Genital Herpes

Herpes Simplex Viruses (HSV) are a group of viruses which can cause infections that present as small often painful blisters on the skin of the mouth, lips, eyes or genitals. 

They can be categorised as either Type 1 Herpes (Oral Herpes) or Type 2 Herpes (Genital Herpes). Type 1 Herpes can cause sores on the mouth or lips. Type 2 herpes can cause sores or blisters on the genitals or in the genital area. This is not concrete however, as Type 1 can sometimes cause genital herpes.

Of those with the Herpes virus, 67% of the global population under 50 have Type 1 Herpes.

Symptoms

What are the symptoms of Genital Herpes?

Primary Genital Herpes Outbreak
During your first genital herpes outbreak, you may experience flu-like signs and symptoms. These may include:

  • Sore throat
  • Swollen lymph nodes in the neck and groin
  • Headaches
  • Muscle ache
  • Fever

Women may develop sores and ulcers on their:

  • Vulva
  • Vaginal wall
  • Cervix
  • Anus
  • Buttocks
  • Upper thighs
  • Lips and surrounding area
  • (and rarely the face)

Men may develop sores and ulcers on their:

  • Foreskin
  • Penile shaft
  • Glans penis
  • Urethra
  • Scrotum
  • Anus
  • Buttocks
  • Upper thighs
  • Lips and surrounding area
  • (and rarely the face)

Men and Women may experience at the site of sores and ulcers:

  • Ulcers
  • Fluid-filled blisters
  • Rawness of the affected area
  • Pain, itching or tingling in the anal or genital area
  • Small red bumps
  • Ulcers and blisters which join together to form a larger area
  • Scabs and scarring may form as a result of the ulcers and blisters healing
  • Swelling and tenderness of lymph nodes in groin

Women may experience:

  • Symptoms which mimic cystitis, a UTI or thrush
  • Sudden increase in copious, thin vaginal discharge (generally due to the presence of ulcers in the cervix and vaginal wall along with ulcers on the external genitalia)

Men may experience:

  • Extreme or severe pain on passing urine when sores and ulcers are at the tip of the penis
  • Rarely there can be massive swelling of whole penile shaft

Can I get Genital Herpes again?

Genital herpes is different for each person. The signs and symptoms may recur, off and on, for years. Some people experience numerous episodes each year. For many people, however, the outbreaks are less frequent as time passes.

During a recurrence, shortly before sores appear, you may feel:

  • Burning, tingling and itching where the infection first entered your body
  • Pain in your lower back, buttocks and legs

However, recurrences are generally less painful than the original outbreak, and sores generally heal more quickly.

Can I have Genital Herpes without knowing it?

Genital Herpes (or cold sores) are caused by the Herpes Simplex Virus (HSV). It is common to speak of a herpes ‘outbreak’ when signs and symptoms present themselves.

Most people infected with Genital Herpes don’t know they have it. This is because the signs of symptoms of HSV are not easily noticeable.

The symptoms of genital herpes can be variable as well as latent.

Symptoms of genital herpes may be variable as some may experience signs and symptoms from 2 to 12 days after exposure, but others may only have an outbreak weeks or months (and even decades) after exposure to the virus.

The fact that many people don’t show signs or symptoms of the virus is because of a property known as latency. This is where the virus is sitting idly inside the body without causing any problems.

What if i’m pregnant and have Genital Herpes?

Please tell your clinician.

Your clinician may recommend that you start taking herpes antiviral medications late in pregnancy to try to prevent an outbreak around the time of delivery. If you’re experiencing an outbreak when you go into labour, your doctor will probably suggest a cesarean section to reduce the risk of passing the virus to your baby.

Complications

Pregnancy
Herpes can be acquired during pregnancy because of an altered immune system.

The third trimester of pregnancy is the most important as the mother can pass on the herpes virus to the child if she has a vaginal birth.

We recommend this to be discussed with your midwife or obstetrician if HSV is suspected or confirmed during this trimester, as a caesarean section may be recommended to prevent passing on the virus to the child.

