Genital herpes

Summary

• Herpes is one of the most common skin to skin infections and is also transmissible sexually but causes mild or no symptoms in most people.
• The herpes simplex virus (HSV) causes cold sores and genital herpes.
• 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.

Genital herpes is a common sexually transmissible infection (STI) caused by the herpes simplex virus (HSV) types 1 and 2. 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 can occur on the lips, mouth, and genital or anal areas. It is possible for a person to be infected with both HSV1 and HSV2.

Approximately one in 8 sexually active Australians has genital herpes. Up to 80% of Australian adults carry HSV1 and more than half of primary genital infections are caused by HSV1 in young people. Recurrences of genital herpes blisters are more common with HSV2.

It is not completely understood what causes the virus to activate and cause blisters. Isolated factors such as stress or general illness, menstruation, emotional upset and sexual activity have been known to trigger an episode. Environmental factors such as windy days or sunburn can trigger a herpes episode on the face or lips.

Signs and symptoms

The initial HSV infection can be painful for some people, recurrences are usually less painful and can be symptom-free. An episode of genital herpes usually occurs in several stages over 7–10 days and may include:

• a mild tingling or itching, which lasts 12–24 hours
• glands located in the groin may become swollen and tender
• small blisters accompanied by irritation, pain, redness and swelling of the affected area
• the formation of shallow ulcers. Once the ulcers are healed, there is a residual area of red or peeling skin
• often people do not experience any signs or symptoms before or during an episode of herpes. It is possible for the infected person to pass the virus to sexual partners and not be aware they themselves are infected.

There are a small number of people who experience more severe symptoms during the primary and recurrent episodes. These may include the following: flu-like symptoms, general unwellness, 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 severe cases, it can take up to 3 weeks for the blisters to heal and associated symptoms to disappear. It is advisable to attend a sexual health clinic or visit a doctor once the blisters appear to discuss the management of the condition.

Treatment

Testing is not part of regular sexual health checks and because herpes is so common, isn't recommended except in special circumstances such as severe episodes or pregnancy.

If HSV is acquired in the third trimester of pregnancy or close to the time of delivery, there are risks for the baby, so suppression treatment is advisable and can be discussed with a sexual health specialist if needed. A caesarean delivery may also be considered.

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
• avoiding soap on the affected area, instead bathing the affected area with salt water when lesions are present.

Transmission

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 uncommon)
• genital herpes can be spread through the rubbing of genital skin that is not protected by a barrier during sexual activity.

Prevention

Avoiding sex when signs of HSV are present and using condoms with a water-based lubricant reduces the chance of passing on herpes or contracting it but cannot be 100% effective as other areas of skin where the virus is present may not be covered. Daily antiviral suppressive treatment may be considered if episodes are common, and the other partner does not already have HSV.

To help reduce the risk of transmission:

• Avoid sexual intercourse if you feel an episode of herpes 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 the ulceration is completely gone.
• Wearing condoms during sexual intercourse will help to prevent the spread of herpes.
• If a person engages in oral sex, condoms or dental dams should be used.
• If a person has been infected with herpes, it is important to manage the condition through a healthy diet, adequate rest, sleep and minimising stress.

The risk of transmission to a newborn is highest when a woman acquires an initial herpes infection in the last trimester.

During pregnancy, to reduce the risk of infection:

• A partner with cold sores should not perform oral sex on their pregnant partner unless the pregnant partner is known to already have HSV1.
• A partner with genital herpes should consider using suppressive antiviral therapy, condoms or dental dams and lubricant throughout their partner's pregnancy.
• Mother-to-baby transmission is by direct contact with the baby with vaginal fluid during birth. Pregnant people with recurrent herpes may choose to take suppressive therapy during the final few weeks of pregnancy, to prevent recurrences and therefore avoid caesarean delivery.

Health outcome

Other resources

Related content

• Safe Sex
• Genital herpes and pregnancy

Help and assistance

Get qualified health advice 24/7 for the cost of a local call 13 HEALTH (13 43 25 84).

This factsheet provides general information and is not intended to replace the need to see a health professional or have a sexual health check. For more information on herpes or sexual health please talk to a healthcare provider. A doctor, nurse or health worker can assist with:

Healthdirect

• Genital herpes