Getting diagnosed with genital herpes
- Do I have herpes?
- Do I have to see my GP before I can go to a clinic?
- Will details of my diagnosis be sent to my GP?
About herpes simplex virus
- What is herpes simplex?
- What are the symptoms of genital herpes?
- How long will it take for symptoms of genital herpes to appear?
- Can I spread the herpes simplex around my body?
- How common is herpes simplex?
- What is the difference between the herpes simplex type 1 and type 2?
- What are the other herpes viruses?
Passing on/transmitting herpes
- How is herpes simplex caught and passed on?
- Can I catch herpes again on another part of my body? Can my partner catch herpes back off me – on another place?
- How can I protect my new partner? What about my new partner? How likely am I to infect my new partner?
- How long after the symptoms disappear before I can have sex?
- Can using a condom prevent transmission of herpes simplex?
- Can I pass herpes simplex to a partner if I have no symptoms?
- What if my partner already has herpes simplex?
- What if my partner already has facial cold sores?
- My partner doesn’t have genital herpes so how can I have caught it?
- Can I catch herpes simplex off towels, cups, or anything?
- Can my children catch herpes from me?
- Can genital herpes be caught from a cold sore?
- Can I get genital herpes from kissing? Is herpes simplex virus in saliva?
- Risk of transmission between recurrences (asymptomatic shedding or viral shedding)
Herpes recurrences explained
Treating genital herpes
- Does herpes need to be treated (first infection)?
- What is the usual treatment for genital herpes?
- How do I treat genital herpes?
- Are there side effects from taking antiviral drugs for genital herpes?
- What can I do to stop discomfort and speed up healing? Self-help for genital herpes – first outbreak
- I sometimes get twinges and pains around my buttocks or down one leg. What does this mean?
- What are recurrences of herpes and how likely are they?
- Does everyone get herpes recurrences?
- What can I do to prevent frequent herpes recurrences?
Genital herpes, pregnancy and childbirth
Other herpes questions
- Does herpes mean I have a greater risk of cervical cancer?
- Can I give blood now I have herpes?
- Is herpes simplex ever serious?
- Where can I get answers to my other questions?
Do I have herpes?
The only way to find out what is causing a genital problem is to go to a clinic or doctor. Go to a sexual health clinic or department of genitourinary medicine (GUM clinic). There may be one at your local hospital. Often, you won’t need to make an appointment, but if you do, tell them you think it is genital herpes because it can only be diagnosed while you have symptoms. Ring your nearest hospital for the address and clinic times – or search the list of clinics you can find here.
It is only possible to diagnose genital herpes when symptoms are present, so don’t delay. Do not apply creams to the area before attending the clinic as the doctors may need to take a swab from a lesion and the products might interfere.
A regular sexual health check-up does not include any test for herpes simplex, unless there are signs on the skin – for example, spot, blister, little cut, ulcer, etc.
A positive result from the swab will confirm the diagnosis.
You may see blood tests for herpes advertised but these cannot be used to diagnose genital herpes. They check for antibodies but this does not identify the part of the body that might be affected – only a swab of a sore can do that. An asymptomatic facial cold sore infection will also cause the immune system to make antibodies. Antibody tests are not very reliable. One in three test results may be wrong.
Urine tests should not be used to diagnose genital herpes. Beware, these may be offered inappropriately by private testing services
Your symptoms may not be caused by genital herpes. There are more than 24 other conditions that could be causing them. A research study found that 3% of genital ‘herpetic ulcers’ were in fact caused by herpes zoster virus, also known as shingles.
Do I have to see my GP before I can go to a clinic?
No, you can arrange this yourself.
Will details of my diagnosis be sent to my GP?
No. Your visit to the clinic is confidential. You don’t even have to use your real name. The clinic may ask for your doctor’s details but this is simply to allow internal charging within the NHS.
If you took a letter with you from your GP, the clinic will wish to write back to the GP with your test results but you can tell the clinic not to do this.
What is herpes simplex?
Herpes simplex is the name given to two viruses in a family of herpes viruses. All of them, once caught, remain in the body. The two viruses that cause genital herpes are:
Herpes simplex virus: type 1 and type 2. You may see them referred to as HSV-1 and HSV-2. Both types can cause symptoms on the genitals (genital herpes), the face (facial cold sores), or the hand or finger (called a herpetic whitlow) depending on where they are caught. But they are rare on other parts of the body. The information on this page refers to genital herpes whether caused by type 1 or type 2 – except where we specifically mention the different types.
What are the symptoms of genital herpes?
Symptoms may start with itching, tingling, soreness and discomfort in the area affected. There can also be general flu-like symptoms with backache, headache, temperature, aching and mild swelling of the lymph glands in the groin, armpits and neck.
