Sexually Transmitted Infections

HERPES SIMPLEX VIRUS INFECTION

What is Herpes?

Genital Herpes is caused by the herpes simplex virus (HSV).
There are two types of HSV and both types can affect the genital skin.
Type 1 can cause genital herpes as well as cold sores around the mouth. This is the commonest type. 60% of the adult population have been infected with this virus often as young children. Only 50% of people infected with type 1 HSV will have a further attack.
Type 2 causes genital herpes. If you are infected with this type of HSV you have a 90% chance of having further episodes of genital ulceration.

What are the symptoms of Herpes?

The first episode of herpes often starts with the person feeling run down and flu-like. They can complain of headaches, a sore throat, tiredness, a temperature and generalised aches and pains. They then notice that the genital skin becomes itchy and uncomfortable before they notice small raised lumps on the skin. These lumps quickly become small ulcers, which are very painful. The place on the genital skin that the ulcers appear determines the symptoms. It is common for women to complain of pain passing urine and difficulty opening their bowels as well as an increase in vaginal discharge.

What does the test for Herpes invlolve?

A swab test is taken from a genital ulcer to look for herpes. The test can be taken in GUM or at a Family Planning Clinic or your GP practice. The test needs to be taken as soon as possible after the ulcers appear, as if taken too late the test can be negative, despite having herpes.

How is Herpes treated the first time?

This infection is caused by a virus, and our bodies protect us against all viruses by producing antibodies.
During a first episode it is important to rest as much as possible, to allow the body to produce antibody which will fight the herpes infection.
Painkillers such as Ibuprofen or Paracetamol taken regularly (as per instructions with the product) are very helpful in reducing pain and temperature.
It is important to drink plenty of fluids to keep the urine dilute, as this is less irritating to the skin than concentrated urine. Many people find that passing urine in the bath is much more comfortable as it prevents the urine from splashing on the ulcers.
An antiviral drug called Aciclovir should be taken 5 times a day for 5 days. It normally takes 10 days to 2 weeks for the ulcers to heal after the first episode of genital herpes.
Having plenty (4-5 each day) of warm baths without using any soap will reduce the discomfort and will ensure the skin is kept clean. Putting a large handful of sodium bicarbonate in the bath water will also help.
It is better not to use creams on the genital ulcers because this increases the chance of the ulcers becoming infected with bacteria. However for some people who are in a lot of discomfort local anaesthetic gels can be useful. Other people find the use of ice packs helpful.

Does Herpes come back?

There is always a chance that the herpes ulcers can come back. Herpes infection is a bit like an iceberg.

Most people with herpes are under the level of the water; they have been infected with herpes at some point in their life but have never had any ulcers on their skin and therefore do not know that they have had the infection. This group can shed virus from their skin from time to time and are therefore able to infect other people, although they do not know when they are infectious, as they have no symptoms.
Above the water are the much smaller group of people who know that they have had herpes because they have had ulcers around the mouth or on the genital skin. Many of these people will never get another episode of ulceration, while others will get occasional mild attacks. Individuals in this group will shed virus from their skin when they have ulcers, but can also do so when they have no symptoms, as mentioned above.
A still smaller group at the tip of the iceberg continue to get frequent recurrent episodes of herpes.

However, recurrent attacks are never as severe as the first attack. The number of ulcers is normally less and the lesions last for less time. Also people do not feel unwell with a recurrent attack of herpes.

If Herpes comes back how is it treated?

Normally there is no benefit in taking Aciclovir with recurrent episodes of herpes. Research shows that the tablets only speed up the healing time by 12 hours, as the individuals own antibodies do the same job as the Aciclovir tablets. Having plenty of baths to keep the genital area clean is usually all that is required during recurrent attacks.

Is my present partner at risk of picking up the infection?

If you are in a regular relationship when you get your first attack of herpes your partner has probably unknowingly passed the infection to you and will therefore not get the herpes back from you.

Is my new partners at risk of picking up the infection?

If you move on to a new partner after being infected with herpes there is a chance that your new partner could pick up the infection from you. It is therefore important to use a condom throughout sex and before any genital contact to reduce the chance of this happening. Once you know your partner well enough you should discuss herpes with them.
However remember that many people will already have been infected with the herpes virus and are therefore protected from being re-infected.

Herpes and Pregnancy

A first attack of herpes in pregnancy needs to be managed by those looking after the woman’s obstetric care . This is important to ensure that the baby does not pick up this infection, which can be very serious.
If a woman who has recurrent attacks of herpes becomes pregnant she should inform her midwife at her first ante-natal appointment, but it is unlikely it will change her pregnancy or delivery.
Please phone and ask to speak to a health advisor to discuss this further if required. (See later for contact information)

What can I do if I get frequent attacks of Herpes?

If you get frequent attacks of herpes, which are interfering with your life, make an appointment at your GP or the sexual and reproductive clinic to discuss how to manage these attacks.
It is helpful if you keep a diary of when you get an attack, how long it lasts for and what symptoms you experience. We can then decide how best to manage the herpes.

FOR MORE INFORMATION ABOUT HERPES PLEASE CONTACT THE HEALTH ADVISORS AT NINEWELLS ON 01382 632 600.

Click here for the latest Genital Herpes sexual health leaflet (and translations in 9 core languages).

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