Help & Advice

What is the cause of Herpes Infections?

Herpes is caused by the Herpes simplex virus (HSV) and can be divided into two types:  HSV-1 and HSV-2.  Genital herpes is most commonly caused by HSV-2 and oral herpes is most commonly caused by HSV-1. 

What is Genital Herpes?

Genital Herpes is a sexually transmitted infection (STI) that affects around 25% of the sexually active population in the UK.  This rate is low compared to many other areas of the world.

What are the symptoms of Genital Herpes?

Genital herpes typically affects the genitals, buttocks and anal area.  The first noticeable outbreak often occurs 2-10 days after exposure to an infected partner although the first attack can occur much later. 

Symptoms of primary infections (the first outbreak) can include:

  • Flu-like symptoms such as muscle aches, headache or fever
  • Pain and itching in the genital area
  • Small red bumps or tiny white blisters in and around the genital area.  These blisters rupture and ooze forming ulcers and eventually heal when the ulcers scab over.
  • Pain upon passing urine, especially in women, when urine passes over the ulcers
  • Most experience very mild symptoms or even no symptoms at all but are still contagious and can continue to pass the disease along.  An asymptomatic carrier is the most common means of disease transmission.

The disease lies dormant in the nerves after an infection.  Recurrence occurs when the disease travels from the nerve back to the skin.  The frequency of recurrence varies from person to person but the disease can recur several times a year.  Over time, recurrences typically decrease in frequency.

Symptoms of recurrent infections include; burning, tingling and pain are early warning signs. These can be followed by similar symptoms to those experienced during a primary infection but generally less severe and less painful.

Who is at risk of getting Genital Herpes?

Those more likely to get genital herpes include:

  • Women (Genital herpes affects both men and women but is more easily passed to women)
  • People with multiple sexual partners (sex workers)
  • People who engage in unprotected sex
  • People with HIV

What is the treatment for Genital Herpes?

Herpes is a self-limiting infection, which means that it can resolve on its own without treatment.  Although there is no cure for herpes, several medications are available for symptomatic relief and to reduce frequency and severity of outbreaks. 

Some find it helpful to keep a diary to track frequency and severity of recurrences and assist the doctor in determining how to approach treatment. 

Some of the treatments available include:
Topical agents

    • Numbing gels or ointment such as lidocaine
    • Saline baths
    • Topical antivirals are not recommended

Oral agents

    • Paracetamol or ibuprofen for pain and fever
    • Antivirals can reduce the severity and duration of an outbreak especially if taken as soon as possible:
      • Aciclovir
      • Valaciclovir and famciclovir are as effective as aciclovir but more convenient for many patients as there are fewer doses taken in a day.  These agents can be more expensive.

How can Genital Herpes be prevented?

Ongoing therapy may be needed if you experience at least 6 attacks a year.  It can reduce the frequency of attacks as well as the chance you might infect others when you have no symptoms. Aciclovir is the usual treatment and should be discontinued and reassessed every 12 months to determine if preventative therapy is still needed since the frequency of recurrences typically decreases over time.

What is Oral Herpes

Oral herpes is often acquired in childhood by contact with oral secretions that contain the virus.  In the UK, around 25% of the population have been infected by the age of 15 and 50% have been infected by age 30.  It is prevalent in 70% of people in developed countries and 100% of people in developing countries.

What are the symptoms of Oral Herpes?

Oral herpes often leads to cold sores around the mouth or face.

  • Symptoms of primary infection can include:
    • Painful blisters and ulcers in the mouth including the teeth, tongue, cheeks, lips and palates.  Fever, fatigue and appetite loss can accompany this condition.
    • Lesions in the throat leading to inflammation and pain
    • Some experience mild symptoms or no symptoms at all
  • Symptoms of recurrent infection can include:
    • Early warning signs such as tingling, pain or itching 6-24 hours before the appearance of a cold sore
    • Cold sores (the most common form of recurrence)

What is the treatment for Oral Herpes?

Topical agents:

    • Numbing creams, mouthwashes and gels such as lidocaine
    • Antivirals (such as acyclovir and penciclovir) to be applied to the affected area as soon as prodromal symptoms begin

Oral agents:

    • Paracetamol and ibuprofen for pain and fever
    • Antivirals such as aciclovir and valaciclovir can be used for severe cases or in the case of a compromised immune system.

How can Oral Herpes be prevented?

Triggers can include stress, trauma, sunlight, menstruation, and immunosuppression.  Those who are obese are at increased risk of infection.

  • Avoiding identified triggers can help to prevent infection
  • Avoiding kissing or oral sex when symptomatic may prevent spread of the disease
  • Either virus can cause outbreaks in any region of the body including the eyes, skin and other areas which is why it is important to avoid touching the lesions if possible and to wash the hands if contact with the lesions occurs. 

Further information about Herpes Infections:

Children, pregnant women or those with HIV require specialists to evaluate their condition and treatment of HSV-2

Crossover can occur so that HSV-1 can infect the genitals and HSV-2 can infect the mouth.  This commonly occurs with oral sex.  When crossover occurs, the infection is often less severe with fewer or no recurrences as the virus finds it more difficult to thrive in a new environment, especially HSV-2.