Genital herpes (herpes-genitalis)

Genital Herpes or HSV-2

In most everyday conversations herpes is a term used mainly for genital herpes, which is caused by the Herpes Simplex Virus Type 2 (HSV-2).

Did you know that:

  • Herpes Genitalis is the latin name for herpes infections in the genital area.
  • Genital Herpes is typically a result of the HSV-2, and is the second most common form of herpes.
  • HSV-2 infections are typically transmitted through sexual contact.
  • Up to 10% of adults in England suffer from the HSV-2 virus.
  • Herpes causes fluid filled blisters on the genitals, but these symptoms can also occur in other areas on the body.
  • Oral sex increases the risk of contamination and infection from genitals to mouth and vice versa. Resulting in some people suffering from HSV-2 on their mouth and lips.

Genital Herpes/Herpes on the genitals

Herpes Genitalis is the original latin term for the now commonly known genital herpes or HSV-2, this virus attacks the genitals and the area surrounding them, through the skin and mucous membranes. 10% of UK adults carries the HSV-2 virus, read more. HSV-2 behaves differently for each person, some can get frequent outbreaks, others can be unaware that they are infected and will not have any flare ups. The usual incubation period from primary infection can range from a few days to a few weeks. Meaning you may not see symptoms of infection of HSV-2 for a couple of weeks from first infection.

Herpes as an STD through infection by HSV-1.

It is worth explaining that, although HSV is a viral disease genital herpes is most commonly caused by HSV-2. HSV type 1 is the cause of only 30% of herpes outbreaks in the genital area. This is probably due to the risk of transmission of HSV-1 through contact of mouth to genitals when having oral sex.

Is it possible to carry both HSV-1 & HSV-2?

Yes! However, there is some good news, as those infected with HSV-1 or cold sores before being infected with HSV-2 or genital herpes will have some immunity to the HSV-2 virus already. Which means you will rarely suffer from genital herpes outbreaks if you already suffer from cold sores on the face. The same goes for the opposite, if you already suffer with genital herpes you will suffer less from the HSV-1 virus, however, cases of this scenario are rare, it is more common to be infected with HSV-1 first and then HSV-2.

Symptoms of HSV-2

The picture below demonstrates an outbreak with the characteristics of a herpes outbreak, with small fluid blisters appearing on the skin. If you suffer with frequent outbreaks you will notice they most commonly appear in the same area on the skin or genitals. This also applies if you are infected with herpes around the anus.

Several outbreaks of herpes at the same time is normal!

It is common for people – especially if it is their first outbreak – to have more than one patch of blisters appear at the same time. But as with any course of a disease, it can be different from person to person and some will only feel minimal discomfort and think they only have a small cut or bump on their genitals, which they would not give much attention to. However, if you have been unfortunate to have been hit hard by your first experience, grab the opportunity, you are not alone and there is plenty you can do to treat and avoid future outbreaks.

Infected with HSV without symptoms

Once infected with herpes the virus will live in the nerve pathways of the body forever. Here it can effectively remain inactive and there are few lucky people who never discover they carry the virus. But you can still infect people if the virus never breaks out so it is always good to get checked. However, The majority of people who suffer from genital herpes will have no doubt something is wrong down there and will soon realise they have had herpes. There are a few cases of carriers who hardly notice they have been infected with HSV-2 and don’t take any notice of their first flare up, maybe they find out they carry the HSV virus later in life or maybe they never find out.

The course of HSV: the first signs of Genital Herpes

The first symptoms of an outbreak of herpes are typically noticed within 2-12 days after infection and this first outbreak of herpes may last up to several weeks. However, it can take considerably longer for the first outbreak to appear, therefore it is difficult to know for sure if you carry the herpes virus. Some never have visible or noticeable outbreaks but still carry the virus and can infect others without being aware of it.

The infection and outbreak of herpes can be associated with flu-like symptoms including, headaches, mild fever, sore throat, groin pain and sore muscles. The onset of genital herpes can cause a number of symptoms to appear, itching, redness, burning and swelling. You will also begin to see small fluid-filled blisters that will eventually break and become wounds within a few days. A herpes outbreak can be quite painful, especially during the first experience, also known as a primary infection.

