Sexually transmitted infections (STIs) – Genital herpes
Genital herpes is a common infection caused by the herpes simplex virus (HSV). It causes painful blisters on the genitals and the surrounding areas.
As genital herpes can be passed to others through intimate sexual contact, it's often referred to as a sexually transmitted infection (STI).
HSV can affect any mucous membrane (moist lining), such as those found in the mouth (cold sores).
Genital herpes is a chronic (long-term) condition. The virus remains in your body and can become active again. The average rate of recurrence is four to five times in the first two years after being infected. However, over time, it tends to becomes active less frequently and each outbreak becomes less severe.
The herpes simplex virus (HSV)
There are two types of herpes simplex virus (HSV), type 1 and type 2. Both types are highly contagious and can be passed easily from one person to another by direct contact.
Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with an infected person. Even if someone with genital herpes doesn't have any symptoms, it's possible for them to pass the condition on to a sexual partner.
At least eight out of 10 people who carry the virus are unaware they have been infected because there are often few or no initial symptoms. However, certain triggers can activate the virus, causing an outbreak of genital herpes.
Who is affected?
Genital herpes is a common condition, especially in people from 20 to 24 years old.
In 2013, 32,279 people attended a sexual health clinic in England with an attack of genital herpes for the first time.
Treating genital herpes
Although there's no cure for genital herpes, the symptoms can usually be controlled using antiviral medicines.
However, it's important to prevent the spread of genital herpes by avoiding sex until symptoms have cleared up and continuing to use a condom afterwards.
Genital herpes can cause problems during pregnancy. These complications can be more serious depending on whether you already have genital herpes, or develop it for the first time while pregnant.
Symptoms of genital herpes
Most people with the herpes simplex virus (HSV) don't experience any symptoms of genital herpes when first infected. As a result, many people don't know they have the condition.
Symptoms may not appear until months or sometimes years after you're exposed to the virus.
If you experience symptoms when first infected, they usually appear four to seven days after you have been exposed to the virus. The symptoms are usually more severe first time around than in cases of recurrent infections.
The symptoms of genital herpes for the first time include:
small blisters that burst to leave red, open sores around your genitals, rectum (back passage), thighs and buttocks
blisters and ulcers on the cervix (lower part of the womb) in women
vaginal discharge in women
pain when you pass urine
a general feeling of being unwell, with aches, pains and flu-like symptoms
These symptoms may last up to 20 days. However, the sores will eventually scab and heal without scarring.
Although the initial symptoms of genital herpes clear up, the virus remains dormant (inactive) in a nearby nerve. The virus may be reactivated from time to time, travelling back down the nerve to your skin and causing recurrent outbreaks.
Symptoms of a recurrent outbreak may include:
a tingling, burning or itching sensation around your genitals, and sometimes down your leg, before blisters appear
painful red blisters that soon burst to leave sores around your genitals, rectum (back passage), thighs and buttocks
blisters and ulcers on the cervix (lower part of the womb) in women
Recurrent outbreaks are usually shorter and less severe. This is because your body has produced protective antibodies (proteins that fight infection) in reaction to the previous infection. Your body now recognises the virus and mounts a response that is able to fight HSV more effectively.
Over time, you should find any recurrent genital herpes infections become less frequent and less severe.
Causes of genital herpes
Genital herpes is caused by the herpes simplex virus (HSV). The virus is highly contagious and spreads from one person to another through skin-to-skin contact, such as during vaginal, anal or oral sex.
There are two types of HSV:
type 1 (HSV-1)
type 2 (HSV-2)
Genital herpes is caused by both type 1 and type 2 HSV.
Whenever HSV is present on the surface of your skin it can be passed on to a partner. The virus passes easily through the moist skin that lines your genitals, mouth and anus (the opening where solid waste leaves the body).
In some cases it is also possible to become infected by coming into contact with other parts of the body that can be affected by HSV, such as the eyes and skin. For example, you can catch genital herpes if you have oral sex with someone who has a cold sore. A cold sore is a blister-like lesion around the mouth that is also caused by HSV.
