genital herpes treatment

Genital herpes is a common and very contagious infection caused by the herpes simplex virus (HSV). It’s a sexually transmitted infection, STI, passed from one person to another by intimate sexual contact. It causes painful blisters on the genitals and the surrounding areas.
Genital herpes is a long-term condition where the virus remains in your body, lying dormant but can become active again. On average, most people have four to five outbreaks in the first two years after being infected with HSV. However, over time, it tends to cause fewer outbreaks and each outbreak becomes less severe.

There are two types of herpes simplex virus (HSV), type 1 and type 2. Both types are highly contagious and can be passed easily from one infected person to another non-infected person by vaginal, anal or oral sex.

Most cases of genital herpes are caused by infection with the herpes simplex virus type 2 (HSV-2). Herpes simplex virus type 1 (HSV-1) is more often the cause of cold sores but can also be a cause of genital herpes.

Most people who carry the virus are unaware they have been infected because there are often few or no initial symptoms but it's still possible for them to pass the condition on to a sexual partner.
Symptoms may not appear until months or sometimes years after you're exposed to the virus.

If you experience symptoms when first infected, they usually appear four to seven days after you have been exposed to the virus. The symptoms are usually more severe first time around than in cases of recurrent infections.

Primary Infection (first outbreak)

Feeling unwell, with aches, pains and flu-like symptoms .
Small blisters that burst to leave red, open sores around your genitals, anal area, thighs and buttocks
blisters and ulcers on the cervix (neck of the womb) in women.
Vaginal discharge in women.
Pain when you pass urine (particularly in women).
These symptoms may last up to 20 days but the sores will eventually scab and heal up without leaving a scar.

Recurrent infections

The virus remains dormant (inactive) in a nearby nerve but certain triggers can result in the virus travelling back down the nerve that supplies feeling to the area of skin where a breakout can occur again.
You may experience :-
A tingling, burning or itching sensation around your genitals, and sometimes down your leg, before blisters appear. 
Painful red blisters appear that burst to leave sores around your genitals, anal area, thighs and buttocks.
Women may get blisters and ulcers on the cervix (neck of the womb).
Most people have four to five outbreaks during the first two years after being exposed to the virus.
However, recurrent outbreaks usually become less severe and occur less often. This is because your body has produced protective antibodies in reaction to the previous infection. Now, your body recognises the virus and is able to fight it more effectively. Also, the virus may reactivate without causing any symptoms of infection at all.

Certain triggers may be responsible for the symptoms of genital herpes recurring.

• being unwell or stressed.
• exposure to ultraviolet light especially in a hot climate   or using sunbeds 
• drinking excess amounts of alcohol
• surgery on your genital area
• having a weakened immune system eg as a result of having cancer
• friction in your genital area during sexual intercourse

If you think you may have genital herpes for the first time (a primary infection), you should visit your local sexual health clinic. This is because an initial diagnosis of genital herpes should be made by a sexual health specialist. If you cannot get to a sexual health clinic, you should see your GP instead. They may refer you to a clinic for a formal diagnosis and treatment.

The recommended preferred regimen from the British Association for Sexual Health and HIV, BASHH, is either aciclovir 400 mg three times daily or
valaciclovir 500 mg twice daily,  to be taken for 5 days.

Treatment for genital herpes will depend on whether you have a primary or recurrent outbreak of the viral infection.
Primary infection
If you have genital herpes for the first time, you would be better to visit your local sexual health clinic. They will be able to diagnose and treat you with antiviral tablets. This is because you should be seen by a sexual health expert for an initial diagnosis.
The antiviral tablets used during a first and subsequent outbreaks are the same. The antiviral tablets used to treat genital herpes include aciclovir, valaciclovir and famciclovir. BASHH recommend either aciclovir or valaciclovir but the most commonly used is aciclovir. They work by stopping the herpes virus from multiplying. They do not clear the virus from the body but they keep it under control.
The severity and duration of an outbreak can be reduced if an antiviral medicine is started as soon as any symptoms are experienced eg as soon as tingling occurs. They can shorten your outbreak by one to two days if taken within five days of the first signs of an outbreak. The medication might even prevent an outbreak from occurring at all.