Symptoms of herpes can often be confused with Cystitis.

Both men and women can experience a burning sensation whilst going to the toilet, during an outbreak of HSV-2. In fact, some only discover they are having a herpes outbreak because they believe they have a urinary tract infection due to the burning sensation whilst urinating. But this symptom, even though similar, can be proven to be an irritation of the mucous membrane as a result of the herpes virus and not a bacterial infection which causes diseases such as cystitis and urinary tract infections.

Contact your doctor if you suspect you have herpes.

You should always contact your doctor and have an examination if you feel you may have been infected with herpes. Genital herpes is highly contagious and once infected you will carry the disease for life. But if you know the diagnosis there are ways of minimising the risk of outbreaks and transmission. Although in the majority of cases herpes is not dangerous for us, there is every reason to get a diagnosis and understand what you can do to treat and avoid outbreaks as well as learn the risks of infecting others.

Is herpes different for men and women?

Typically in cases of male genital herpes, outbreaks occur under the foreskin, but for women outbreaks primarily occur on the inside of the labia or around the vagina. But both men and women can experience outbreaks on the inner thighs, buttocks and around the anus (also known as rectal herpes). Herpes can sometimes even hide from the naked eye preferring to break out on the inner mucous membranes of the vagina (vaginal herpes), causing extreme discomfort and symptoms similar to cystitis. You can read more about the symptoms, treatment and risk of infection in the following sections.

Why are more women than men infected with herpes

As you can see from the picture below, statistically there are more women worldwide infected with the HSV-2 virus than men, read more. The reason for this has been found that men often infect women rather than vice versa. For example, if a man is having a herpes outbreak and has unprotected sex with a woman, the chance of her contracting the virus is much higher than the other way around.

Therefore it has nothing to do with women having more unprotected sex, having a weaker immune system or poorer hygiene standards. It just means as a man you should pay more attention to the higher risk of transmitting the infection and should avoid sexual contact during an outbreak, and that as a woman you should be mindful and never have unprotected sex if you want to avoid becoming infected with HSV-2.

Below you can read about the differences that men and women experience as carriers of the HSV-2 virus.

Herpes in women: menstruation and herpes.

Many of the women we have spoken to have experienced recurring outbreaks in the days leading up to or during menstruation. It is not really known why this occurs, other than that it could be linked with the hormonal changes that occur in the female body during the cycle. The best defence against these recurring outbreaks is to strengthen your immune system and therefore equip your body to avoid and fight frequent outbreaks. Paying particular attention to symptoms such as pain in the groin and itching around the commonly affected area, as this can indicate an imminent outbreak.

Genital herpes and fertility

Herpes can attack both the inner and outer parts of the genital area, there is no evidence to suggest that the HSV virus negatively affects fertility (or positively for that matter) in both men and women. Other sexually transmitted diseases on the other hand can cause sterility, such as Chlamydia, but there is nothing to worry about if your carry the herpes virus. Read more about herpes, pregnancy and children here.

Herpes in men: herpes on the penis.

The same as women, men can get an outbreak of herpes anywhere on the body, but there is nothing worse than discovering a sore red rash down there. We are all aware of the horror stories associated with men getting checked by the doctor for STD’s, that dreaded cotton swab. But luckily when checking men for herpes, there is no pain, even when checking the penis. The doctor gently swabs over the affected area, which is enough to check whether the rash is herpes genitalis. So do not let your fear stop you from seeing a doctor and getting help and treatment and also understand the risk of future infections and risk of transmission.

As we mentioned above men more often infect women with HSV-2 than vice versa, so you need to be extra careful when experiencing an active outbreak of herpes and taking part in sexual acts.

Do I have herpes?

If you suspect you have been infected with HSV, you should always visit a doctor and have the symptoms checked. Most often a doctor will be able to quickly diagnose whether you have a herpes outbreak or not, but of course doctors can sometimes be mistaken and the symptoms will usually require a test to be 100% sure. If for one reason or another you do not wish to be checked over by your own GP there are other places you can get checked such as free sexual health clinics where you can be examined anonymously. Find you local free clinic here.

