Herpes is a common viral infection. When it occurs on the face it is called a cold sore but you can also get it on the genitals (when it is called genital herpes) or anywhere else. Herpes can be passed from person to person through skin to skin contact, so for genital herpes this can happen during any kind of sex - oral, vaginal and anal. Many cases of genital herpes occur when a person has infection around the mouth and kisses their partner's genitals.

Like cold sores, genital herpes can recur.

Herpes infection is very common. In the UK, about 70% of people will have been infected by their 25th birthday. However, only about a third of people will be aware they have herpes.

Often there are no symptoms and most people are unaware they have genital herpes. Men and women may have one or more symptoms such as:-

• Tingling or itching on around the genital or anal area
• Appearance of small painful fluid filled blisters (these break open to leave painful ulcers which heal after a few weeks)
• General flu like symptoms such as headache, muscle aches or fever (these are more common during the first episode)
• Burning sensation when passing urine (peeing)
• Swollen glands in the groin

In most people symptoms appear between 2 days and 2 weeks after catching the virus. However, some people develop sores months or years after catching herpes.

When symptoms are present the virus is highly infectious and sex should be avoided until the skin is fully healed. However, the virus can sometimes be passed on at other times when no symptoms are present. This is called asymptomatic shedding. Using a condom may offer some protection but herpes can still be passed on if the condom does not cover the infected area.

A virus called Herpes Simplex, of which there are 2 types - type 1 and type 2. Both of the types can cause genital herpes or cold sores. Recurrent genital symptoms occur more often with type 2.

Catching type 1 herpes does not protect people from catching type 2 (and vice versa). However, if someone with one type of herpes virus does catch the other type, that person often has few (if any) symptoms from the other type.

In some, but not all, people the herpes sores can come back (recur). Most people find that recurrences don't happen very often and they are usually much less painful and smaller in size than the first episode. Over time they tend to happen less often.

Recurrences usually appear in the same area of skin as the first time. For some people they move a short distance, for example from genitals to buttocks.

By a swab taken from the blisters. It is also important that you are tested for other STI's. A routine screen in a sexual health clinic will offer testing for chlamydia, gonorrhoea, HIV and syphilis.

Often no treatment is necessary as the symptoms can be mild and episodes will resolve on their own. However, some patients may benefit from taking an anti-viral tablet which can reduce the severity and length of the episodes. The tablets are often helpful during the first episode as symptoms tend to be more severe, but they can be taken for any recurrence if needed. They usually only help if they are taken within 5 days of the blisters first appearing. However, if you are getting new blisters after this time or are unwell then you may still be offered treatment. You can get treatment from your GP or Sexual Health clinic.

Painkillers such as paracetamol and ibuprofen can also help ease any pain and sitting in a warm bath to pass urine can help if it is sore to pee. Bathing with salt water every day helps to keep sores clean.

You should avoid sex until your skin has fully healed to reduce the risk of passing the virus on to your partner.

You should also avoid touching or scratching the herpes blisters or sores and then scratching the skin somewhere else on your body as this could spread the infection. The risk is greatest during a first episode of genital herpes.

Most people find that recurrences don't happen very often and that they tend to be very mild. However, if you are getting 6 or more recurrences per year that are causing you bother your doctor might suggest going on long term suppressive treatment for a few months to prevent recurrences.

It's not always necessary to treat genital herpes, especially if the symptoms are mild and short-lived. The aim of treatment is to make the sores less painful and to help them heal more quickly, so if you are not treated healing will take longer.

If your partner has never had any signs of genital herpes it is not essential for them to attend a sexual health clinic. However, if your partner is pregnant or has symptoms or thinks they may have had genital herpes then they should attend the clinic for advice.

If your partner has not been infected with the herpes simplex virus in the past, it is possible for you to pass the virus on to them even if you have no blisters or sores. This is because small amounts of the virus can be present on the genital skin (called asymptomatic shedding). The risk is much greater in the first few months after you catch herpes. Asymptomatic shedding happens less over time and is rare after 2 years. However, after this time it is more common if you are having frequent recurrences. Using condoms offers some protection to your partner but does not reduce the risk completely.

Treatment may be recommended in pregnant women to prevent the baby becoming infected. This is important as herpes can be a more serious infection in a baby (neonatal herpes). However, if you had your first episode of genital herpes before you became pregnant then having recurrent genital herpes during pregnancy does not harm the baby in any way as your antibodies offer some protection to the baby. You may still need to take antiviral treatment from 36 weeks of pregnancy until the baby is born to prevent a recurrence at the time of delivery.

If you have your first episode of genital herpes during pregnancy then treatment depends on whether the infection develops before or after 28 weeks of pregnancy. Prior to 28 weeks of pregnancy, women are recommended to re-start antiviral medication from 36 weeks until the baby is born and should expect to have a normal vaginal delivery. If a woman then goes into labour before 32 weeks the baby may need to be delivered by caesarean section.

If you have your first episode of genital herpes after 28 weeks of pregnancy, then it is advised to continue antiviral medication until the baby is born. The baby may need to be delivered by caesarean section.

If you are pregnant it is important that you let your doctor or midwife know if you have had genital herpes in the past or develop it for the first time during pregnancy, or if your partner has genital herpes. Your obstetrician will discuss all the options with you.

The Herpes Virus Association (HVA) is a patient support group that offers help and advice topple with herpes infection.
HVA Helpline - 0845 123 2305 (weekdays only)
HVA e-mail - [email protected]
HVA Website - www.herpes.org.uk

You cannot tell by looking at someone if they have a sexually transmitted infection, so if you are having sex (oral, anal or vaginal) the only way to make sure you are not putting yourself at risk is to practise safer sex.
This means:

• Always using condoms or femidoms (female condom inserted within the vagina) for vaginal sex.
• Always using condoms with water based lube for anal sex. Do not use condoms with spermicide if you are having anal sex.
• Always using flavoured condoms or dental dams (a latex shield that covers the mouth) when having oral sex.
• Trying non-penetrative sex like massage or mutual masturbation.
• Not sharing sex toys. If you do share sex toys, wash them or cover them with a new condom between each person who uses them.

Condoms / Femidoms also protect you from other STIs including HIV. Always check the packaging for the British Standard kitemark or European product mark as well as the date of expiry.
Free condoms are available throughout Dumfries & Galloway. See the Clinic List.

• General Practitioners

Tel: 0345 702 3687 for other appointments