On ordinary skin (e.g. under pubic hair, or on the shaft of the penis or scrotum, on the fingers, hands or other parts of the body), you are likely to get blisters, spots or red bumps which may be quite painful. These burst and form sores, raw spots or ulcers which will crust over and new skin will form as they heal. On mucous membrane, (e.g. under the foreskin for men and on the inner side of vaginal lips for women), the virus causes ulcers which heal directly into new skin. You will not normally have any scarring, although the new skin may be paler for a while. This first episode may last from 2 to 3 weeks.
It will appear on the area of your skin that has been in contact with the affected area of the other person.
Some people get recurrences – these are not like the first illness. Because the body now has developed antibodies to fight this virus, repeat outbreaks usually heal much more quickly (often in only in a few days). They are usually mild and seldom involve the flu-like symptoms.
How long will it take for symptoms of genital herpes to appear?
It usually takes two to fourteen days after contact for the first symptoms of genital herpes to appear, with 4 or 5 days being most likely. Some people catch it but show no symptoms.
It can appear for the first time years after you caught it. This means that it can turn up unexpectedly during a long-term faithful relationship. This is why genital herpes is not proof of infidelity. About two out of three people get no clear symptoms when first infected. There is more in our transmission leaflet – free to members when they join.
Can I spread herpes simplex around my body?
It is extremely unlikely that you will reinfect yourself with herpes virus on other parts of your own body after the first episode. (Not even your eyes.) You will not spread it when applying topical ointments.
Even during this first outbreak, the infection is usually limited to one part of the body. Some people will catch it in two places, for instance they may get it on their hands, as well as on the genitals, since hands can be involved in sexual activity. If you have caught it in more than one place, you will probably notice this during your first outbreak.
How common is herpes simplex?
Very common. By age 25, about six out of ten people in the UK carry type 1 and about one in ten carries type 2, more in the sexually active population. If this surprises you, it is because most people who have it don’t know that they do, because they have no symptoms or because they get it so mildly, they do not notice.
Most facial cold sores are caused by type 1. Herpes simplex on the genitals may be type 1 or type 2.
Each year the number of new people diagnosed by STI services is recorded by Public Health England. It is over 33,000 – see the data STIs 2015. A survey in 2000 found that a further 1.4 cases are diagnosed by each GP in the country – say about 53,000 cases.
What is the difference between the herpes simplex type 1 and type 2?
They are genetically slightly different but cause similar symptoms. Either can be caught anywhere on the body.
- Type 1 is more likely to reappear when it is caught on the face and is less likely to recur when it is caught on the genitals.
- Type 2 is more likely to recur when it has been caught on the genitals.
There is no difference in the visible symptoms caused by the two types, so it is only possible to establish which type you have caught through a laboratory test. Both viruses are called herpes simplex virus. On this page, we are referring to genital infection caused by type 1 and type 2 – except where we specifically mention the different types.
What are the other herpes viruses?
- Varicella-zoster virus (also called herpes zoster). This causes chickenpox and shingles which are occasionally mistaken for herpes simplex. Shingles is a recurrence of chickenpox and in the elderly it may cause painful nerve damage.
- Cytomegalovirus (CMV) and Epstein Barr virus, also called glandular fever. These viruses do not cause spots or blisters like herpes simplex. They may cause flu-like illnesses.
- And four others: humanherpes viruses 6, 6a, 7 and 8.
People ask “What does herpes do to you?” What does herpes do to my body?” “I have herpes, now what?” The answers to those questions are: Herpes simplex does nothing to your body or your overall health. It causes spots, which admittedly can be painful, and if they come often then they are very annoying… Now what? Well, if it were on your face, you would not be asking that question. You can make a big deal of it, there are websites that suggest you have to. However, the HVA experience is that people can get over it and move on to live happily ever after. Each issue of Sphere magazine tells a ‘personal story’ from one of our members. You can read a sample magazine.
How is herpes simplex caught and passed on?
The virus is passed directly from the affected area of skin (which could be the genitals, face or hands), by direct skin to skin contact, with friction, when the virus is present.
Herpes simplex gets in easily through mucous membranes, i.e. the moist skin inside the mouth and genital-anal area. Sometimes it gets into ordinary skin, on other parts of the body, if there is a cut or break in the skin. This can be the fingers/hands, knees, etc., if these come into direct contact with the affected area of another person. A finger sore is called a herpetic whitlow.
It can be passed from the face on one person to the genitals of another (or genitals to face) through oral sex when the virus is active.
You can pass it on from the affected area, when the virus is present on the skin surface: from the first warning signs that a recurrence is starting (tingles, burning skin sensations, aches, stabbing pains), through the time when there are sores or blisters, until they have healed and fresh skin has grown back.