Does it hurt to be tested for genital herpes.

No! The doctor uses a swab to gently take a sample from the affected area. The small amount of fluid from the wound that is taken is enough to test for whether herpes is present. An outbreak of herpes can in many ways be associated with pain and discomfort but the tests and checking by a doctor is nothing to worry about, all doctors know herpes can be uncomfortable and sore and so will do all they can to minimise the discomfort felt during these tests.

The test for herpes: when will I find out whether I have herpes?

It usually takes up to a week since you have been to the doctor for the results to come back, they will most likely email or text you the results, but may call if there is any concern. This time frame may also vary from clinic to clinic.

Will I have herpes forever?

Yes, once infected with herpes, unfortunately you will carry the virus for life. There is – at this moment in time – no definite cure for herpes. There is no one treatment scientifically proven to remove or cure viruses of all kinds. However, this does not mean there is no treatment to avoid and minimise frequency of outbreaks. As long as the herpes simplex virus is dormant or inactive, the body will display no symptoms of herpes. Keep reading to learn how to avoid and treat outbreaks of herpes.

How often should you get herpes outbreaks?

It varies from person to person how often outbreaks occur after being infected with genital herpes. From the moment of primary infection, the virus resides in the nerve pathways of the skin and at the area of infection. It then works its way through the nerve pathways of the body, all the way through to the root of the nerves (nerve cells). Once here viruses are no longer active and can in effect remain inactive forever (this is also known as the latent/dormant stage). But it can also live here and cause frequent and recurrent outbreaks. Everything in between these two ends of the spectrum is normal.

How do you get the HSV-2 infection?

Infection of genital herpes usually occurs primarily between humans during physical contact such as, skin to skin or mucous membrane to mucous membrane. Herpes Simplex Virus type 2 in the majority of cases is transferred from person to person in the form of sexual intercourse and other sexual acts and is therefore categorised as an STD. You can also be unfortunate enough to become infected with herpes by using the same towel as someone suffering from an outbreak, however cases of this are extremely rare. The Herpes Simplex Virus does not survive long when it is exposed to air or comes into contact with any other surface that is not skin or a mucous membrane.

The risk of infection of herpes:

As HSV-2 is classed as an STD and a highly infectious one, you can be infected with genital herpes through touch, oral sex and intercourse. The risk of transmission is highest when there is an active outbreak of herpes and the wounds are visible. To avoid becoming infected and a carrier of herpes, it is important to use protection every time you have a new sexual partner. If you, yourself carry the virus, it is your responsibility to protect others from infection of genital herpes. You should ideally avoid sexual contact during an outbreak, but at the least you should use a condom every time and ensure to wash your hands if you have touched an area of herpes to avoid spreading the virus. Unfortunately, condoms do not protect 100% against the spread of genital herpes, as the area in outbreak is not always covered by the condom.

My girlfriend has herpes – how do I avoid herpes?

If your regular partner carries the virus then it can be difficult to avoid becoming infected, but it is possible. You need to be extra cautious and pay particular attention to any common symptoms associated with the herpes virus and then take some precautions. The best way of avoiding infection is to not have sex if your partner is having an active outbreak of herpes, when risk of transmission is highest. If you choose to have sex anyway, remember to use a condom until all symptoms and signs of herpes have disappeared. Only when the skin has healed and the area looks and feels normal again can you have unprotected sex again.

Can herpes infect others without an active outbreak?

Yes! It is not always possible to know whether you are infected or you are unable to see or feel an outbreak. But in some rare cases the virus can be passed from person to person in saliva or secretions from the genitals even when there are no signs of an active outbreak of herpes. Therefore it is possible to infect others and become infected with genital herpes without clear signs of herpes.

Read more about treatment and prevention of genital herpes here.

Is genital herpes dangerous?

No! Even though suffering from genital herpes can be uncomfortable and painful and it is not nice to know you will carry the virus for the rest of your life, it is not dangerous. There is no evidence to show that those infected with HSV-2 become seriously ill or live shorter lives than those not infected with herpes. Further treatment may be required for herpes if infection occurs in one of the wounds of a herpes outbreak, however this is not a common occurrence. There are only a few cases where a herpes infection has become serious. You can read more about these unique cases below.