Genital herpes cannot usually be passed on through objects, such as towels, cutlery or cups because the virus dies very quickly when away from your skin. However, you may become infected by sharing sex toys with someone who has the virus.
Genital herpes is particularly easy to catch when an infected person has blisters or sores. However, it can be caught at any time, even when someone has no symptoms at all.
Once you have been infected with HSV, it can be reactivated every so often to cause a new episode of genital herpes. This is known as recurrence.
It is not completely understood why HSV is reactivated, but certain triggers may be responsible for the symptoms of genital herpes recurring.
For example, friction in your genital area during sexual intercourse may cause a recurrence. Using a lubricant can help – these are available from pharmacies without needing a prescription.
Other possible triggers include:
drinking excess amounts of alcohol
exposure to ultraviolet light, for example, using sunbeds
surgery on your genital area
having a weakened immune system (the body’s natural defence system), for example, as a result of having chemotherapy (treatment for cancer)
Diagnosing genital herpes
Genital herpes can be diagnosed more easily and accurately when the infection is still active, so you should seek medical attention as soon as you develop symptoms.
If you think you may have genital herpes for the first time (a primary infection), you should visit your local sexual health clinic (see below) as soon as possible. These are also called genitourinary medicine (GUM) clinics.
Wherever possible, an initial diagnosis of genital herpes should be made by a GUM specialist. If you cannot get to a GUM clinic, you should see your GP instead. They may refer you to a GUM specialist for a formal diagnosis and treatment.
When being tested for genital herpes you may also be asked:
whether you have experienced similar symptoms before
whether you have ever had a cold sore, which are also caused by the herpes simplex virus
whether you have ever had a sexually transmitted infection (STI)
about your history of sexual partners
A swab is used to collect a sample of fluid from a blister. A swab is a small piece of absorbent material, such as gauze or cotton, which is attached to the end of a stick or wire. The sample will be sent to a laboratory to be tested for the herpes simplex virus (HSV). You may also be screened for other STIs.
You should be aware that even if your swab result comes back negative for HSV, you may still have genital herpes and a diagnosis will only be confirmed by any recurrent outbreaks.
Sexual health clinics
What happens at a sexual health clinic?
Some sexual health clinics are walk-in clinics, whereas others require you to book an appointment. Phone the clinic to find out.
When you attend a clinic, you will be asked for some details including:
your name and contact details – you do not have to give your real name or tell staff who your GP is if you do not want to, but any details you provide will be treated confidentially
why you have attended the clinic – try not to be embarrassed and say you think you may have a sexually transmitted infection (STI)
your sexual history – for example, when you last had sex, whether you used a condom and whether you have had an STI in the past
If you are attending the clinic for genital herpes, you may be offered tests for other STIs. You do not have to agree to have these tests, but it is recommended that you do. Tests can only be carried out with your consent. You may need to give a urine or blood sample for other STI tests.
Results from tests for STIs are usually available in a few weeks. If you need treatment, this will be discussed with you.
If you have an STI, your partner (and recent previous partners) will need to be tested and, if necessary, treated to prevent the infection being passed to anyone else.
Staff at the sexual health clinic will be able to advise you about which of your sexual partners will need to be contacted, and may be able to contact them on your behalf. If you wish, your anonymity will be protected when contacting your previous sexual partners.
Do I have to pay for tests at sexual health clinics?
Sexual health services are free of charge and they are available to everyone, regardless of age. If you go to your GP, you will probably have to pay a prescription charge for any treatment you require.
Are sexual health services confidential?
Check-ups and treatments for STIs at GP surgeries and GUM clinics are completely confidential. Your parents or carers will not be told, even if you are under 16 years of age.
However, you may be advised to contact your partner and any previous partners so they can be tested and treated as well. Staff at the GUM clinic may be able to help you with this.
Referral to a specialist
If you have genital herpes and you are pregnant, it is very important you are referred for specialist treatment. This is because the infection could pass to your unborn baby.