There is also a slight possibility that virus may be transmitted through asymptomatic shedding which can occur between outbreaks. You can get the transmission leaflet – free to members – when you join. Another useful resource is the Herpes Simplex – the Guide booklet: 16 page, 6,000 words.
About six in ten adults by age 25 carry herpes simplex virus type 1 and one in ten carries type 2. Even more people carry herpes simplex virus in older age groups – but most don’t know. Only around one in three of those infected – with either type – is aware of this.
How long after the symptoms disappear before I can have sex?
Don’t have sex from the first warning signs that a recurrence is starting (tingles, burning skin sensations, aches, stabbing pains). Wait until the skin has healed and fresh skin has grown back.
Can I catch herpes again on another part of my body? Can my partner catch herpes back off me – on another place?
It is rare for people to re-catch a virus that they already have for a second time – even on a different part of the body. Their immune system defends them against this.
The virus does not travel through the body. So a person with a genital infection can kiss or perform oral sex – there is no risk of infecting a partner by doing this; the virus will not travel inside the body from the genitals to the mouth.
How can I protect my new partner? What about my new partner? How likely am I to infect my new partner?
Already, you are a safer partner than many others because you have been diagnosed so you will avoid sex from the moment you notice the start of an outbreak, until the time when it has totally cleared up.
A man with genital herpes can protect a partner easily if his outbreaks appear in the area covered by a condom. (See next section.)
A woman with genital herpes can tell a man that he is half as likely to catch genital herpes from a woman, compared to the chance of a woman catching it from a man. This information can be useful for diagnosed women when talking to a new partner.
Antiviral tablets taken daily should prevent outbreaks, make a big reduction in asymptomatic shedding and make passing the virus to a partner very unlikely.
Herpes simplex infections are common. Many new partners will have one or both types already but not know. See the government’s statistics for new genital herpes infections diagnosed in clinics – and add a further 53,000 cases which how many are probably diagnosed by GPs.
Can using a condom prevent transmission of genital herpes?
Yes it can make a big difference.
Herpes simplex virus cannot get through a condom. The condom should be put on the penis before it touches the partner’s sensitive (genital) skin. If the virus is active on the skin outside the area covered by the condom, transmission may still happen.
Using a condom more than 25% of the time can lower transmission by 50%, if the woman has genital herpes. If the partner with genital herpes is male and uses a condom, the transmission rate will be even lower.
A Femidom (female condom) covers a larger area so may be more effective. If you have obvious genital symptoms, make sure they do not touch a partner.
Contact should be avoided until symptoms have healed.
Can I pass herpes simplex to a partner if I have no symptoms?
This sometimes happens but is not likely. When the virus is inactive (dormant) inside the nerve cells it cannot be caught by a partner. If there is virus on the skin surface where you get your symptoms, it may be passed on – see What is asymptomatic shedding? There may be a tingly or itchy feeling at the place where this is happening.
Diagnosed people are less likely to pass it one when there is nothing to see on the skin, because they are usually more aware of these prodromes (the warning feelings), whereas undiagnosed people often ignore highly infectious and obvious symptoms, because they do not know what they are.
An antibody test (blood test) might show that your partner has already caught one of the herpes simplex viruses – although all these tests, whether you get it from clinics or off the internet, are very unreliable and results should be treated with caution. If the test shows your partner probably has antibodies, it means the partner will have either total or partial protection. Subscribers can request our leaflet explaining the antibody test in full.
What if my partner already has herpes simplex?
When you and your partner have the same virus you will not reinfect each other – even on a different part of the body.
• If you have caught a genital infection from a partner’s genitals, they will not catch the virus back on their face.
• If you have caught a genital infection from a partner’s facial cold sores, they will not catch the virus back on their genitals.
• If you have caught it on your face from your partner’s genitals, then they will not catch it on their face if they do oral sex on you.
• If you have caught it on your face from your partner’s facial cold sores, then they will not catch it on their genitals if you do oral sex on them.
What if my partner already has facial cold sores?
If your new partner has had facial cold sores in the past, this either means that they have the same herpes virus as you, or will have the other type (there are only two types of herpes simplex). When you both have the same type, it is highly unlikely that either of you will reinfect the other.
If you have different types and either of you catches a second type, symptoms will probably be slight or non-existent. This is because the antibodies for one type will have some immediate effect on the other type as well. It is called ‘partial protection’.
My partner doesn’t have genital herpes so how can I have caught it?
Your partner could be one of the ‘two out of three’ people with herpes simplex who have it so mildly they do not realise. So they could have sex when the virus is active. Mild symptoms can appear as a pimple, a little cut or an itchy bit of skin and yet these are very infectious. When people with these mild symptoms learn to recognise them, then they can avoid sex at these times. Another possibility is that your partner does not have herpes simplex and you caught it from a previous partner. It is possible to have a ‘first’ outbreak many years after first catching it.
