Genital herpes
Of all the sexually transmitted infections, this is the one that frightens people most, and almost always more than it deserves.
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Medicines commonly prescribed for Genital herpes
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 200 mgActive substance: aciclovirManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: TABLET, 200 mgActive substance: aciclovirManufacturer: Aristo Pharma Iberia S.L.Prescription required
Of all the sexually transmitted infections, this is the one that frightens people most, and almost always more than it deserves. The virus does stay in the body for life, and that is the only genuinely bad news. Everything else works out better than it sounds. The first episode can be painful, later ones are shorter and milder, in many people they stop happening altogether, and there are medicines that both shorten an outbreak and cut the risk of passing it on. The useful question is not how to get rid of it forever, but what to do now, what is actually worth fearing, and how to carry on without infecting anyone.
What appears on the skin, and how it feels
It rarely starts with blisters. It starts with a sensation: hours or a day beforehand, the skin in one particular spot begins to tingle, itch or ache. Then small blisters filled with clear fluid appear, break quickly and leave round, painful ulcers, which later dry out and heal. The site can be anywhere in that region: the genitals, the perineum, around the anus, the inner thighs, the buttocks. On brown and black skin the redness around the sores shows up less, so the rash is easier to miss.
A first episode is unlike any that follow. It lasts longer, up to two or three weeks, the ulcers are more numerous and more painful, and the local problem is joined by a general one: fever, aching limbs, swollen tender glands in the groin. Passing urine often stings, because it runs over open sores. In women the sores may be internal, and then the only clues are pain and discharge that is not usual for them.
Recurrences are much gentler: a couple of blisters in the same old place, no fever, healed within a week or sooner. Over the years they grow rarer and milder. What sets them off is nothing exotic — a cold or any other illness, stress and broken sleep, a period, friction and strong sun on the area, smoking, alcohol. And, separately, a weakened immune system, for example during treatment that suppresses it.
How the virus is passed on
Transmission happens through skin-to-skin and mucosa-to-mucosa contact: vaginal, anal and oral sex, and also hands and shared sex toys. Infectiousness peaks from the first tingle until the sores have fully healed, but it is not zero in the quiet periods either: the virus surfaces on the skin from time to time with no symptoms at all, and the person has no way of knowing. That is why the reasoning "my partner can't have given it to me, he had nothing there" is simply wrong.
One detail wrecks relationships for no real reason: a cold sore on the lip, the kind most people shrug off, causes genital herpes if there is oral sex. It is the same virus, just in a different place. The second detail is timing. Anything from a few days to several years can pass between catching the virus and the first sores, because it is quite capable of lying quiet. Sores appearing today prove nothing about anyone being unfaithful, and arguing on that basis leads nowhere.
What does not happen: you cannot catch it from a towel, a toilet seat, a swimming pool, a sauna or shared cutlery. Outside the body the virus survives only minutes, and none of those involve direct skin-to-skin contact.
How the diagnosis is confirmed
The best method is to swab a fresh blister or ulcer and look for the virus by PCR. The same test identifies which type of virus it is, and the type partly determines how often recurrences can be expected. It is worth being seen in the first few days, while the sores are new: on a dried crust the result can be falsely negative, and on healed skin there is nothing left to sample.
A blood test for antibodies answers a different question — whether the body has ever met the virus at all. It cannot say what caused today's sores, when the infection happened, or who it came from. So it is not the main test, although a doctor will occasionally order it, for instance to judge the risk to a pregnant woman whose partner has herpes.
One more caution: not every genital ulcer is herpes. Syphilis looks similar, so do several other infections, and so do some non-infectious skin and mucous membrane conditions. That is why a first episode is a sensible moment to be checked for other sexually transmitted infections, HIV included — not out of suspicion, but because they often travel together and are treated in completely different ways.
What the medicines actually do
Nothing on the market clears the virus from the body, and any promise of that sort is reason enough to walk away. What works is antiviral tablets: they stop the virus multiplying, so they shorten the episode and take the edge off it. Antiviral creams achieve little in this area; the real treatment is taken by mouth.
There are two approaches, and the choice depends on how often the illness troubles you.
- On demand: a short course at the start of each outbreak. It only helps if started early, within the first day or two, ideally at the tingling stage. That is why people with frequent recurrences are often given the prescription in advance, so the tablets are already at home and no days are lost waiting for an appointment.
- Continuous: a small daily dose for several months. This is discussed when outbreaks are frequent, roughly six a year or more, or when they are severe. It almost abolishes recurrences and also noticeably lowers the chance of infecting a partner. After some months it is stopped to see how the body behaves without it.
