Herpes (HSV)

Herpes is spread by skin-to-skin contact (including skin-to-skin contact that happens during sex) with someone who has the virus. For example, cold sores on the mouth can spread to a person’s mouth through kissing  or spread the virus to the genitals during oral sex.

There is no cure for herpes. Once you have the virus, it stays in the nerves of the of the area of skin where the blisters first appeared. There can be long periods of time between the presence of sores or blisters, but the virus is still in the body. When someone has sores or blisters it is sometimes called a herpes ‘episode’ or a ‘flare up’.

Before sores or blisters appear, people may feel tingling of the skin, numbness or shooting nerve pains. Herpes is most likely to be passed on to another person from these first signs of a herpes episode until the sores have completely gone.

Herpes can be passed on to someone even when there are no visible sores or blisters. This is most likely in the first 2 years of having the virus.

You can’t get herpes, or pass it on to another person, unless you have skin-to-skin contact with the area of skin where sore or blisters occur.

You can reduce the risks of getting or passing on herpes by:

• avoiding sex when there are any signs of sores or blisters on the genitals
• avoiding kissing and oral sex when there is any sign of a cold sore on the mouth
• using condoms with water-based lubricant and dental dams. (Condoms and dams only protect the area of skin covered by the condom or dam and sores can be on and around other parts of the genitals. Condoms also protect you from other STIs such as chlamydia, gonorrhoea, syphilis and HIV).

There is currently no approved vaccination for herpes simplex.

Many people with herpes don’t know they have it because they have no signs or symptoms.

The first time you get sores or blisters is usually the worst. You may feel generally unwell, as if you are getting the flu, then small blisters appear. They burst and become sores. Later, scabs form, and finally the skin heals after 1 or 2 weeks.

Blisters may appear:

• on the labia (lips of the vulva)
• around or inside the vagina
• on the penis and foreskin
• on the scrotum (balls)
• around or inside the urethra
• on the perineum (area in between genitals and anus)
• around the anus (bum).

Rarely, herpes can appear on other areas of skin if they have come in contact with herpes sores (e.g. hands, breasts, back, fingers).

Many cases of genital herpes don’t show up as blisters. They can appear as a small area of rash, cracked skin, or some other skin condition on the genitals. Symptoms can be very mild and not noticed. Some people can have herpes but never have symptoms at all.

Although herpes sores and blisters heal, the virus stays in the body. Some people with herpes only get blisters and sores once. Some people have ‘recurrent episodes’. Recurrent episodes usually occur on the same part of the body that the blisters and sores first appeared. They are often shorter and less painful. Usually they happen less often and are milder over time, and stop entirely.

Herpes episodes are more likely to happen when your immune system is weak. Illness, tiredness, stress periods and irritation to the skin area can make episodes of herpes more likely to happen. Other STIs can also make it more likely for episodes to occur.

To test for herpes a healthcare worker will swab the sore or blister and send it to a laboratory.

It is best if you see a healthcare worker within 4 days of the first signs of the blister or sore.

If you have any unusual skin condition around your genitals, get these checked by your doctor. Ask them to test for herpes and syphilis (both can cause sores or ulcers in and around the genitals and mouth). You will need a blood test to see if you have syphilis.

There is no cure for herpes, but if you have symptoms they can be easily managed.

Your doctor may prescribe antiviral tablets if you have recurrent episodes. These can make the sores or blisters less painful and heal faster, especially if you take them within 2 days of any sign of blisters.

You can buy over-the-counter treatments for cold sores from chemists that do not need a prescription from a doctor.

Antiviral tablets can help reduce the risk of passing herpes on to others, but they will not stop you passing on the virus if you have sores or blisters, so it is important to avoid skin-to-skin contact, (including sexual contact) where the sore or blister is located until it is healed and gone.

During an episode of genital herpes

• Paracetamol or aspirin can reduce pain and soreness.
• Bathing sores with salt water can help them heal (2 teaspoons of salt per litre, or 1 cup of salt in a bath).
• Applying an anaesthetic jelly or cream can reduce the pain, particularly when using the toilet.
• Urinating while in the shower, can help if it hurts to urinate.

Some people prefer to tell their sexual partners so that they can have open discussions around how they can protect each other from herpes and other STIs. Other people choose not to tell their sexual partners and avoid sex while they have an episode to avoid passing herpes to their sexual partners. You do not legally have to tell sexual partners that you have herpes.

Something that prevents people from telling their sexual partners is a concern that they will be treated differently. There is a lot of stigma related to herpes which are caused by myths and misunderstandings.

Some important facts to know are:

• herpes is very common – most sexually active people will have been exposed to the virus at some point in their life
• many people with herpes don’t know they have it – they may never have an episode or the symptoms may be so mild that they don’t notice
• herpes only affects a small area of skin and heals by itself within a week or two
• it is very rare for people to have any serious long-term side effects.

Herpes should not stop people from living the life they want to live including having relationships and sex.

A pregnant person can pass herpes on to their baby during birth. This can cause serious illness for the baby. This is most likely to happen if a person has their first episode of herpes just before giving birth. People who already have the virus when they get pregnant have protective antibodies which protect the baby too, meaning it is very unlikely for herpes to be passed on to the baby.

If you are pregnant it is important to tell your doctor early in your pregnancy if you or your partner have ever had herpes. Your doctor can provide advice on how you can protect your baby.