Aciclovir and Valaciclovir tablets are both effective in treating a full outbreak of genital herpes.

Valaciclovir is a "prodrug" meaning it is converted into aciclovir by the body. The effectiveness is similar but valaciclovir is better absorbed by the body and therefore can be taken less often. Valaciclovir is also known by the brand name Valtrex. Valtrex is much more expensive than valaciclovir but both are identical medically are equally effective.

How often do I take aciclovir or valaciclovir?
Episodic treatment
If you have fewer than 6 recurrent outbreaks a year we can prescribe a five day course of aciclovir or valaciclovir each time you experience tingling or numbness before symptoms begin or if you have an outbreak.

You take one aciclovir 400mg tablet three times a day for a total of 5 days OR
You take one valaciclovir 500mg tablet twice a day for 5 days.

Caution:  It’s important to maintain adequate hydration while taking either of the treatments for genital herpes.

Aciclovir and valaciclovir can shorten your outbreak by one to two days if taken within five days of the first signs of the outbreak. The symptoms should be less severe and the outbreak might even be prevented from occurring at all.

If you have six or more recurrent outbreaks of genital herpes a year or if your symptoms are very severe and causing you distress, you can take aciclovir or valaciclovir every day on a long-term basis. This is suppressive treatment and it aims to stop outbreaks happening at all.

How often do I take suppressive treatment?
You take one aciclovir 400mg tablet twice a day or one valaciclovir 500mg tablet once daily.
The treatment is continued for six to 12 months. Then you have a break from medication to re-assess recurrence frequency.  Suppressive treatment may be restarted if you have further severe outbreaks.
Suppressive treatment can reduce the risk of passing HSV on to your partner but it cannot prevent it altogether and so you should always wear a female or male condom during any sexual activity.
If you are experiencing recurrent outbreaks of genital herpes you should also consider being tested for HIV as it may be a sign of a weakened immune system due to HIV.

Genital herpes can cause problems during pregnancy. These complications can be more serious depending on whether you already have genital herpes, or develop it for the first time while pregnant. The risk of transmission from a mother to her baby is greatest for babies born to a woman with first episode genital herpes around the time of delivery. If you have herpes and are pregnant then you should consult your GP for advice and treatment.

Side-effects of anti-viral treatment

• Abdominal pain
• Nausea and vomiting
• Fatigue
• Headache
• Diarrhoea
• Light sensitivity
• Itchy skin and rashes

Applying petroleum jelly, such as Vaseline, or an anaesthetic  cream, such as 5% lidocaine to any blisters or ulcers will reduce the pain especially when you pass urine.
If you drink plenty of fluids to dilute your urine then it should make passing urine less painful or try to urinate while sitting in a bath.
Applying an ice pack or frozen peas wrapped in a t-towel, not directly to the skin, may help to soothe the pain.
Use pain relief tablets eg paracetamol
Wash the affected area with either plain or salt water to help stop the blisters from acquiring any secondary infection and to promote healing.
Avoid wearing tight clothing because it may irritate the blisters and ulcers.

If you have genital herpes, it's important to avoid having sexual intercourse, including vaginal, anal and oral sex, until all your blisters and ulcers have cleared up. During an out-break the virus is highly contagious, even from the first tingle or itch.
Avoid sharing sex toys but if you do, make sure you wash them and cover with a condom.
You shouldn’t kiss your partner if either of you has a cold sore as you will pass it on and you should also avoid oral sex when you have a cold sore as this is another way that you can get genital herpes.
It’s important to always wear a condom, particularly with new partners, when having any kind of sexual activity. You should wear one even if you have no symptoms as the virus may still be on your skin and you could pass it to another person.

It is very important to inform current or new partners about your Herpes diagnosis and/or treatment.

You can get more information and advice on herpes.org.uk