HIV & Genital Herpes
Genital herpes can be more serious with those living with HIV.

In the most extreme of cases, herpes can affect the eyes, brain and lungs. This requires specialist care.

If you are experiencing symptoms of Genital Herpes, we would recommend getting tested and begin treatment without delay.

Causes

How do I get Herpes Type 1?

HSV-1 is the type of herpes that usually produces cold sores or blisters around your mouth.

HSV-1 is most commonly gotten by anal, oral or vaginal sex. Also via intimate social contact.

HSV-1 is typically spread through skin-to-skin contact and can also be spread from the genital area during oral sex.

HSV-1 is less likely to be the cause of recurrence.

How do I get Herpes Type 2?

This is the type of Herpes that causes genital herpes. Can be common and highly contagious, whether or not you have an open sore.

  • Anal, oral and vaginal sex
  • Intimate social contact

Can I get Genital Herpes even if I use a condom?

You can still get the virus even with condom use, because a condom only covers the penis, and if the virus is in another area you can acquire it without knowing.

Can I get Genital Herpes from sitting on a toilet seat?

Because the virus dies quickly outside of the body, it’s nearly impossible to get the infection through contact with toilets, towels or other objects used by an infected person.

Can I find out who gave me Genital Herpes?

Sometimes because symptoms might not appear for months to even years, it might be difficult to determine when you contracted the virus.

There is a greater likelihood of catching Genital Herpes if you:

  • Are a women
  • Have multiple sexual partners (like with other STIs)

How can I prevent getting Genital Herpes?

One of the key ways of protecting yourself against herpes is having protected anal, oral and vaginal sex. However, this cannot guarantee protection because condoms do not provide sufficient coverage of herpetic ulcers.

  • Use, or have your partner use, a latex condom during every sexual contact
  • Avoid intercourse if either partner has an outbreak of herpes in the genital area or anywhere else

How can I prevent getting Genital Herpes again?

There are two things that may help in preventing a recurrence of Genital Herpes:

  • Avoid ultraviolet light
  • Friction in your genital area

However, some other triggers which may cause a recurrence are unavoidable. These may include:

  • Being unwell
  • Having a period
  • Surgery on your genital area
  • A weakened immune system

Herpes Swab Test

A DNA PCR swab test for Herpes (types 1&2) is recommended when symptoms suggestive of Herpes are present. A lesion swab is taken by your clinician and the sample is sent to our lab – this is a straightforward and painless process.

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Window Period

N/A

Sample required for men

Swab from the suspected lesion

Time for test results

Within 4 working days 

Cost of test

£120 (or £70 if taken with another test)

What is a Herpes swab test?

The Herpes Swab test is carried out when a lesion is suspected to be due to the Herpes simplex virus. 

In the simplest terms, a positive test confirms the diagnosis of Herpes, and a negative test result rules out this diagnosis.

How does Herpes swab test work?

Polymerase Chain Reaction (PCR in short) is a sophisticated technology that allows a tiny amount of genetic material of the virus to be amplified for easy detection.

The test can confirm the presence of Type 1 Herpes virus or Type 2 Herpes virus. Rarely both Type 1 and Type 2 Herpes simplex virus can be detected from the same lesion.

What sample does the test require?

A swab is taken from the area of the suspected Herpes outbreak. Taking a swab from gently bursting blisters gives the best yield. The swabbing is generally done by a clinician, but can sometimes be done yourself.

If there are no external lesions to take a swab from, a urine sample or a high vaginal swab can be used to test for the Herpes virus. Your doctor may suggest this after an assessment of your symptoms.

How is it different from the Herpes blood test?

The Herpes swab test looks for the genetic material of the virus to confirm any present infection (i.e. active infection).

On the other hand, the Herpes blood test looks for proteins in the blood called antibodies which the body makes after exposure to the virus, as part of immune response of the body.

Do I need a Herpes swab test?

A swab test for Herpes (types 1&2) is recommended when symptoms suggestive of Herpes are present.