You should also be referred for specialist treatment if you have a weakened immune system (the body’s natural defence system), for example, if you:
have HIV or AIDS
are receiving chemotherapy (treatment for cancer)
If you have a weakened immune system you will need specialist treatment because genital herpes can last longer and be more severe.
Treating genital herpes
Treatment for genital herpes will depend on whether you have the infection for the first time (a primary infection) or your symptoms keep coming back (a recurrent outbreak).
If you have genital herpes for the first time, see your GP or visit your local GUM clinic (also called sexual health clinics). They may prescribe antiviral tablets, such as aciclovir, which you will need to take five times a day.
Aciclovir works by preventing HSV from multiplying. However, it does not clear the virus from your body completely and does not have any effect once you stop taking it.
You will need to take a course of aciclovir for at least five days, or longer if you still have new blisters and open sores forming on your genital area when your treatment begins.
Aciclovir can cause some side effects, including being sick and headaches.
Other antiviral medications that may be used to treat genital herpes include famciclovir and valaciclovir.
For more information, see the patient information leaflet that comes with your medicine or read our medicines information page.
You should visit your GP if you have been diagnosed with genital herpes before and are experiencing a recurrent outbreak.
If the symptoms are mild, your GP may suggest things you can do at home to help ease your symptoms without the need for treatment.
Keep the affected area clean using either plain or salt water. This will help prevent blisters or ulcers from becoming infected and may encourage them to heal quicker. It will also stop affected areas from sticking together.
Apply an ice pack wrapped in a flannel, or cold, wet, tea bags on the sores to help soothe pain and speed up the healing process. Do not apply ice directly to the skin.
Apply petroleum jelly, such as Vaseline, or an anaesthetic (painkilling) cream, such as 5% lidocaine, to any blisters or ulcers to reduce the pain when you pass urine.
Drink plenty of fluids to dilute your urine. This will make passing urine less painful. Passing urine while sitting in a bath or while pouring water over your genitals may also help.
Avoid wearing tight clothing because it may irritate the blisters and ulcers.
If your symptoms are more severe, you may be prescribed antiviral tablets (aciclovir), which you will need to take five times a day for five days.
If you have fewer than six recurrent outbreaks of genital herpes in a year, your GP may prescribe a five-day course of aciclovir each time you experience tingling or numbness before symptoms begin. This is known as episodic treatment.
If you have more than six recurrent outbreaks of genital herpes in a year, or if your symptoms are particularly severe and causing you distress, you may need to take aciclovir every day as part of a long-term treatment plan.
This is known as suppressive treatment and aims to prevent further outbreaks developing. In this instance, it is likely you will need to take aciclovir twice a day for six to 12 months.
It is important to note that while suppressive treatment can reduce the risk of passing HSV on to your partner, it cannot prevent it altogether. Your GP may refer you for specialist advice if you are concerned about transmitting the virus to your partner.
Suppressive treatment will usually be stopped after 12 months. As long as recurrent outbreaks of genital herpes are infrequent and mild, you will only need to take a five-day course of aciclovir as and when it is needed. Episodes of recurrent genital herpes usually become less frequent and less severe after around two years.
Suppressive treatment may be restarted if you have further severe outbreaks. Your GP may refer you for specialist treatment if you continue to have outbreaks of genital herpes while you are having suppressive treatment.
HIV and genital herpes
If you are experiencing recurrent outbreaks of genital herpes you should also consider being tested for HIV. This may be a sign of a weakened immune system (the body’s natural defence against infection and illness), which may indicate you have HIV.
Read about diagnosing HIV for more information about getting tested for this condition.
If you have HIV and genital herpes you will be referred to a GUM specialist. This is because genital herpes can be a more serious condition in people with HIV.
Preventing genital herpes
If you have genital herpes, it's important to avoid having sexual intercourse, including vaginal, anal and oral sex, until all your blisters and ulcers have cleared up.
You should also avoid sharing towels or flannels with others to ensure that you do not spread the herpes simplex virus (HSV).
Complications of genital herpes
In rare cases, the blisters caused by the herpes simplex virus (HSV) can become infected by other bacteria. If this happens, it could cause a skin infection to spread to other parts of your body, such as the lips, hands or fingers.
