Genital herpes

Genital herpes is a sexually transmitted infection (STI) that can cause sores and blisters to appear on your genitals. There is no cure but symptoms usually go away on their own, and you can take steps to prevent its spread and reduce your risk of having an outbreak of genital herpes.

It is caused by infection with a virus called herpes simplex virus (HSV). Often genital herpes doesn’t cause any symptoms but can continue to spread via unprotected vaginal, oral and anal sex, and skin-to-skin contact with an infected area.

Here, we’ll explore its symptoms, risk factors and treatments for genital herpes. 

Does herpes only affect the genitals?

There are two types of HSV: HSV-1 and HSV-2. HSV-1 usually causes oral herpes, while HSV-2 usually causes genital herpes but can also cause anal herpes. 

Oral herpes presents as cold sores ie small painful blisters on your lips or around your mouth. Before the blister appears, you may notice a burning, tingling or itchy sensation. 

Anal herpes presents as itching and pain around your anus, red bumps or white blisters around your anus and changes in your bowel habits.

Symptoms of genital herpes

Often genital herpes does not cause any symptoms or its symptoms are mild. When symptoms occur, they usually appear two to 12 days after infection; however, it is possible to develop symptoms months or years after infection. 

Symptoms include burning, itching, tingling or discomfort around your genitals, pain when you urinate, and small bumps or blisters around your genitals that burst. When blisters burst, they ooze clear liquid and can also bleed. This results in open, red sores around your genitals. As these sores heal, scabs will develop. 

If you have a vagina, you may notice unusual vaginal discharge. If you have a penis, you may notice unusual discharge from the end of your penis.

You may also develop flu-like symptoms, particularly if it is the first time you have had genital herpes. You may feel achy, have a fever and/or headaches, and the lymph glands around your groin may be swollen.

How does genital herpes spread?

Genital herpes is contagious and is spread through direct contact with the infected area even if no obvious blisters or sores are present, as well as through contact with vaginal secretions, semen and saliva. 

This means if you touch an infected area or bodily fluid and then touch someone else, you can spread the infection to them. Sharing sex toys can also spread genital herpes if the sex toys are not covered with a condom or washed in warm soapy water before each use. 

Once the virus is present on your skin (eg on your fingers), it can enter your or someone else’s body through contact with areas of the body that have mucosal membranes, such as the mouth, nose, anus or vagina, or through damaged skin ie a cut, scrape or graze (abrasion).  

As the specific type of HSV that causes cold sores (HSV-1) can sometimes also cause genital herpes, it is possible to catch genital herpes if someone with a cold sore gives you oral sex. 

As HSV can’t survive for long when it is no longer in contact with the human body, it is highly unlikely that you will catch herpes from sharing cutlery or drinkware.

Risk factors for genital herpes

As genital herpes is an STI, your risk of developing it is higher if you have unprotected oral, anal or vaginal sex. This means sex without the use of barrier protection ie a condom or dental dam. 

Having multiple sexual partners and/or sex with someone you know is infected with HSV-1 or HSV-2 also increase your risk.

When to see a doctor

If you develop any of the above symptoms of genital herpes, particularly the presence of blisters or sores, visit a sexual health clinic as soon as possible. 

You can alternatively visit your GP. If they suspect you have genital herpes, they may refer you for sexual health testing at a sexual health clinic. NHS sexual health clinics offer free prescriptions to treat STIs, including genital herpes. 

Diagnosing herpes

Herpes can only be tested for if you have visible blisters or sores. A nurse or doctor will ask you about your symptoms and medical history, and will then perform a swab test. 

This involves using a cotton bud to gently wipe a blister or sore to collect the fluid leaking from it. This fluid will then be tested in a lab.

Treating herpes

Genital herpes cannot be cured. This means once you’re infected, the virus will remain in your body for the rest of your life. However, your symptoms will usually go away on their own within two to four weeks; during this time, you should not engage in any type of sex. 

Medication

The first time you develop genital herpes, you may be prescribed antiviral tablets to reduce the severity of your symptoms and speed up your recovery. You may also be prescribed an antiviral cream (topical acyclovir) to reduce any discomfort in your genital area. 

After your initial outbreak of genital herpes has resolved, you may develop outbreaks in the future if you’re stressed, tired, ill or your immune system is weakened (eg if you’re having chemotherapy). If you’re of reproductive age and have a vagina, your period can trigger a genital herpes outbreak. 