Can I catch herpes simplex off towels, cups, or anything?
No, you will not catch it off anything. The virus is caught from the skin, not from objects. It is a delicate virus and dies quickly when away from the skin where the sore is. There is more about transmission in our “Transmission” leaflet – available to members. This statement is taken from the guidelines for doctors produced by the British Association for Sexual Health and HIV.
Is there any risk that my children could catch herpes from me?
Parents do not need to worry about passing on genital herpes to their children because it is caught through direct skin contact with the affected place when symptoms are present and not from hands or objects. Even sharing a bath with small children is not a problem because herpes simplex virus is not transmitted in water. (See here for pregnancy and childbirth – which is a different issue.)
- Parents do not pass on genital herpes to their children through the normal activities of family life. Do not allow a fear of transmission to get in the way of ordinary family touching, hugging, sharing, etc.
- Beds: herpes simplex virus is never transmitted on sheets.
- You can wash clothes together in the same machine, even when a person has a recurrence.
- Bathing or showering together will not transmit herpes simplex virus – the same is true for jacuzzis and swimming pools. A child brushing against your upper thighs or abdomen while you have a recurrence won’t catch the virus.
- Even if you have used the toilet or you have touched the genital area and forgotten to wash your hands, this is not a problem. This virus is fragile and dies when it leaves living cells.
- Washing with ordinary soap and water is clean enough – there’s no need to use any special hand or toilet seat sanitisers.
Children do all sorts of odd things that you can’t anticipate, but even if they put your worn knickers on their head they are not going to contract the herpes virus – relax and laugh with them. (We thank the New Zealand Herpes Foundation for this last example!)
Can genital herpes be caught from a cold sore?
If a person with a cold sore on the mouth does oral sex he or she can give his/her partner ‘cold sores on the genitals’ which is genital herpes.
Also, cold sores on the face may be caught from someone with genital herpes through oral sex.
Only the face of a person with cold sores is infectious – so they can have sex, but should not kiss or do oral sex when they have a cold sore. See the description of the two types.
You will find Herpes Simplex – the Guide booklet (16 pages, 6,000 words) useful too.
Will I get genital herpes from kissing? Is herpes simplex virus in saliva?
Mouth to mouth kissing cannot give anyone genital herpes but you could catch a facial cold sore this way, if you have not had one before. The virus is only found in saliva of people who get cold sores on the face.
Risk of infection between recurrences (asymptomatic shedding or viral shedding).
Studies have shown that virus may sometimes be found on an infected area, even when there are no visible symptoms. This is called asymptomatic shedding. If enough virus is present when direct skin contact (sexual contact) takes place, a partner may become infected.
- The fewer recurrences a person has, the less chance there is of asymptomatic shedding.
- Asymptomatic shedding tends to decline with time. It may happen during the first year and is much less likely after that.
The virus most often transmitted during the first months of a new relationship – although partners can be together for years without the virus passing from one to the other. Studies have shown that a majority of people catch it from someone who does not know that he or she has got this virus.
Asymptomatic shedding is something that people find difficult to understand – there is a lot more detail in the transmission leaflet you can choose when you join (you decide if you want it sent by post or by email).
Why does genital herpes come back?
Between recurrences the virus travels from the skin along the nerve to the nerve ganglion (a junction for several nerves supplying the same area) where it remains. Once you have been infected, the virus remains in the body, just as chickenpox and some other viruses do.
Recurrent symptoms occur when the virus is reactivated or ‘triggered.’ The symptoms normally appear in the same area as the first time. For some people they may move a short distance, e.g. from genitals to buttocks, but always within the same dermatome (nerve region).
Some people feel aching, tingling, burning or sharp pains in the area affected (leg, genitals or buttock) preceding a recurrence. These are called prodromal symptoms or prodromes. They are a sign that the virus is trying to reactivate and there may be virus on the skin surface. Sometimes they last for a few days then disappear without any symptoms appearing on the skin.
How often can genital herpes come back?
Some people get no further episodes, while a few get frequent recurrences. If you do, you could ask your doctor for antiviral pills to prevent outbreaks – see antiviral treatment, or you can try self-help treatments. There are two pages of suggestions on our “Tips to prevent recurrences” leaflet. It is available to members. Outbreaks normally decline in frequency and severity over time.
There are websites with headings like ‘Living with oral herpes’, ‘Living with herpes simplex type 2’ or just ‘Coping with herpes’. We don’t use these phrases. Would anyone expect to read ‘Living with cold sores’? Or ‘Living with shingles’? Or ‘Coping with thrush?’ These phrases seem to be created to dramatise the condition. Granted some people are unlucky with their outbreaks – see below for treatment. Most of us (and our partners) soon realise what a small issue it really is. See a sample of a ‘happy ever after’ personal report in a copy of our quarterly magazine, sent to subscribers.