In very rare cases, the virus can spread to areas of the body such as the brain, eyes, liver or lungs. People with a weakened immune system are at higher risk of these complications. For example, people with HIV or those using certain medications.
Genital herpes and pregnancy
In some instances, the herpes virus can pose problems during pregnancy and may be passed to the baby around the time of the birth.
Existing genital herpes
If you had genital herpes before becoming pregnant, the risk to your baby is very low. This is because during the last few months of your pregnancy, you will pass all the protective antibodies (proteins that fight infection) to your baby. These will protect your baby during the birth and for several months afterwards.
Even if you have recurrent episodes of genital herpes throughout your pregnancy, your baby should not be at increased risk. However, you may need to take an antiviral medication, such as aciclovir, continuously from week 36 of the pregnancy until the birth to reduce the severity of your symptoms.
If you have genital herpes blisters or ulcers (open sores) at the time of the birth, the chance of passing the infection on to your baby rises to three in 100.
First and second trimester
If you develop genital herpes for the first time (primary infection) during the first or second trimester, which is up to week 26 of the pregnancy, you may be at risk of having a miscarriage (losing the pregnancy). There is also an increased risk of passing the virus on to your baby.
To prevent this, you may need to take antiviral medicine, such as aciclovir, while you are pregnant.
If you develop genital herpes for the first time during the third trimester (week 27 of the pregnancy until birth), particularly during the last six weeks of the pregnancy, the risk of passing the virus on to your baby is considerably higher. This is because you will not have time to develop protective antibodies to pass to your baby, and the virus can be passed to your baby before or during the birth.
To prevent this happening, you may need to have a caesarean section delivery. A caesarean section is an operation to deliver your baby by making a cut in the front wall of your abdomen (tummy) and womb. If you give birth vaginally, the risk of passing the virus on to your baby is around four in 10.
If you develop genital herpes during the latter stages of pregnancy, you will need to take antiviral medicine continuously for the last four weeks of your pregnancy. However, this may not prevent the need for a caesarean.
Neonatal herpes is where a baby catches the herpes simplex virus around the time of the birth. It can be serious and, in some cases, fatal. However, in the UK neonatal herpes is rare, affecting one or two babies in every 100,000 live births.
There are three types of neonatal herpes that affect different parts of the body. Neonatal herpes can affect:
the eyes, mouth and skin
the central nervous system (brain, nerves and spinal cord)
In babies with symptoms affecting only their eyes, mouth or skin, most will make a complete recovery with antiviral treatment. However, the condition is much more serious in cases where multiple organs are affected and nearly a third of infants with this type of neonatal herpes will die.
Preventing genital herpes
The following advice can help prevent the herpes simplex virus (HSV) spreading to others.
Avoid having sex
If you have genital herpes, avoid having sex (vaginal, anal and oral) until any blisters or ulcers (open sores) around your genital area have cleared up. It's best not to have sex if you have symptoms of genital herpes because at this point the condition is highly contagious, even from the first tingle or itch.
Avoid sharing sex toys as they can also pass on sexually transmitted infections (STIs). If you do share them, make sure you wash them and cover with a condom.
You should also avoid kissing your partner if either of you have a cold sore around your mouth.
Always use a condom
Always use a condom while having any kind of sexual intercourse (vaginal, anal and oral), even after your symptoms have gone. This is particularly important when having sex with new partners.
However, while using a condom may help prevent genital herpes from spreading, the condom only covers the penis. If the virus is also present on or around your anus (the opening where solid waste leaves the body), it can still be passed on through sexual contact.
As HSV survives within the nerves of your skin, the virus may still be present on your skin after you no longer have any symptoms. This means there is still a chance you could pass it to someone else.
Testing your partner
If you have genital herpes, and your partner experiences symptoms, they should be encouraged to visit a genitourinary medicine (GUM) clinic (also called sexual health clinics) so they can be tested for the condition.
A first case of genital herpes (a primary infection) often develops some time after exposure to the virus, so they may be unaware they are infected.