold sore) on the face or lips.
An episode of herpes usually occurs in several stages over seven to ten days these include:
- a mild tingling or itching, which lasts 12 to 24 hours
- glands located in the groin may become swollen and tender
- small blisters accompanied by irritation, pain redness and swelling of the affected area
- formation of shallow ulcers (usually a couple of days after the blisters break) once the ulcers are healed, there is a residual area of red or peeling skin (for a few days).
- Often people do not experience any signs or symptoms before or during the primary episode or consequent herpes episodes. . In these instances, it is possible for the infected person to pass the virus to sexual partners and not be aware that they themselves are infected
- Other people will experience a small outbreak of blisters, low level discomfort and related symptoms with the primary episode of herpes only.
- There are a small number of people who experience more severe symptoms during the primary and recurrent episodes, these may include some or all of the following: flu like symptoms, generally feeling unwell, fevers, joint pains, groin discomfort, tingling or itching and painful blisters followed by ulceration of the affected area
- Ulcers can form in the vaginal opening, anus, penis or scrotum and may be accompanied by pain when passing urine and/or a bowel motion.
- In more severe cases, to can take up to three weeks for the blisters to heal and associated symptoms to disappear. It is advisable for people to attend a sexual health clinic or visit a doctor once the blisters appear to discuss management of the condition.
Currently, there is no cure for herpes. There are antiviral drugs to manage the virus, and if taken at the beginning of an episode, they can help reduce the duration and severity of the episode. The antivirals do not kill the virus; they act on the body to decrease the amount of virus present which decreases the likelihood of future herpes episodes and the risk of transmission between partners.
An episode can also be managed by:
- keeping the area as dry as possible
- wearing loose non-restrictive clothing
- using anaesthetic gels to help reduce pain (monitor the skin when using these creams as to not irritate the skin in the genital area).
- avoiding soap on the affected area, instead bathing the affected area with salt water when lesions are present.
There is a high risk of the virus spreading between sexual partners before, during, and for the week following an episode. Even when a person has no symptoms, herpes can be directly spread to their partner, if the infected person is currently "shedding" the virus at the time of sexual intercourse or oral sex.
Both HSV1 and HSV2 can be passed through close body contact. This means:
- oral herpes can be transferred to the genital area of a sexual partner via a cold sore on the lip when engaging in oral sex
- genital herpes can be transferred to the mouth of a sexual partner when engaging in oral sex (this is not common)
- genital herpes can be spread through the rubbing of genital skin that is not protected by a barrier (condom) during sexual activity.
If a person is aware of a potential herpes episode they should take extra precautions to protect their sexual partner from infection. There is potential to pass on the virus even if there are no symptoms or visible signs of an outbreak.
To help reduce the risk of transmission:
- avoid sexual intercourse if you feel an episode coming on
- avoid kissing, oral sex and sexual intercourse if herpes lesions are present on the mouth, lips, genital or anal areas.
- It is advisable to follow these suggestions until one week after the sores have healed and ulceration is completely gone.
- Wearing condoms during sexual intercourse will help to prevent the spread of herpes, but not prevent this from happening completely. Herpes can be spread through skin to skin contact from the genital area that is not covered by the condom. If a person engages in oral sex with a man condoms should be used. Dental dams should be used for oral sex (activity involving the mouth and anus or vulva). This is the case for both genders.
- If a person has been infected with herpes, it is important to manage the condition through, healthy diet, adequate rest, sleep and minimum daily stress.
Unfortunately, it is not possible to predict how or when a herpes episode will occur in an individual. Some people may never experience visible signs or symptoms; others may only experience one episode, whilst a minority of people will have recurrent episodes. These episodes will vary between people, in general, after a person has the initial episode, recurrences are less severe, usually involve more rapid healing of the affected area and longer intervals between episodes.