Does herpes need to be treated (first infection)?
Treatment may not be necessary. Herpes simplex infections clear up even if no treatment is given. But treatment can be helpful – particularly if there are severe symptoms. Some people are affected more than others. See below for the rare occasions when it can be serious.
What is the usual treatment for genital herpes?
The doctor may prescribe antiviral tablets to speed up healing and reduce the severity of a first episode. Aciclovir is the most commonly used antiviral drug for this purpose. You don’t need the tablets if the first episode is mild, or if you have almost recovered before you see the doctor.
If you get more episodes later on, you will be less likely to be offered with antiviral tablets as outbreaks clear up without treatment. However, if you do want to treat a recurrent outbreak with antiviral tablets, you need to start taking them within 24 hours of noticing the beginning of the outbreak. When you start after 24 hours, it is unlikely that the tablets will have much effect. Therefore, you should have a prescription or tablets ready, so that you can start to take them as soon as possible – see dosing information below. Members can ask for our antiviral drug fact sheet – see subscription form. And we offer self-help suggestions too.
How do I treat genital herpes recurrences?
For most people antiviral medicine is not necessary either because their body prevents recurrent symptoms or because they find that adopting a healthier life style makes a difference. See What can I do to prevent frequent recurrences?
For people who are unlucky and get frequent recurrences, there are two ways that antiviral tablets can be used: Short course therapy, which should be started within a 24 hours of noticing the start of the symptoms:
- Aciclovir 800 mg three times a day for two days- or
- Valaciclovir (Valtrex) 500 mg twice daily for three days – or
- Famciclovir (Famvir) 1 g twice daily for one day.
Suppression therapy, when the tablets are taken daily to keep the virus dormant – perhaps for six months or longer. These are now known to be extremely safe drugs. With regard to aciclovir, it is now considered to be so safe that and annual kidney function test is no longer required for long term use:
- Aciclovir 400 mg twice daily – or
- Aciclovir 200 mg four times a day
- Valaciclovir (Valtrex) 250 mg twice daily (this dose is not available in UK), OR 500 mg daily – or
- Famciclovir (Famvir) 250 mg twice daily.
If breakthrough recurrences occur on standard treatment, the daily dosage should be increased e.g. aciclovir 400 mg three times daily – i.e. 8 hours apart.
Be aware that when you stop a long course of tablets, there may be an outbreak 4 or 5 days afterwards. This is not a sign that future recurrences will be frequent – you will need to wait and see.
Most antiviral pills are suitable for vegans and vegetarians. See Professional’s page for more information.
There are now UK-based websites, such as MedExpress, which are authorised by the Care Quality Commission to sell aciclovir to diagnosed patients.
Beware: Many websites advertise fake ‘treatments’ or even ‘cures’. They may include testimonials and statements by people who claim to be doctors. They are scams. Do not be fooled.
Are there side effects from taking antiviral drugs for genital herpes?
Antiviral drugs are very well-tolerated by most people because they target the virus, not healthy cells. Side effects are rare. Specialist guidelines state that regular kidney function tests for people taking aciclovir long-term are no longer required. The drug has now been used without problems for over thirty years. It can be used in pregnancy.
What can I do to stop discomfort and speed up healing? Self-help for genital herpes – first outbreak
People with genital herpes have reported to us that these ideas have helped them – they have not been through a medical trial:
- If required, take a painkiller, e.g. co-codamol, ibuprofen, paracetamol or soluble aspirin – they reduce pain and inflammation. (Always follow manufacturers’ instructions.)
- Wash your hands before (as well as after) touching blisters or sores, e.g. when applying medication, as this can introduce bacteria and delay healing.
- Apply a a local anaesthetic ointment, e.g. lidocaine 5% ointment. It can be used on genital or facial sores. Some people prefer a stronger anaesthetic such as Xylocaine 10% spray. Dab on (or spray on) as required to relieve pain, especially before urinating – see below. (These items are all available from a pharmacy without a prescription.) There is a low risk of a negative reaction from these topical anaesthetics. If you find that soreness increases, stop using them.
- Keep the sores moist, you can apply Vaseline (petroleum jelly).
- Keep the area clean: washing gently once a day is sufficient. Many people have found a warm salt water solution (1 teaspoon to 1 pint water) very soothing. Gently bathe the area using cotton wool.
- Avoid scented soap and deodorants. It is best not to use wipes, gel or soap in this area, but if you do, use an unscented brand.
- Avoid over-washing as this can increase irritation and delay healing.
- Dab dry carefully with a tissue after washing or use a hair dryer set at ‘cold’.
- To reduce itching, keep the area as cool as is practical: apply a well wrapped ice pack for up to 90 minutes. DO NOT put ice directly on the skin.
