Genital Herpes - Symptoms, Diagnosis, and Treatment

What is Genital Herpes?

Genital herpes is one of the most common sexually transmitted infections (STI) worldwide. In Australia, approximately 12% of people carry genital herpes [1]. While most with the condition will remain asymptomatic, there can be periods where people report symptoms resurfacing. During this period, many people will experience issues such as redness and blistering around the genital area. While there is no cure, speaking privately to a GP can help this condition's management. Treatments are available for reducing symptoms, transmission and frequency of breakouts.

The Herpes Virus

This condition is caused by the herpes simplex virus, which comes in two forms. Those with Herpes simplex virus 1 (HSV-1) mainly experience lesions around the mouth known as cold sores or oral herpes. In comparison, herpes simplex virus 2 (HSV-2) usually causes lesions around the genitals or genital herpes.

Genital Herpes Symptoms

Initially, people infected with genital herpes won't immediately experience symptoms. As a result, those that carry the condition won't be diagnosed or realise they have it. For many, symptoms may take at least 4-7 days to appear [2]. The first episode of genital herpes may be particularly irritable and stressful. People who have been previously exposed to the herpes virus are particularly vulnerable. For some, these severe symptoms can last anywhere between 2-4 weeks [3]. A visit to the GP will be able to help with diagnosis, treatment and management. Future recurrences will usually not be as severe as the first time.

Symptoms During Episode [3]

Herpes blisters and sores which can either occur:
- Around the penis, particularly the shaft, foreskin and glans.
- Outside the vagina, vulva and cervix
Pain and itchiness around the areas affected
Flu-like symptoms, such as fever, body aches and swollen lymph nodes.

What does herpes look like?

During an episode, there may be several types of growth around the genitalia region. Small red spots and white blisters can form around the genitalia. Over time, these blisters can begin to ooze and bleed, which can become even more painful. Eventually, scabs will start to form during the healing process.

Genital Herpes Causes

As noted earlier, genital and oral herpes (cold sores) are caused by the human simplex virus (HSV). This is a very contagious condition that spreads from contact. In the case of oral herpes, this is transmitted through activities such as sharing utensils or kissing.

How do you get Genital Herpes?

Genital herpes spreads through sexual contact. Even without any signs or symptoms, carriers are still able to transmit this condition. Additionally, the risk of contracting genital herpes is higher in those who do not use protection. When using condoms, this protects the spread by approximately 30% [3].

Tests and Diagnosis

An experienced GP can clinically diagnose genital herpes. Doctors will look at important information, such as medical history and symptoms. Further testing [3] may be required to confirm a diagnosis, including:

A swab of the herpes lesion
Blood tests
Viral culture

Genital Herpes Treatment

While there is no herpes cure, symptoms can be reduced and managed effectively with proper management. Strategies and treatment plans can be developed collaboratively by consulting with your GP.

Herpes Prevention

As with most health conditions, prevention is better than cure. Several preventative measures can be taken to prevent herpes transmission [3]. Examples include:

Using condoms during sexual activities
Avoid sexual activity if you or your intimate partner has a herpes outbreak.
Reduce alcohol consumption before having sex. This prevents risky behaviours.
Limit the number of intimate partners. The more sexual encounters, the higher the risk of infection.
If your partner has been diagnosed with genital herpes, taking these preventative measures can help reduce the spread.

Easing symptoms

Once infected, most people will remain asymptomatic until genital herpes or outbreak. When symptoms appear, there are strategies to help ease the discomfort [4], including:

Wearing loose-fitting underwear and pants
Keeping sores around genitals dry and clean
Salt baths for 10-20 minutes
Using over the counter pain medications such as paracetamol

Herpes Medication

To help reduce symptoms and speed up recovery during outbreaks, GPs may prescribe antiviral medications. These should be commenced as soon as possible after the appearance of sores to be most effective. As established earlier, the most severe symptoms occur during the first herpes outbreak. Especially during the initial episode, long durations of genital herpes can lead to further complications (detailed below). Antiviral medications may need to be taken frequently over days or weeks to speed recovery. Those who do not respond to medication and experience worsening symptoms (e.g. urination difficulties, infection, etc.) may require more hospitalisation. Recurring episodes are generally milder. For some people, symptoms can be managed with simple strategies, such as salt baths and proper hygiene practices. Like the initial outbreak, doctors can offer similar antiviral therapy medications to speed up recovery and reduce symptoms. However, doses are often smaller compared to initial episodes.

Complications

Having genital herpes and/or HSV-2 can lead to complications to both sexual and general health. Especially when left untreated or unmanaged, this condition can lead to poorer health outcomes. Those diagnosed with HSV-2 or genital herpes are 3 times more likely to develop HIV. This is a condition that leads to an impaired immune system and an increased likelihood of getting sick [2]. Especially during outbreaks, genital herpes poses a sexual burden. Sexual abstinence, additional precautions, and even self-esteem issues can lead to psychological stress. Seeking a counsellor's guidance may be beneficial for learning safe practices and talking about any of these problems [3]. Other related complications can also include:

Infertility
Pregnancy-related issues
Infections (e.g urinary tract infections, cellulitis, etc.)
Nerve-related pain
Meningitis

References

Cunningham, A. L., Taylor, R., Taylor, J., Marks, C., Shaw, J., & Mindel, A. (2006). Prevalence of infection with herpes simplex virus types 1 and 2 in Australia: a nationwide population based survey. Sexually transmitted infections, 82(2), 164-168.
World Health Organization. (2016). WHO guidelines for the treatment of genital herpes simplex virus. World Health Organization.
http://guidelines.aaus.info/aaus/index.php?title=Genital_herpes&mobileaction=toggle_view_mobile
https://www.aad.org/public/diseases/a-z/genital-herpes-treatment

Genital Herpes – Symptoms, Diagnosis, and Treatment