Genital Herpes Treatment

Antiviral tablets like Aciclovir and Valaciclovir stop the herpes simplex virus multiplying. Antivirals won’t get the virus out of your system completely, but they keep it in under control.

The first time that you have a herpes outbreak – your sexual health clinic can prescribe antiviral tablets, to stop the herpes simplex virus multiplying. Antiviral drugs that can be used to manage herpes simplex include.

For recurrent outbreaks – speak to your GP, because your treatment plan will depend on the severity and frequency of the outbreaks.

If you have fewer than 6 recurrent outbreaks a year, but these are severe: your doctor may well prescribe a five day course of an antiviral each time you have an outbreak. This is called episodic treatment.

If you have six or more recurrent outbreaks a year: you may need to take an antiviral daily on an ongoing basis as part of a treatment plan. This is suppressive treatment – it aims to stop outbreaks happening at all.

Usually for suppressive genital herpes treatment – you take an antiviral twice daily for 6-12 months. This is also the case for people with very severe symptoms or for people who find their symptoms extremely distressing. It makes it less likely that you will pass HSV on to your partner (although it does not prevent this completely). Normally, suppressive treatment would stop after a year because, by that point, the risk of outbreaks is less frequent and the outbreaks themselves will be considerably milder. Most people manage to control any subsequent outbreaks using episodic treatment (a five day course of aciclovir), but if the severe outbreaks come back repeatedly, you can speak to your doctor about returning to a suppressive herpes treatment plan.

After herpes treatment, what should I expect? – remember that, as long as you keep them clean, the blisters/sores will scab and heal with time. They won’t leave a scar. If this is your first herpes outbreak, you can expect to have four or five outbreaks over the next couple of years. These are known as recurrent outbreaks. They are usually much less severe than the first outbreak. Over time recurrent outbreaks become increasingly infrequent and milder. If you are concerned or distressed, speak to your doctor.

Only using outbreak treatment – taking either repeated, short-term courses to treat an outbreak or long-term treatment to prevent genital herpes treatment do not cause any additional long-term effects apart from the ones that have been listed above. However, if you repeatedly have outbreaks of genital herpes, we recommend that you get either short courses of treatment or a long-term course to stop outbreaks as well as doing some of the steps to help clear the infection and ease the pain. 

Not getting effective treatment – if genital herpes go untreated, it can have some serious long-term complications. Blisters and sores can be very painful. As well as this, genital herpes can be passed on from mother to baby during delivery if you become infected whilst you’re pregnant. This can be life-threatening to the baby. Genital herpes may also make it easier for partners to pass on HIV. 

Genital herpes is an infection caused by the cold sore virus which is called herpes simplex virus or HSV. The symptoms are sores and blisters on and around the genitals. It can be very painful. Because you can get genital herpes by having sex or from intimate sexual contact, it is known as a sexually transmitted infection. HSV can infect any mucus membrane in the body, like the mouth, for example.

Which types of herpes are there? – there are two types of herpes: herpes simplex virus type 1 and herpes simplex virus type 2. Both can cause genital herpes. The virus is passed from person to person by physical contact. Usually, people get infected with genital herpes by having sex (vaginal, anal or oral). Even if someone has no symptoms, i.e. is not in the midst of a herpes outbreak, they can still pass on the virus. This is known as asymptomatic shedding. That said, it is much easier to catch it from someone who has blisters or sores at that time. Often people carry the virus for a while, before their first outbreak is triggered. After the first outbreak, the virus retreats into your system and stays dormant, until something triggers a recurrent outbreak.

What are the long term issues? – genital herpes is itself a chronic long term condition. Unfortunately, there is no cure, but it is possible to manage the symptoms using antiviral medicines. If the herpes blisters get infected, they can result in a skin infection elsewhere in your body. If you are suffering recurrent outbreaks of genital herpes, it is wise to get tested for HIV. Severe and frequent outbreaks of genital herpes can be a sign of a weak immune system.

If you have HIV or aids, or if you are undergoing chemotherapy, or if you have a weakened immune system, you should be referred to a specialist for treatment. Herpes can last longer and be more severe in people with weak immune systems.

Herpes can cause problems in pregnancy. If you are pregnant and have genital herpes, make sure you get referred to a specialist. The infection could pass to your unborn baby and it can be serious.

Will it affect my fertility? – no. Genital herpes does not affect fertility in men or women.

Herpes can cause problems in pregnancy though. If you are pregnant and have genital herpes, make sure you get referred to a specialist. The infection could pass to your unborn baby and it can be serious.

Herpes (HSV) is a virus – whenever HSV is on the skin (and it can be there without symptoms), it can be passed to another person. It is passed between people by direct skin-to-skin contact, including sex. You can also catch it if you share sex toys (without washing them or covering them with a new condom each time they’re used).