- Women who experience pain when urinating during a first episode can try doing it in the bath or shower, or sitting on the edge of the bath and pouring water over the area. This will dilute the urine and ease discomfort. Or try urinating through a tube or into a bottle to prevent urine coming into contact with the sores. You can put lidocaine ointment on the area about 15 minutes before urinating to anaesthetize the area, or use Vaseline (petroleum jelly) or Orabase on the sore as a barrier.
Do not over-treat the sores – let the skin heal. Symptoms will heal with or without treatment.
Beware: Many websites advertise fake ‘treatments’ or even ‘cures’. They may include testimonials and statements by people who claim to be doctors. They are scams. Do not be fooled.
I sometimes get odd feelings/pains around my buttocks or down one leg. What does this mean?
Occasionally, herpes simplex virus can cause ‘burning skin’ sensations, deep aches or sudden twinges in the genital area. When they occur in the thighs or buttocks, they are sometimes compared to ‘sciatica’. These symptoms are called prodromes – or prodromal symptoms. They are a sign that the virus is trying to reactivate and there may be virus on the skin surface. Sometimes sores will follow, but very often your immune response overcomes the virus before visible signs appear. For email version or posted version of more information on treatment, select “tips to prevent recurrences” on the subscription form.
What are recurrences of herpes and how likely are they?
Recurrences (also called outbreaks, episodes, flare-ups) are repeat symptoms (sores, blisters, patches of red skin or tiny splits) which appear at or close to the place where the infection was first noticed. These are often fairly minor and may be no more than a small spot that heals in a few days. They may be accompanied by sensations – itches or nerve twinges. They are unlikely to be as severe as first symptoms and may be almost unnoticed.
Does everyone get herpes recurrences?
Around half the people diagnosed only get symptoms once so do not get recurrences – wait to see what happens. Recurrences may occur several times a year or can be much less frequent. They usually get milder, heal faster and happen less often as time goes by.
What can I do to prevent frequent recurrences?
There is no need to change your lifestyle or take steps to prevent recurrences until you know whether or not you are going to get any.
You will see plenty of internet sites offering dubious ‘treatments’ that are unnecessary and probably have no effect.
These suggestions to help control outbreaks come from people with genital herpes, based on their own experiences. The HVA cannot confirm that any of them will work for you, but we believe they are worth considering:
- Try not to worry: worry or stress is known to affect the immune system and lower our ability to fight infections. As you learn more, you will be able to put your diagnosis in perspective and worry less. Your immune system will benefit from this and you may get fewer outbreaks. (Stress can also be a trigger factor for many other skin conditions, e.g. eczema, psoriasis.)
- Get enough sleep and avoid getting too tired.
- Eat a well balanced, healthy diet with plenty of fruit and vegetables.
- A modest vitamin E supplement (200 i.u. per day) has been shown to boost immune response.
- Give up smoking and cut down on excessive drinking.
- Take regular exercise: 20 minutes brisk walk each day is a good start.
- Try taking one soluble low dose aspirin each day with food. (For adults only. This is not recommended for people with stomach problems. Talk to your doctor first.)
- Try to avoid causing soreness to genital skin. ‘Skin trauma’ caused by waxing, shaving, thongs, tight trousers, horse or bike riding or even sexual activity may trigger outbreaks.Talk to the helpline on 0845 123 2305 if you need advice about these.
- If sex is a trigger try using silicone based lubricant (sold to enhance pleasure).
- Avoid direct sunlight or ultraviolet rays from sunbeds on the site of infection, i.e. no nude sunbathing! If you have cold sores (facial herpes simplex), use a sunblock to protect your skin.
- Join SPHERE and ask for the ‘Tips to Prevent Recurrences’ – two sides of A4. Sample issue of the magazine can be read here.
- Talking to someone else who has personal experience of herpes simplex can be helpful. Join the HVA, come to meetings and/or call our helpline: 0845 123 2305. Experience, advice, understanding and useful information are just a call away.
- Come to a London meeting hosted by one of our volunteers – they are informal and open to all – see Events page .
You will see plenty of internet sites offering dubious ‘treatments’ that are unnecessary and probably have no effect. Our “Tips to prevent recurrences” is a two page list of self help suggestions. We also produce leaflets on “Stress”, “Boosting Immunity”, and reports of our trials on “Olive Leaf Extract” and “Eleutherococcus senticosus” (Elagen). Members can order these when they join.
Genital herpes, pregnancy and childbirth
Getting pregnant: Having herpes simplex does not affect fertility or the ability to conceive. Talk to your doctor about taking antiviral tablets if you need to prevent outbreaks when you want to conceive. This is safe.