Treatment of genital herpes

There are several medical precautions that can be taken that are said to shorten or prevent outbreaks of genital herpes. However, there is no medical cure rather medicines that can inhibit the herpes virus. But, in our experience these medicines can have side effects, so we therefore recommend a healthy lifestyle and natural supplements to treat and prevent genital herpes outbreaks. Whether you are having your first outbreak or suffer from frequent appearances of herpes it is never too late to put defences in place to prevent future outbreaks and know how to treat outbreaks if they cannot be prevented.

What can I do to avoid herpes?

There are various reasons the herpes virus can awaken and cause an outbreak on the skin or mucous membranes, but most often outbreaks are caused by a weakened immune system or the skin being damaged, where the nerve lives containing the herpes virus. When, for whatever reason, the virus decides to flare up, it transports itself through the body to the skin, resulting in an outbreak of the unpleasant herpes wounds.

There is a lot that can be done to avoid becoming infected with herpes. Firstly using a condom every time you have a new sexual partner. Try not to have sex if there is even the slightest sign or symptoms that an outbreak of herpes is due for yourself or your partner. If you know you carry the HSV virus and want to try and avoid outbreaks, it is worth noting that herpes outbreaks can be triggered by stressful situations and for women outbreaks are common in the days leading up to menstruation. There are some simple dietary changes that can be made and natural supplements you can use to easily prevent outbreaks of herpes. You can find more information on this in treatment and prevention here.

Where on the body can you get HSV-2?

A herpes outbreak in the form of fluid filled blisters and sores usually appear around the outer genitals. Herpes often occurs in the same place for each new outbreak, this can often be the site where the infection was transmitted. However, you can also be ‘lucky’ enough to find outbreaks on new areas of the body than before.

Herpes in the brain (Encephalitis)

In some extreme cases, herpes infections can reside on the brain and cause encephalitis or meningitis, which are two different things, read more about the differences here. Encephalitis causes inflammation of the brain, whereas meningitis causes inflammation of the brain membrane, however cases of these are extremely rare and it is not something to worry about, even if you are infected with herpes.

It is important to note that if you have an outbreak of herpes and come in contact with a young child or baby, you should take extra care to thoroughly wash your hands and be vigilant with your personal hygiene. Herpes for infants can be fatal in some cases, but fortunately these cases are very rare.

Herpes in the eye: what is Herpes Keratitis?

Inflammation in the cornea of the eye or Herpes Keratitis, is often caused by infection of the HSV-1 virus, the same virus that produces cold sores. Being infected with herpes in the eye is one of the most serious infections caused by the herpes simplex virus. If infected with herpes of the eye it can cause impaired vision if not treated quickly. Common symptoms of a herpes eye infection are irritation or flushing of the affected eye, as the corneal outer layer of the eye is attacked by the virus. At this stage it is not dangerous but if not treated, the virus could continue to attack the cornea eventually reaching the inner layer of the cornea. The worst case scenario, when the virus begins to attack the inner cornea it can cause what is called an iris inflammation, which in extreme cases can result in complete loss of sight.

Symptoms of herpes in the eye (corneal inflammation)

Common symptoms associated with herpes in the eye is if you suffer from running eyes or a constant feeling of having something in the eye but can’t see anything physical to affect it. Also if you notice any redness, sensitivity to light, pain, diminished or blurred vision, this can be a sign of a more serious infection.

Treatment for corneal inflammation caused by herpes

In less serious cases of herpes in the eye, the symptoms will disappear on their own within 1-2 weeks. Usually to shorten the course of the virus, doctors will prescribe adrenal gland hormone, but this is rarely necessary. In the majority of cases the body will fight the infection and resulting inflammation itself without medical treatment. It can take up to two week for the cornea and eye to heal itself.

In the more serious cases of herpes in the eye (herpes keratitis) some slight medical intervention may be needed. Under local anesthetic, the doctor will gently remove the damaged cells from the surface of the cornea. It may sound terrifying but it is an extremely effective method of removing the infection and potentially save your sight.

There are more types of herpes, other than HSV-1 and HSV-2, for example, Herpes Zoster, which we have explained below.

