Affecting approximately 10% of UK people by the age of 25,
herpes simplex type 2 (HSV-2), or genital herpes, is one of the most common
sexually transmitted infections (STIs) in the country. Once a person is
infected with HSV-2, their body will contain the virus for life. For some
people, this may cause no further symptoms once the initial infection has
cleared, but for others is it a nuisance as recurrent outbreaks can occur.
Although there is no cure, HSV-2 symptoms can be managed with the right
medication and self-care, allowing you to get on with your life. (1)
What is HSV-2?
HSV-2 is the main virus which causes genital herpes and is a
strain of the herpes family of viruses. Other strains include HSV-1 which is
responsible for cold sores but can also cause genital herpes, varicella-zoster
virus which causes chickenpox and shingles, and Epstein Barr virus which is
implicated in glandular fever.
Once it has found a way into the body and has caused an
initial infection, HSV-2 remains within the body indefinitely. For most of this
time it is in a dormant (inactivated) state within a nerve close to the initial
point of infection, but outbreaks of genital herpes can occur and often have a
trigger such as ill health, cuts or friction to the area, periods or UV light.
(2)
What are the symptoms
of genital herpes?
The earliest symptoms of genital herpes are usually a
tingling or itching sensation in the genital area, followed by the formation of
blisters on the area of the groin that was in contact with the infected area of
the other person.
This may be the penis, vulva, anus, thighs or buttocks. These
blisters burst, leaving sores which scab then heal. Under the foreskin of the
penis and on the inside of the labia, ulcers will form as opposed to blisters.
As part of the initial infection there may be associated general malaise -
aches and pains, fever and slightly swollen glands in the neck, armpits and
groin. Discomfort when urinating and unusual discharge from the vagina are also
possible symptoms. Symptoms of initial infection should clear within three
weeks. (1, 2)
Subsequent outbreaks of genital herpes generally involve
milder symptoms and clear up in a matter of days. (1)
How can I be tested?
If you have blisters in your genital area and think you may
have genital herpes, you can attend a sexual health clinic to be tested. One of
the blisters will be swabbed to obtain a sample to send off for testing. The
sample can only be taken if there are blisters present. (2)
If your result comes back positive, anyone with whom you’ve
been sexually active also needs to be tested. This is because symptoms of
genital herpes can, in some cases, take years to appear after initial
infection. If you don’t want to or can’t contact the partners yourself, the
sexual health clinic may be able to contact them on your behalf. They will not
reveal your identity while doing so. (2)
You can also test for genital herpes with our 7-in-1 test kit which tests for the 7 most common STI's.
How is genital herpes
treated?
There is no cure for genital herpes, so the aim of treatment
is to ease symptoms and sometimes shorten the duration of an outbreak.
Aciclovir, an antiviral drug, is the
first line treatment. It is taken in tablet form three or five times a day,
depending on the tablet strength, for five days.
The course may be extended if
blisters appear after the course is started or if they have not healed
sufficiently. Outbreaks can be treated with shorter courses if higher strength
tablets are taken. An oral suspension and topical cream are also available.
Alternative antivirals famciclovir
and valaciclovir can be used orally
in a similar way. (3)
For people who suffer from frequent outbreaks, antivirals
can also be used for suppression to keep viral levels under control and prevent
outbreaks from happening in the first place.
Instead of being taken as a
course, they are taken every day for up to a year, after which treatment is
halted to determine whether outbreaks return. If they do, treatment may be
started again. If outbreaks keep happening despite taking suppressive
treatment, your GP may consider referral to a specialist. (3)
Is there anything
else I can do to ease the discomfort of an outbreak?
During an outbreak, you may benefit from the following
self-care steps:
An ice pack covered with a flannel pressed against the
area can help to ease the pain of the blisters. Do this for as long as is
needed or comfortable.
You may want to try pouring water onto the groin as you
urinate to reduce pain and discomfort.
Petroleum jelly or anaesthetic cream applied to the
blisters may also help with discomfort during urination. Always make sure you
wash your hands thoroughly before and after touching blisters.
Open sores are a potential site of a secondary
bacterial infection. To avoid this, bathe regularly using plain or salt water.
Wear loose-fitting underwear and clothing to avoid
rubbing of the area and therefore pain and potential bacterial infection. (2)
How can I reduce the
spread of genital herpes?
The most effective way to prevent infection of partners is
to abstain from any sexual contact while symptoms are present, from the
tingling or itching until blisters and ulcers have completely healed. This
includes sexual activity involving hands, as not only does this mean the virus
can be transferred to a partner’s genitals, but it is possible for it to enter
the body via the hands. (1, 2)
Additionally, always use condoms for vaginal or anal sex and
dams for oral sex or vulval contact between partners, even when there is no
outbreak. (2)
Avoid sharing sex toys. If you do, wash the toy thoroughly
and cover with a fresh condom before each use. (1)
The antiviral drug valaciclovir can also be prescribed to
help make HSV-2 less transmissible to partners. (3)
Is genital herpes a
threat to other aspects of my health?
Fortunately, for healthy people, genital herpes is nothing
more than an annoyance. It doesn’t predispose you to other diseases, affect
fertility or alter your lifespan. Nevertheless, it can cause problems for
people with HIV, so people with HIV who catch herpes will be managed by a
specialist. If you need any further information or support, click here or consult your GP, pharmacist or sexual
health clinic. (1, 2)
References
- Herpes Viruses Association. About herpes simplex virus [cited 16 March 2018]. Available at: https://herpes.org.uk/frequently-asked-questions/herpes-simplex-virus/
- NHS Choices. Genital herpes [cited 16 March 2018]. Available at: https://www.nhs.uk/conditions/Genital-herpes/
- British National Formulary (version 1.3.7) [Mobile application software]. Retrieved from: www.bnf.org
Author: Gabby Gallagher MPharm
Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 06/04/18