Early pregnancy – first and second trimester: A primary infection at this time will not affect the baby or cause a miscarriage. It used to be thought that there might be an increased risk of miscarriage if the mother caught genital herpes in the first three months. Recent research has disproved this theory.
Having outbreaks during pregnancy is normal. These will not harm the baby. Some women have more outbreaks during pregnancy. You may choose to take aciclovir 400 mg three times daily from 36th week of pregnancy to ensure you don’t have an outbreak at term.
Childbirth: If you have caught herpes simplex before becoming pregnant you can give birth normally. This is stated in the 2014 Guidelines for herpes simplex and childbirth from the Royal College of Obstetrics and Gynaecology together with the British Association for Sexual Health and HIV. If you wish, you can take aciclovir 400 mg three times daily from 36 weeks on, to ensure you don’t have an outbreak during the birth.
Towards the end of pregnancy, babies in the womb receive antibodies to all the infections that their mothers have previously caught. These antibodies protect the baby from catching these viruses during childbirth and afterwards, longer when the mother breast feeds. After that, this protection fades away.
Summary: During pregnancy, herpes simplex only causes concern:
- if the mother has a first infection during the last few months of pregnancy because there may not be time for the baby to acquire antibodies from the mother before the birth. Taking aciclovir 400 mg three times daily will probably be prescribed by your obstetrician and may prevent the need for a C-section.
- if baby is being born before 32 weeks (very premature). These babies do not have full antibody protection so they could be infected during the birth if the mother has sores.
In these cases, there is a danger that the baby could contract herpes simplex so a Caesarean-section is usually performed. Women who do not have genital herpes should be careful not to catch it in the last two months of pregnancy – as explained above. This means that if their partners are already infected (facially or genitally) they should avoid contact that might transmit the virus to the mother.
Small babies can be susceptible to viruses. Anybody with cold sores on the face should not kiss young babies.
It used to be thought that there was a risk of miscarriage if the mother caught it in the first three months of pregnancy. Now we know there is no evidence for this at all. A primary infection will not cause miscarriage.
A referenced “Pregnancy and Childbirth” leaflet is available to members.
Can I pass genital herpes on to a baby or toddler?
A person with genital sores who is looking after a baby or toddler will not infect the child. Small babies can be susceptible to viruses. Anybody with cold sores on the face should not kiss young babies.
Does herpes mean I have a greater risk of cervical cancer? Does herpes cause cervical cancer?
There is no greater risk of cervical cancer if you have genital herpes. It was thought for a time that herpes simplex infections could be one of the causes of cervical cancer. Further research has shown that this is not so.
Can I give blood now I have herpes?
Yes, you can be a blood donor. The virus is not found in blood.
Is herpes simplex ever serious?
Genital herpes can cause severe discomfort and a flu-like illness.
- In rare cases cases there may be urinary retention during a first outbreak and a catheter may be needed but this does not mean that it is considered to be medically serious.
- You may read about viral meningitis caused by herpes. Viral meningitis is very different from the dangerous bacterial meningitis. Most cases of viral meningitis are mild and clear quickly.
- Some people with weakened immune systems or on certain medications may have many outbreaks and will be prescribed antiviral medication to prevent them.
- People with widespread eczema (or some other skin conditions) can have a more severe infection if a large area of skin is infected.
Although genital herpes is not serious, facial herpes simplex can sometimes have serious complications – see links below. Rare complications of facial cold sores are:
- Bell’s palsy is a temporary partial paralysis of one side of the face that usually gets better in a few weeks. It can happen when the nerve in the face is affected by cold sores. This causes loss of taste, drooping features and unresponsive facial muscles – typically in only one side of the face. Bell’s palsy usually resolves in a few weeks though it can last longer. www.bellspalsy.org.uk can give you more information.
- Very rarely, when the virus has been caught on the face, it can reactivate inside the eye. This is called ophthalmic herpes simplex or herpes keratitis, dentritis or uveititis. It should be referred to a specialist eye doctor: if left untreated it may damage sight. The RNIB has more information.
- Extremely rarely, when the virus has been caught on the face, it can reactivate in the brain. This is called encephalitis; if untreated, it may leave damage. www.encephalitis.info is a specialist charity for people with encephalitis.
- An even rarer complication is an allergic reaction to the herpes simplex virus called erythema multiforme or Stevens-Johnson syndrome. It is so rare that many doctors never see it. It is more likely with a facial infection – unlikely with a genital infection. Symptoms are blisters over a wide area (trunk, face, arms, etc.). Patients may need treatment in hospital. These extra symptoms are not infectious as this is an allergic reaction – there is no virus in the blisters that arise from the allergy.
Where can I get answers to my other herpes questions?