Herpes is very contagious – it can pass through the moist lining of your genitals, anus and mouth very easily. An example of this is that if you have oral sex with someone who has a cold sore (a blister/lesion on their mouth that is also caused by the herpes simplex virus), you can get herpes on your genitals.

HSV can’t live for a very long time outside the human body. It’s for this reason that it is thought that you can’t catch herpes by sharing baths or using swimming pools, using a toilet seat, or from sharing plates/cups/cutlery. However, you should avoid sharing towels or flannels just in case. Whilst it is unlikely that the virus could survive this way, this is an extra precaution that you can take for your own peace of mind.

Who gets it? – genital herpes is common, but it is especially common in young people who are aged 20-24 years.

Anyone can catch it. Whenever HSV is on the skin (and it can be there without symptoms), it can be passed to another person. It is passed between people by direct skin-to-skin contact, including sex. You can also catch it if you share sex toys (without washing them or covering them with a new condom each time they’re used).

However, you are at a higher risk of getting herpes if: you have had a sexually transmitted infection in the past, if you started having sex young, if you have had sex that was unprotected with many partners.

Outbreaks result in sores – when your body is infected by the herpes virus, it can cause sores when there is a large number of virus in your body. These are called ‘outbreaks’. Sometimes your body can get rid of outbreaks by itself, at other times your body needs help from medication. 

Why do you not always have sores? – when a person does not have sores, it means that the body is keeping on top of the outbreaks and there is only a small number of viruses in the person’s body. It does not mean that the person is cured from herpes completely. Different things can mean that the body is less able to keep on top of the viruses, from stress to sunshine to other infections. 

Why do sores turn up in different places? – different types of herpes find it more difficult to survive in different parts of the body, which is why different strains tend to cause cold sores on the mouth to the ones which cause genital sores, although these can be interchangeable.

When the first outbreak clears up, the virus lies dormant in a nerve that’s nearby. A recurrent outbreak of the virus can be triggered at a later date, whereupon the virus travels back down the nerve to the skin.

Predicting an outbreak – most people find that they have recurrent outbreaks four or five times in the first couple of years after getting infected with HSV. Recurrent outbreaks are usually much less severe and will continue to get easier with time. This is because your body has produced antibodies to deal with the first infection and so it is better equipped to fight recurrent infections of the same virus.

The main symptoms of recurrent outbreaks begin with a sensation that itches, burns or tingles near, on or around your genitals, or down your leg, before the blisters come out. Next, sore red blisters will appear around your genitals, rectum, thighs and buttocks. In women, they might also appear on the cervix (neck of the womb).

How is it diagnosed? – wherever possible, it is better to get any symptoms of genital herpes checked at a genitourinary medicine (GUM) clinic/sexual health clinic. If you can’t get to a GUM clinic, then see your GP.

It is easier for your GUM specialists to diagnose genital herpes, whilst you’ve got the blisters or sores. They’ll do a swab test (where they wipe a small cotton bud on one of the blisters to collect fluid from it). Whilst it is easier to test for genital herpes when the infection is active, sometimes the test can still be negative, even though you have all the symptoms. For this reason, the GUM specialist will also examine you and make a diagnosis based on what they see. If they are unsure and if the test is also negative, then you may have to wait to see if you have a recurrent outbreak to confirm whether the diagnosis should be herpes.

At the GUM clinic, you will probably be asked: if you have had sexually transmitted infections in the past; about the history of who you’ve had sex with; whether you get cold sores; and whether or not this is the first time you’ve had these symptoms.

You need to let your sexual partners know so that they can get tested – if you don’t feel comfortable contacting them yourself, your sexual health clinic can contact them for you. They can send them a contact slip suggesting that they might have been exposed to a sexually transmitted infection and recommending that they go for a check up. Your name won’t be on the slip, although sometimes it states which infection they might have picked up.

You should also tell new partners that you have genital herpes – you can pass on the herpes virus, even if you do not have symptoms, so it is very important to use condoms to minimise the risk of spreading the infection when having any kind of sex (oral, vaginal or anal). It is worth bearing in mind though, that it is still possible to pass on the virus during sex, even if you use condoms. The condom only covers the penis and the herpes virus can appear elsewhere (around, as well as on, the genitals, for example). For this reason, condoms just reduce the risk. They will not prevent the virus from spreading completely. Your partner needs to be aware of this.

When can I have sex again?

• Don’t have sex until all the blisters and sores have completely healed and cleared up
• If you have sex whilst you’ve got the sores, you are very likely to pass on the virus. Herpes is extremely contagious, even from the point that you feel the first tingle/itch, before you get any blisters
• Don’t share sex toys (unless you wash them and cover them with a condom in between usage). Also, if you have/your partner has a cold sore by your/their mouth, avoid kissing until this has cleared up
• Don’t have oral sex whilst one of you has a cold sore. This is one of the ways you can get genital herpes