You should not have any type of sex during an outbreak, whether it is your first outbreak or subsequent recurrent outbreaks. 

Some people do not develop further outbreaks after their initial outbreak of genital herpes, while others may have multiple outbreaks every year. If you have more than six outbreaks in a year, your doctor may prescribe a course of antiviral tablets for six to 12 months to reduce the frequency of your outbreaks. 

Outbreaks usually become less frequent and less severe over time. 

Home remedies

If you have developed blisters or sores from genital herpes, make sure you gently clean the area with clean water or salt water (saline) to reduce the risk of the blisters or sores becoming infected. 

If you’re experiencing discomfort when you urinate, you can apply an over-the-counter analgesic cream (eg lidocaine) or petroleum jelly to soothe the area. You should wash your hands thoroughly before and after creaming or touching your genitals. 

You can also pour water over your genitals while you urinate to lessen the stinging effect of your urine on your blisters or sores. 

If you’re experiencing persistent discomfort, you can apply an ice pack wrapped in a clean towel to your genitals — do not place an ice pack or ice directly onto your genitals.

As mentioned earlier, you should not have any type of sex during an outbreak. You can have sex again after all of your blisters and sores have scabbed over and completely healed. 

Complications of genital herpes

Genital herpes increases your risk of developing internal inflammatory disease, where organs in your genital area become inflamed. This can include the anus, rectum, womb, cervix (entrance to the womb), vagina and ureter (the tube through which urine leaves your body). 

Genital herpes also causes changes in the genital area that make it three times more likely that when exposed to HIV, you will become infected. 

Your risk of infecting other parts of your body with herpes increases with genital herpes too. For example, if you touch your genitals and then touch your eye, you may develop herpetic simplex keratitis where the front covering of your eye (cornea) becomes infected with the virus. This leads to eye pain, redness, blurred vision and a gritty feeling in your eyes; left untreated, it can cause vision loss. 

Similarly, if you touch your genitals with your fingers but there is a break in the skin of one of your fingers, the virus can infect your finger. This causes a herpetic whitlow with symptoms of swelling, redness and sores. 

If you are pregnant and have genital herpes, there is a risk that your newborn will become infected. 

Herpes and pregnancy

If you develop genital herpes during pregnancy, you can pass the infection onto your newborn during childbirth if you have a vaginal delivery. 

The risk of passing the infection onto your newborn is highest if this is the first time you have had genital herpes and you become infected during the last six weeks of your pregnancy. The risk is significantly lower if your outbreak of genital herpes is a recurrent outbreak ie you have had genital herpes before. 

A newborn can also become infected with herpes if someone with a cold sore kisses them or they come into contact with a herpes-infected sore (eg a herpetic whitlow on someone’s finger). 

When a newborn is infected with herpes, it is called neonatal herpes. Their risk of infection is highest from birth until four weeks when their immune system is least developed. Although neonatal herpes can be fatal, in the vast majority of cases, newborns recover with antiviral medication given directly into their bloodstream. 

If you’re pregnant and are concerned that you have genital herpes, inform your midwife as soon as possible. Genital herpes during pregnancy can be effectively treated with antiviral medication. In most cases, with treatment, a vaginal delivery is still possible. 

Preventing genital herpes

To reduce your risk of genital herpes, it is important to use barrier protection when having any type of sex ie use a condom or dental dam. You should also make sure any sex toys are washed in warm, soapy water before each use and where possible covered with a condom. 

As the virus can still spread through skin-to-skin contact, these precautions won’t eliminate all risk of contracting genital herpes. It is, therefore, important to be aware of the symptoms.  

You can also reduce your risk of genital herpes by limiting the number of sexual partners you have and avoiding sex with anyone who has visible signs of genital herpes. 

Living with genital herpes

Getting a diagnosis of genital herpes can be upsetting and feel life-altering as the virus will remain in your body for the rest of your life. However, you can continue to have a healthy sex life. While it is important not to have sex during an outbreak, outbreaks will usually become shorter and less frequent with time, if you have further outbreaks at all.

You can find relief from the discomfort of genital herpes during an outbreak by avoiding wearing tight-fitting clothing around your genital area and applying painkilling cream and a towel-wrapped ice pack. Once your outbreak is over, you can have sex again as usual.

It is important to be open and honest with your sexual partners about your herpes status. This can be a difficult conversation, but understanding how herpes is spread and how to reduce its spread can help ease any worries that your partner(s) may have.