We run a helpline answered by trained volunteers who have herpes simplex themselves. Phone 0845 123 2305 with a pen and paper handy to jot down the times when the next volunteer is available (it tends to be weekday afternoons and evenings). You can come and talk informally and personally to the patient representative for the medical Herpes Simplex Virus Panel, at the London meetings open to all – see News page.
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Sources used to create this information:
1. BASHH: 2014 UK national guideline for the management of anogenital herpes https://www.bashh.org/documents/HSV_2014%20IJSTDA.pdf
2. van Rooijen MS, Roest W, Hansen G, et al. Sex Transm Infect – Published Online First: [11-01-16] doi:10.1136/sextrans-2015-052213
Shows 12-33% false negatives,especially in type 1 results.
3. BMJ publications: A Scoular Using the evidence base on genital herpes: optimising the use of diagnostic tests and information provision Sex Transm Infect 2002;78:160-165 doi:10.1136/sti.78.3.160
Shows false positive of 10% or more using the commercially available serology tests.
4. Scoular A, Norrie J, Gillespie G, Mirr N, Carman WF. Longitudinal study of genital infection by herpes simplex virus type 1 in western Scotland over 15 years. BMJ 2002; 324:1366-67.
This gives 60% with type 1
5. Looker KJ, Magaret AS, May MT, Turner KME, Vickerman P, Gottlieb SL, et al. (2015) Global and Regional Estimates of Prevalent and Incident Herpes Simplex Virus Type 1 Infections in 2012. PLoS ONE 10(10): e0140765. doi:10.1371/journal.pone.0140765
6. Vyse AJ, Gay NJ, Slomka MJ, Gopal R, Gibbs T, Morgan-Capner P, Brown DW. The burden of infection with HSV-1 and HSV-2 in England and Wales: implications for the changing epidemiology of genital herpes Sex Transm Inf 2000;76:183–187
This gives 10% with type 2
7. Looker KJ, Magaret AS, Turner KME, Vickerman P, Gottlieb SL, Newman LM (2015) Global Estimates of Prevalent and Incident Herpes Simplex Virus Type 2 Infections in 2012. PLoS ONE 10(1): e114989. doi:10.1371/journal.pone.0114989
8. Woolley PD, Chandiok S. Survey of the management of genital herpes in general practice. Int J STD AIDS 1996;7(3);206-211
In a questionnaire survey of the management and treatment of genital herpes in the community by general practitioners (GPs) in 16 UK cities considered to have good access to genitourinary services, the mean number of cases seen per GP in the previous 12 months was 1.37 for first episodes and 0.96 cases for recurrent episode genital herpes.
9. Stanberry LR, Bernstien DI, Kit S, Myers MG. Genital Reinfection After Recovery from Initial Genital Infection with Herpes Simplex Virus Type 2 in Guinea Pigs J Infect Dis. (1986) 153 (6): 1055-1061.
10. Patel R. An overview of herpes simplex SPHERE 2010;25(3):8-9
“Diaries show that recognition of disease protects partners.”
11. Anna Wald, MD, MPH; Andria G. M. Langenberg, MD; Katherine Link, MS; Allen E. Izu, MS; Rhoda Ashley, PhD; Terri Warren, ARNP; Stephen Tyring, MD, PhD; John M. Douglas, Jr, MD; Lawrence Corey, MD Effect of Condoms on Reducing the Transmission of Herpes Simplex Virus Type 2 From Men to Women JAMA. 2001;285(24):3100-3106. doi:10.1001/jama.285.24.3100
12. Wald A. (2004) Herpes simplex virus type 2 transmission: risk factors and virus shedding. Herpes 11(Suppl. 3), 130A-137A.
“In at least 70% of cases, transmission occurs when the infected partner has no symptoms (i.e. asymptomatic shedding), and they may even be unaware that they have the infection. Although men and women shed the virus equally, women are more susceptible to acquiring it.”
13. Phipps W, Saracino M, Magaret A, Selke S, Remington M, Huang M, Warren T, Casper C, Corey L, Wald A. Persistent Genital Herpes Simplex Virus-2 Shedding Years Following the First Clinical Episode. J Infect Dis 2011;203 2): 180-187. DOWNLOADED
14. Crespi CM, Cumberland WG, Wald A, Corey L, Blower S. Longitudinal study of herpes simplex virus type 2 infection using viral dynamic modelling Sex Transm Infect 2007;83:359-364
reduction in asymptomatic shedding in two years: DOWNLOADED:
15. BASHH and RCOG: Management of Genital Herpes in Pregnancy. 17/10/2014 https://www.rcog.org.uk/globalassets/documents/guidelines/genitalherpesotherguideline.pdf
16. http://www.nhs.uk/conditions/erythema-multiforme/Pages/Introduction.aspx accessed 3-1-17
17. http://www.nhs.uk/conditions/stevens-johnson-syndrome/Pages/Introduction.aspx accessed 3-1-17