Genital herpes is caused by infection with a virus called Herpes simplex (HSV). There are two strains, HSV-1 and HSV-2, both of which can cause genital herpes and cold sores in the mouth area. Infection with the virus does not always result in symptoms, but if it does so, these usually consist of blisters and sore areas on the skin surface.
How common is it?
Four out of five adults carry HSV-1 and about one in five carries HSV-2. All will shed the virus from time to time, either from the mouth or genital area. However, most people (about three quarters) carrying the virus are unaware that they're infected, because they have no symptoms.
How can I tell if I have genital herpes?
In most people, symptoms are mild or non-existent. If symptoms do occur, they typically include itching/ burning/tingling of the skin, followed by redness and small blisters which break open to form little sores. The first outbreak can last two or three weeks. It often feels like flu, with muscle aches, headaches, swollen glands and burning on passing urine. If you get your first episode of herpes in the anal/rectal area, this can cause quite severe discomfort, diarrhoea and an anal discharge.
Sometimes there are no further outbreaks. Generally, HSV-1 is less likely to cause recurrences than HSV-2. Recurrences result in fewer blisters/ sores, they are much less painful and healing only takes a few days. For very many people, the frequency of recurrences declines with time. At present, the only way of confirming that you have either HSV-1 or HSV-2 is by taking a swab from a blister or sore in the lip or genital areas. In the future, there may be a new blood test which can reliably diagnose each strain of the virus - this is at present limited to a research tool.
How is it transmitted?
Herpes is transmitted by direct contact, including genital-to-genital, mouth-to-mouth, mouth-to-genital and genital-to-mouth contact. Herpes is most infectious during outbreaks, from the first signs of burning/tingling until the skin has completely returned to normal. Sometimes the virus can be active, but not cause visible sores or other signs of infection. This is called "asymptomatic shedding"; research has shown that, on average, this happens about 1-4% of the time (ie about 4-15 days in a year). Although there is much less virus on the surface of the skin than when visible sores occur, it is still possible to transmit herpes to a partner if direct contact occurs at this time. Although condoms do help to prevent transmission, they are not a guarantee of complete protection. This is because the virus is shed from areas not covered by the condom, (including the mouth!) and because so many people are asymptomatic shedders. Dental dams for rimming and spermicides such as nonoxynol-9 can offer some additional protection.
What treatment is available?
During an outbreak, keep the affected area as cool and dry as possible. Bathe the area in tepid salty water or take a cool shower. If it's practical, leave the sores exposed to dry out. If you have sores around the anus, make sure you keep your stools soft by either taking plenty of dietary fibre and fluids, or use a stool softener such as lactulose, protect the area with a little vaseline before going to the toilet - and wash afterwards. Although there is no drug available to kill the virus outright, aciclovir is a prescription drug which is used in two situations; it helps greatly in shortening first outbreaks and, secondly, it may also be taken daily by the very small group of people who experience frequent, prolonged or severe recurrences. Aciclovir cream is much less effective, but like any cool substance, it feels soothing. There are now a number of drugs similar to aciclovir.
How can I prevent outbreaks?
Keep a record of when you have herpes outbreaks, as you may begin to see a pattern of trigger factors. Many people find that recurrences occur when they're run down, under stress or when the skin gets irritated due to friction or tight clothing. Sunlight and sunbeds may also induce an outbreak. If you're HIV positive, you may get more frequent outbreaks - aciclovir can help to reduce their frequency, but there have been occasional reports of drug-resistant strains. If you do see a pattern of trigger factors, try to adjust your lifestyle to avoid them.
How should I tell my partner?
Before you tell your partner, make sure that you yourself are clear about the facts and feel confident. Put genital herpes into perspective - it is identical to cold sores in the mouth area. Basically it is a nuisance skin condition caused by a virus which is carried by 20% (HSV-2) and 80% (HSV-1) of the population. You may wish to talk the facts over with a sexual health doctor or health adviser. It's best to tell your partner before having any kind of contact - or make sure you're having ultra-safe sex. Most partners (or potential partners!) will appreciate being involved in the discussion early. Honesty and trust in sharing this personal information is important, especially when you put it all into perspective by knowing all the key facts. Give your partner some time to think about it all, too. The health adviser at the Steve Retson Project can help you with this important step.