  • Sometimes the lesions are typical of Herpes virus, and the test confirms the diagnosis as well as type of the virus, whether type 1 or type 2. 
  • Having a laboratory confirmation of the diagnosis is important in managing subsequent outbreaks in the future. 
  • Female patients who are planning to conceive, find a confirmed Herpes diagnosis, reassuring in the knowledge that the pre-existing IgG antibody against Herpes virus will cross the placenta and protect the baby at birth.
  • It is not uncommon that even an experienced clinician can get the diagnosis of Herpes wrong just from a visual examination.
  • Sometimes the swabs are taken to rule out a Herpes diagnosis from lesions not likely to be due to Herpes, so that diagnostic work up can focus on other possible causes of the symptoms.
  • In practice the patients present with rash, cuts, soreness or redness of mucosa or skin, and can be due to thrush, trauma, eczema or Herpes. They can not be distinguished just from their appearance. Your doctor may recommend a Herpes Swab test in some of these situations.

When should I get tested?

The chances of detecting the virus is highest when the lesions are active, indicated by presence of signs of inflammation. Once the lesions have scabbed and dried up, there may not be any virus in the sample to detect.

How accurate is this test?

We process our Herpes swab test at an UKAS accredited laboratory.

The accuracy of the Herpes virus PCR test is approx. 99%.

What happens if my test is positive?

If you are tested positive for Herpes (i.e. it is Detected) then we will discuss what it means for you, provide medication to manage the condition and ensure you don’t pass it on to your partner.

With proper care and information, you should be able to live a normal life after having a Herpes outbreak, and this includes a new relationship, a successful pregnancy and a normal vaginal delivery (later 2 for female patients).

Herpes treatment >

Is it possible to have treatment for Herpes while waiting for the test result?

Yes, often a treatment with antiviral medication is offered based on clinical assessment before the test result is available. Treatment for Herpes is most effective when given soon after an outbreak has occurred.

Do I have to tell my current partner(s) if my Herpes swab test is positive?

If your partner does not have any symptoms, there is no requirement to tell your current partner(s).

However, if they are pregnant, it is important to let them know so they can discuss it with their doctor. She may need Herpes blood test [read more here] and take extra precautions to minimise any risk to the pregnancy and the baby.

Do I have to tell my future partner(s) if my Herpes swab test is positive?

There is no requirement to tell your future partner(s) about your Herpes swab result.

However, it is important that you avoid any sexual contact if you have any active herpetic lesions to reduce the risk of transmission to your partner.

Herpes Blood Test

This test looks for the following Herpes antibodies: Herpes 1&2 IgG/IgM

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Window Period

N/A

Sample required for men

Blood from the vein

Time for test results

Within 20 minutes

Cost of test

£120 (or £70 if taken with another test)

What is a Herpes blood test?

The first time you come in contact with the Herpes virus, the body will create an antibody in response to this infection. The antibody is an attempt by your immune system to protect yourself from this infection.

As such, the presence of an antibody tells you that you have been in contact with the Herpes virus.

Exposure to Type 1 Herpes virus will produce antibody to Type 1 Herpes. Likewise, exposure to Type 2 Herpes virus will produce antibodies against Type 2 Herpes.

What types of Herpes antibodies can this test for?

This test can test for IgG & IgM antibodies of both Type 1 and Type 2 Herpes. Please see below for how the results are interpreted.

How is it different from the Herpes swab test?

The Herpes blood test looks for any past infection of the Herpes virus.

The Herpes swab PCR test, on the other hand, looks for any present infection of the Herpes virus.

Do I need a Herpes blood test?

This test is not routinely recommended, and your doctor may advise to take up this test in certain specific situations.

The detection of anti-HSV IgM in the absence of anti-HSV IgG can be an effective method of detecting early stages of HSV infection and an indicator of primary infection.

If you have symptoms of Herpes [sores, cuts, ulcers, spots, area of redness] then we recommend a swab from the lesion to test for the virus itself [learn more here]. A positive test tells that the lesion is due to Herpes.