What is Herpes Zoster?

Although Herpes Zoster and the Herpes Simplex virus sound similar they are quite different. Herpes Zoster is commonly known as ‘Shingles’. It is a skin disorder that causes blisters and ulcers to appear on the skin. But even though there are similarities in the way the virus presents itself, Herpes Zoster is actually caused by a different virus, Varicella Zoster Virus.

Chickenpox and Herpes Zoster

Upon first infection with Herpes Zoster you get what is commonly known as Chickenpox, best known for infection at a childhood age. Most people will never suffer with outbreaks of this disease again, but for people with weakened immune systems, they can be affected with outbreaks of shingles in later life. Particularly, elderly women are affected more commonly than others by Herpes Zoster. Similarly to the Herpes Simplex Virus, the best way to avoid outbreaks is mostly to take care of yourself and take extra precautions to strengthen the immune system daily.

Infection risk and course of the Shingles disease

Shingles appears as a painful, red rash, which is caused by the varicella-zoster virus. Once you have had Chickenpox, the herpes zoster virus remains dormant in the nerves of the body, and as previously mentioned can cause shingles later in life. If you have never had Chickenpox in your life you cannot have shingles. Shingles is seen as a milder version of Chickenpox, as it has the same qualities as Chickenpox but is contained to a small area of skin. Shingles can appear anywhere on the body or face, as we have nerves throughout the body, but it will only ever appear on the left or right side of the body.

Outbreaks of Herpes Zoster

The early symptoms of Herpes Zoster (Shingles) are headaches and a general feeling of weakness. Then you can experience a burning, tingling, itching pain on the area of skin, where the outbreak will appear. Fluid filled blisters as a rash, will begin to appear after 3-6 days, some of the blisters can be filled with blood or puss over time. Eventually the blisters will turn into wounds and scab over. Shingles rashes usually appear in skin areas around the abdomen/lower back, chest, or face, and only ever appears on the left or right side of the body.

True or False

You cannot be infected with Genital Herpes if you use a condom during sex.

False! Unfortunately, Genital Herpes is not always contained to the area covered by a condom, so this is not a foolproof way of stopping infection. Herpes can also be transmitted through oral sex. If you have a cold sore on your lip and have oral sex with your partner you can risk infecting them with HSV-1.

You can be infected with herpes from sitting on a public toilet seat.

In theory, yes, but there is no evidence to support this as a source of infection for the herpes virus. The virus dries out and dies very quickly when exposed to air, therefore herpes can only be transmitted by direct physical contact.

Only those who have frequent sexual intercourse can get herpes.

False! Anyone who partakes in sexual activities can be infected with Genital Herpes no matter how frequent. It is one of the most contagious diseases. The virus is transferred from person to person through physical contact, usually skin to skin, with someone who is already infected.

Can you get herpes by sharing underwear, towels, bedding, etc.?

Potentially, yes! But in reality it should not be possible, as the herpes virus cannot survive once exposed to air. If you make sure to wash your underwear and towels, etc. between uses there should be no risk of transmission from one person to another.

You get genital herpes from masturbation!

False! You cannot become infected with genital herpes from masturbation. However, it is true that if you are already infected with herpes, the friction of masturbation can sometimes irritate the affected area and trigger an outbreak of herpes. The same applies for the friction when having sex with a partner.

I’ve got Herpes! Has my partner been unfaithful?

Not necessarily! Even if you are in a long term relationship and you know you haven’t been with anyone else whilst in the relationship, and you get an outbreak of herpes, it does not mean your partner has been unfaithful. The infection can easily lie dormant in the body for long periods of time before the first outbreak appears. You or your partner could have easily been infected before beginning the relationship, without having any symptoms.

You can only wear cotton underwear if you have herpes!

False! There are no rules to say what underwear you can and cannot wear if you are a carrier of genital herpes. However, it is true that tight-fitting clothes made of Spandex, Lycra, Nylon or other materials like these can cause outbreaks as they are not as breathable. If you feel more comfortable in silk or lace, you go for it girl! However, if you are experiencing an outbreak of herpes, it is a good idea to wear comfortable underwear to speed up the healing process.