Genital Herpes

What causes genital herpes?

Genital herpes is an infection caused by the herpes simplex viruses. There are two main types. The herpes simplex virus type 2 (HSV2) is the most frequent cause of genital herpes. Herpes simplex virus type 1 (HSV1) is usually associated with cold sores around the mouth but is becoming a more common cause of genital herpes

Is genital herpes a common problem?

It is one of the most common sexually transmitted infections world-wide.

How does genital herpes spread?

Genital herpes is spread through contact with an infected partner. Up to 80% of those infected are unaware of their infection as they usually have few symptoms. They may feel genital irritation but may blame it on soap, toilet paper or waxing and shaving etc.

What will I see or feel if I have genital herpes?

This will depend on whether this is your first outbreak or if it is a recurrent outbreak. First outbreaks are referred to as primary outbreaks. Firstly groups of blisters of varying sizes appear on the genital skin. Over a few days these blisters break open leaving small raw ulcers that can be very painful, often with severe burning especially during urination. The glands in your groin may become swollen. You may have a fever with muscle aches, headaches and flu-like symptoms. These symptoms usually resolve in seven to ten days. Symptoms of recurrent infection are milder and do not last as long. Firstly there is tingling and irritation, usually near the sight of the original infection. There often are just a few blisters that break down into sore-like ulcers. This episode lasts just a few days to one week. There may be a low grade fever or flu-like symptoms. Many of these recurrent outbreaks are minor and non-specific. It is the repeated pattern that is the best clue to the diagnosis.

What will start an outbreak?

This varies from person to person. The most common factors that may trigger herpes are:

• stress
• fatigue
• illness (especially a viral infection)
• menstrual period (sometimes the rubbing from pads and tampons)
• surgery
• irritation in the vulval area

How often does genital herpes reoccur?

HSV2 recurs in 90% of people in the first year after a primary infection. Patients can have five to eight recurrences or even more within the first year. With time these recurrences become less frequent. HSV1 will recur about 60% of the time but less frequently as time passes.

How Is genital herpes diagnosed?

Genital herpes is suspected when Dr Kliman recognises the typical changes on the skin via examination. Several laboratory tests can confirm the diagnosis. If the lesion is new (in the first one to two days) a swab can be taken from your lesion to be tested for the virus (viral culture or a nucleic acid amplification test). Blood tests can also confirm your exposure to the virus. This is helpful when you see Dr Kliman after the lesions have healed. This is called a type-specific serology for HSV. This test is used for when there is suspicion for HSV but without a visible outbreak, when the lesions are not typical or even obvious, if you are planning to get pregnant, or if you have a new sexual partner.

Who is at risk of contracting genital herpes?

Anyone who is sexually active is at risk. Women are at higher risk than men of contracting HSV from an unprotected infected sexual partner.

Who is at risk for more frequent recurrences of genital herpes?

Those who are immunocompromised (weakened immune system) particularly those with HIV disease, active cancer, or on special medication that suppresses the immune system, are at a higher risk of frequent recurrences.

How is genital herpes treated?

There is no cure for genital herpes but it can be controlled or minimised.  This is done with the use of antiviral drugs such as acyclovir, valacyclovir and famciclovir.  These are oral (taken by mouth) medications.  They can help the sores heal faster, and if taken daily can decrease recurrences.  This suppressive approach (to stop recurrences) is recommended for those with frequent outbreaks (more than six outbreaks per year), painful recurrences and to prevent transmissions to an uninfected sexual partner.  This should be discussed with Dr Kliman.  Topical therapies (eg: those that are applied to the skin) are expensive and of very limited value.

What should I tell my new partner if I have genital herpes?

Honesty is the best practise. If the new partner is told and preventive measures are taken, then the partner can be protected. This can be a difficult discussion but an important one. If the partner is unsure as to whether he or she has herpes simples, a blood test can be done and advice given through Dr Kliman.

What if someone with genital herpes is pregnant? Will this affect the baby?

Most women (99%) with a history of genital herpes give birth to healthy babies. The greatest risk to the baby is when a primary infection occurs during pregnancy. Even then the outcome depends on when in pregnancy the primary infection is diagnosed. It is important that Dr Kliman is notified as soon as the pregnant woman realises that she may have an infection. In rare circumstances a herpes infection acquired in pregnancy can lead to a miscarriage, prematurity or severe infection in the baby. If an infection occurs near or at delivery Dr Kliman would most likely suggest a caesarean section. Daily oral antiviral medications can help decrease the likelihood of an outbreak, and therefore transmission to the baby when started at the 36th week of pregnancy. If you or your partner has a history of genital herpes infection, please discuss this with Dr Kliman.

How can I protect myself from contacting genital herpes?

1. Do not have sexual contact with someone with open sores around his or her mouth or on his or her sexual organs.
2. Use condoms for sexual activity. Spermicide with or without a condom is not recommended since the spermicide can cause vaginal irritation and fissures which can increase the risk of vaginal transmission and infection.
3. Taking antiviral medication can reduce, but does not eliminate the risk of transmission from person to person.

What else can I do?

Most people feel angry, frustrated and scared when they find out that they have genital herpes. You are not alone. You are not at fault. It is usually passed on from person to person unknowingly. People with genital herpes can live a normal life. By talking to Dr Kliman you can learn about the infection’s natural history and the treatment options.

Learn how to manage the virus. Keep a diary of the dietary and lifestyle factors that trigger an outbreak for you and avoid these where possible. Take care of your overall health by eating a healthy diet, exercising regularly, getting plenty of sleep and managing your stress.

Make sure you have a strong support network around you. If you are not comfortable discussing the situation with someone close to you, speak to your doctor, a counsellor, or join a herpes support group. Remember overcoming the emotional effect of genital herpes is often much more challenging than managing the physical symptoms so take time to learn about the condition.