Herpes blood test can be of value in certain situations:

When you are pregnant
When someone is pregnant and gets an episode of Herpes, it is important to know if the mother has got IgG antibody against herpes virus. IgG can cross the placenta and go from the mother to the foetus, and protect the baby. This minimizes the risk to the newborn baby getting Herpes infection.

If the mother has had not enough time between getting the infection and normal vaginal delivery, the IgG will not yet have been produced and the protection in the newborn will not be in place to protect itself from the virus being shed in mother’s genital tract. In this situation, a caesarean section is recommended to prevent the baby from getting neonatal Herpes (rather than normal vaginal delivery).

When you are planning to conceive
When your partner is known or suspected to have Herpes, knowing your correct Herpes status can help in reducing unnecessary anxiety or specific measures. Also, treatment can be advised in case of discordance in Herpes status.

When you are planning to have a new relationship
When one of the partner’s known or suspected to have Herpes, knowing the correct status of the partner can help in reducing unnecessary anxiety or specific measures. Also, treatment can be advised in case of discordance of their Herpes status.

When you get symptoms suggestive of Herpes, and swabs have been negative for Herpes.
Eliminating Herpes as a possible cause for genital ulcers, and this points to the non-herpetic causes of ulcers, for example, Behcet’s disease, Crohn’s disease and autoimmune ulcers.

If you are just curious about Herpes exposure
It may be that you just want to know if you have been exposed to Herpes virus in the past. If you want to confirm whether you have had herpes in the past then this test will help you.

When should I take this test?

The blood test for Herpes (1&2) is recommended when you want to see whether you have had Herpes (1 or 2) in the past. There is no set window period after which you should get tested.

Serial tests, as baseline after exposure and repeated after 3-4 months can be of value in detecting recent seroconversion. So if you are concerned about a specific exposure, then we would recommend having tests at baseline and repeat them 4 months later. This is because it can take up-to 4 months for Herpes antibodies to show.

How accurate is this test?

The tests we use are CE and IVD marked, with an accuracy of approx 95%.

False negative results can occur if the level of antibody is too low or there has not been a herpes outbreak for a long time or a sample is taken too early in the stage of disease when antibodies have not yet developed.

False positives may occur in specimens from patients with infectious mononucleosis and certain auto-immune conditions.

What do the results mean?

The results of a Herpes blood test will generally be reported as positive, negative, or equivocal (i.e. neither negative or positive).

Type 1/2 Positive Negative
IgM

Can be detected 9-10 days after exposure and last for 7-14 days, though may remain detectable for up to 6 weeks.

Often associated with primary infection but may be detectable during recurrence of the disease.

Will disappear (= turn negative) in a few months time (3 months).

 

Not exposed to the Herpes virus in last 6 weeks.

IgG Can be detected 21-28 days after exposure and remain detectable for rest of life. Not exposed to Herpes virus in the past.

What happens if my test is positive?

Typically, no further action is needed. Please see ‘Do I need this test?’ for a more detailed answer.

Will I know who gave me the Herpes virus?

You may wish to know from whom you got the virus. However, this can be a difficult question to answer. Any attempt to answer such a question takes into account the full sexual history, previous and current herpes test results (swabs and blood tests) as well as the presence of symptoms in you and your partner.

The answer can vary depending on your sexual history. If you have had multiple partners in a short period of time, then this test alone may not tell you who gave you the Herpes virus.

If you have had only one partner for many months, then this test alone may help you determine who gave you the Herpes virus.

Do I have to tell my partner if I test positive?

Unlike testing positive for Chlamydia or Gonorrhoea, there is usually no need to tell your partner about testing positive for Herpes Antibody (Type 1 or Type 2) unless your partner is pregnant or planning a pregnancy.

Some may decide to share their results so they can go into the future with a better understanding of their sexual health and be better prepared for any outbreaks.