For a first episode, treatment is started as early as possible, broadly within the first five days or while new blisters are still forming. If that window has passed, it is still worth being seen: the diagnosis needs confirming, and pain relief and testing are available at any point.
Getting through an outbreak
The aim over those days is twofold: less pain, and no infected sores.
- Wash the area with clean or lightly salted water and dry it by dabbing, never rubbing.
- Hold something cold, wrapped in a cloth, against the area for a few minutes. Ice is not applied straight onto skin.
- If passing urine stings, do it while pouring warm water over yourself, or sitting in a warm bath. Drink more: diluted urine burns less.
- A greasy barrier such as petroleum jelly before urinating protects the sores. A local anaesthetic cream helps too, but ask your doctor or pharmacist which one is suitable before buying it.
- Ordinary over-the-counter painkillers are reasonable; check the choice if you take other medication regularly.
- Wear loose cotton underwear and give tight jeans and synthetic fabrics a rest for a few days.
- Wash your hands before and after touching the sores. Do not rub your eyes with those hands.
- Do not burst the blisters or pick off the scabs.
- Avoid sex until everything has healed: this is when you are most infectious.
When help is needed urgently
An ordinary outbreak is managed at home and calls for no rush. But some situations will not wait.
- Being completely unable to pass urine, with a full, painful bladder. It happens in severe first episodes, when pain and swelling prevent emptying. This is an emergency and needs seeing to at once.
- A severe headache with nausea, a stiff neck, dislike of bright light or confusion. The virus occasionally inflames the membranes around the brain — uncommon, but serious, and treated in hospital.
- A high temperature that will not settle while the sores spread and turn pus-covered.
- A first ever episode during pregnancy, particularly in the last weeks.
- Sores in someone whose immune system is badly weakened: after a transplant, on immune-suppressing treatment, or with untreated HIV. The illness runs a harder course in them, and treatment should start sooner and be more intensive.
For retention of urine, confusion or seizures, call an ambulance; across Europe the single emergency number is 112. Otherwise, being seen by a doctor the same day is enough.
Pregnancy and the newborn
If the herpes predates the pregnancy, the picture is a calm one: the mother's antibodies cross to the baby and protect it, the pregnancy runs like anyone else's, and birth is usually vaginal. The risk to the child in that situation is very low.
The dangerous scenario is a different one: catching the virus for the first time late in pregnancy. There is then no time to build antibodies, and the baby can be infected during birth. Neonatal herpes is rare but severe: it affects the skin and eyes, sometimes the brain and internal organs, and without treatment it can kill. This is why the team looking after the pregnancy needs to know about any herpes, even if it has been silent for years, and certainly if sores appear for the first time.
What is usually offered is an antiviral during the final weeks of pregnancy, so that there is no outbreak when labour starts, and a caesarean section if the infection was caught shortly before the due date or if there are active sores at the time of delivery. The decision is individual: there is no rule that everyone must be operated on.
After birth, the warning signs in a baby are floppiness, refusing feeds, fever or, conversely, an unusually low temperature, unusual irritability, and blisters on the skin or eyes. Any of these means the baby is seen without delay. And one rule for the whole family: nobody with an active cold sore should kiss a newborn.
Lowering the risk for a partner
Transmission cannot be ruled out entirely, but it can be brought down a long way.
- No sex from the first tingle until the sores have closed. This is the single most effective measure.
- A condom every time. It does not cover all the skin that can be infectious, so protection is not total, but it lowers the risk substantially.
- Continuous antiviral treatment for the person who has herpes is a way of protecting the one who does not; it is worth raising with a doctor, particularly if the partner is uninfected.
- Sex toys should be personal; if shared, wash them and change the condom on them.
- Talking about it. This is harder than any of the practical measures, but it is what allows a partner to decide with full information, and it lifts the thing that weighs on many people more than the illness itself: the secrecy.
And one thing worth hearing: an enormous number of people have genital herpes. It does not make anyone a danger to those around them in daily life, and it does not stop anyone working, having children or living entirely normally. It is a long-term skin nuisance, not a sentence.
Online consultation
A remote appointment handles well the questions that keep people from seeking help for months. The doctor will consider whether what you are seeing fits herpes, and will tell you which test to have and how quickly, while the sores are still fresh. They will review the treatment plan if recurrences have become frequent, and explain how to keep the medicine ready at home. They will answer questions about pregnancy, about the risk to a partner, and about how and when to tell them. If this is a first episode, the rest of the screening is worth discussing too. The urgent situations listed above are not dealt with through a screen: those need to be seen in person.
This material is for information only and does not replace medical advice.
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