Herpes Treatment

Method of treatment

Oral antibiotics

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Length of Treatment:

For Outbreak: 5 days
For Suppressive Therapy: approx. 6-12 months

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Further actions:

+ No sex until blisters disappear
+ salt water bath

Cost of treatment

For Outbreak: £80 (or £30 if taken with another service)

For Suppressive Therapy: £100 (or £50 if taken with another service)

Can Genital Herpes be cured?

Whilst genital herpes cannot be cured (in the literal sense), it can be well managed and with effective medications we can ensure that you do not pass it onto your partner.

What is the management for Genital Herpes?

Oral antiviral medications are commonly used as suppressive therapy for genital herpes (i.e. to ensure that it does not flare up again).

How effective is the treatment for Genital Herpes?

Your medications will act directly on the infected cells and will stop the virus from growing any further. This is an effective way of managing an acute outbreak or preventing any recurrent outbreaks.

How long does the treatment take to work?

Patients will see a great improvement of their Herpes outbreak within 24-48 hours of taking the medications – for an outbreak.

If there have been more than 6 outbreaks in 1 year or at client request, the same medication can be taken continuously to alleviate the worry of transmission and suppress the virus from further outbreaks. This medication only acts on the HSV virus and does not work on any other viruses.

Are there any side effects?

Some of the possible side effects include:

  • Dizziness
  • Headache
  • Feeling or being sick
  • Diarrhoea
  • Stomach pain
  • Skin rashes
  • Itching
  • Tiredness
  • Sensitivity to sunlight/artificial light
  • Fever

 

Does my partner need treatment?

Unless your partner has a Herpetic lesion or they require suppressive therapy, they will not require any medications.

Can I begin treatment before receiving my test results?

Yes. Treatment can begin before receiving results, especially if you are experiencing uncomfortable symptoms. It is really important to have tests before any treatment is commenced so we know if the treatment has worked and whether you need to tell your partner(s) or not.

Can I get Genital Herpes again?

Genital herpes is a viral infection, so will always be present in your body.

If you are generally well and have a good immune system, the virus can be managed by your body and you may never see any other lesions.

In times of stress, when the body has something else to concentrate on, this is the time when the virus gets the opportunity to show itself, thus producing lesions.

How long do I have to wait before having sex again?

We highly recommend you wait until your lesions are cleared up before resuming with (oral, vaginal and/or anal) sex with your partner. This will make sure that you don’t pass the infection onto them.

Do I have to get re-tested after my treatment?

You will not need to get retested of Herpes again, unless you are pregnant/planning a pregnancy.

What happens if I don’t get treated?

The symptoms may go away by themselves. However, with modern medicine, it is very easy to take early measures to ensure that the symptoms don’t progress further than they need to. You can read more about complications of herpes here.

Is there anything I can do at home?

If you are in pain and/or distress, the following may help relieve your symptoms. However, we still recommend seeking advice from a sexual health clinician.

Saltwater bath
Lightly salted baths can help alleviate the symptoms of herpes.

  • Add ordinary table salt to warm water in the following proportion:
    • 1x sachet of salt in approx. 200ml of water
    • 1x TEASPOON of salt in a PINT of water
    • 1x TABLESPOON to a BOWL of water
    • 1x HANDFUL to a shallow bath
  • Soak the affected area for 5 to 20 minutes.
  • Rinse the affected area afterwards.
  • Pat the area dry with a clean tissue or towel.
  • Repeat this 1-2 times daily whilst symptoms last.

Painkillers
Over the counter painkillers can help to relieve some of the symptoms

Ice pack
Never apply ice directly to the skin, always wrap it in a cloth or towel first.

Petroleum jelly

Wear loose clothing

Have oral, anal or vaginal sex until they go away

Do not touch your blisters unless you’re applying cream

Page reviewed by Dr. Manoj Malu (Clinical Director)

Last reviewed date: 3 March 2020
Next review due: 3 March 2023

Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.

References & Further Reading

If you think you may have Genital Herpes

It is important to refer to a healthcare provider as soon as possible. Our experience combined with timely detection can help put you on the right track without delay and avoid complications in the future.

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