A guide for people with genital herpes

A guide for people with genital herpes

Contents Getting the facts 4 The key facts 6 What is genital herpes? 8 Genital herpes symptoms 10 Getting tested 12 The first outbreak 14 Recurrent outbreaks 16 Common triggers 17 Genital herpes, sex and transmission 18 Genital herpes treatments 20 Relieving the pain and discomfort 22 Specific groups and genital herpes 23 Genital herpes and pregnancy 24

Getting the facts Genital herpes is a common sexually transmitted infection (STI) caused by a virus that affects one in eight Australians aged over 25 years. The symptoms of genital herpes vary and can often be relatively mild, or not present at all. As a result, many people with the virus are unaware they have been infected, and can pass it on to others without even knowing it. The trouble is that most people s perception of genital herpes is based on a wide range of myths about the condition rather than the facts. As a result, being diagnosed with genital herpes can often be a confusing and confronting experience. There is currently no cure for genital herpes, but the virus can be effectively treated and managed. Antiviral therapy can help reduce the number and duration of outbreaks experienced by a person with this condition. Genital herpes doesn t have to spell an end to your sex life either. Ongoing antiviral therapy (called suppressive therapy) and condoms are effective ways to protect your partner from contracting genital herpes, but do not offer 100% protection. 4

If you ve just found out you have genital herpes, we hope you ll find the facts about the condition and available treatment options both empowering and reassuring. Of course if you have more questions, you should consult your healthcare professional. 5

The key facts 1 in 8 Australian adults over the age of 25 years has the virus that causes genital herpes. Women are twice as likely to have the virus as men. Up to 80% of people infected with genital herpes are unaware they have the virus. The psychological distress associated with being diagnosed with genital herpes often affects people more than the actual symptoms. But most of the worry and anger is based on misunderstanding. The symptoms of genital herpes can vary. They may show up as painful blisters or sores, or just a mild rash. Symptoms may also appear on other parts of the body besides the genitals, such as the thighs and the back. There is no cure for genital herpes, but effective antiviral treatment is available once a doctor has diagnosed the infection. As many people with the virus have mild or unrecognised symptoms, or none at all, they often don t realise they are infected. 6

The virus is usually passed on when there are no visible symptoms. Most people who infect others don t realise they are putting their partners at risk. Using condoms reduces the risk of transmitting the virus, but does not offer complete protection. Simple daily treatment can help to prevent potential outbreaks and reduce the impact of any that do occur. 7

What is genital herpes? Genital herpes is one of the most common sexually transmitted infections (STI), and is caused by the herpes simplex virus the same virus that can cause facial cold sores. There are two types of herpes simplex that can cause genital herpes: Type 1 (HSV-1) is carried by around 70% of adults in developed countries and in the past has mostly caused cold sores Now, partly because oral sex is more common, the traditional distinctions between the two strains are breaking down and both types of herpes simplex virus can appear both orally and genitally. The good news is that, when it comes to treatment, both strains respond to antiviral therapy. Type 2 (HSV-2) is carried by 12.5% (1 in 8) of the population and is generally associated with genital herpes 8

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Genital herpes symptoms Genital herpes affects each person differently, and the symptoms can vary from severe to none at all. Common signs you may experience leading up to an outbreak include tingling, itching and discomfort in the genital region, followed by symptoms such as a rash and blisters or lesions that burst and turn into ulcers. Some people also experience a fever, and pain in their back and buttocks. Not all outbreaks have such obvious symptoms however which can be confusing. Many people don t realise they have genital herpes, often dismissing their symptoms as common conditions such as thrush. This highlights the importance of discussing any recurrent symptoms with a doctor. 10

Signs of an outbreak Tingling, itching and redness Symptoms Blisters or lesions which burst and turn into ulcers, rash, small cracks or fissures in the skin, flu-like symptoms, pain in the back and buttocks Outbreak areas Anywhere on the genitals (including the vulva, vagina or under the foreskin), the groin, in and around the anus (if infection was passed on through anal sex), on the buttocks, lower back or thighs 11

Getting tested Getting tested for genital herpes isn t as straightforward as getting tested for other sexually transmitted infections, and may require both a blood and swab test. Diagnosis of this condition is often missed as testing for HSV-2 is not routinely performed, even when testing for other STIs. Although it is possible to confirm the presence of HSV-2 through a blood test alone, confirming whether the condition is present in the genital or facial region usually requires a swab test. A swab test involves the doctor taking a swab from the base of a lesion, and testing it for the presence of the virus. This test will only detect the virus in 80% of cases when a person has their first outbreak, and is ineffective if no lesions are present. As a result, a blood test, which can be taken at any time, is often needed to confirm a diagnosis. Speak to your doctor if you are experiencing any symptoms associated with genital herpes and ask to get tested. It is also important to practice safe sex, such as using condoms, during this time. 12

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The first outbreak The first outbreak of genital herpes is usually the most traumatic and uncomfortable, and occurs around 4-7 days after sexual exposure. In the more severe cases, it can cause flu-like symptoms such as fever, headache and muscle aches as well as the blisters and sores in the genital region, buttocks and upper thighs. Many people also experience itching and burning on and around their genitals and pain when urinating. A severe first outbreak often means you are more likely to experience outbreaks in the future. Some people only experience mild symptoms such as tingling, itching and redness with their first outbreak, and this often means they are more likely to experience mild outbreaks in the future. The first outbreak of genital herpes can last as long as 20 days, but the good news is that future outbreaks tend to be less severe and less painful. This is because your body develops antibodies which will help fight future outbreaks. 14

Areas where lesions can occur 15

Recurrent outbreaks Almost everyone who has genital herpes symptoms will experience further symptoms at least once more. About 70-90% of people with symptomatic HSV-2 and 20-50% of people with symptomatic genital HSV-1 will have a recurrence within the first year. Most recurrent attacks are much less severe than the first attack, but can still be painful and disruptive to your life. This can vary from person to person, as can the symptoms and location of each outbreak. Outbreaks are often preceded by early symptoms or warning signs (known as prodrome symptoms). These include mild tingling or itching in the genital region, or sometimes pain in the genitals, legs or buttocks. This may last from 30 minutes up to 5 days before an outbreak. The good news is that antiviral therapy can help reduce the number of outbreaks and make them less severe when they do occur. Speak to your doctor about the best way to prevent future outbreaks. 16

Common triggers Once you have experienced a few outbreaks, you may be able to identify lifestyle factors which may trigger another outbreak. These triggers may vary from person to person, however stress is one that is commonly reported. Other factors believed to trigger a genital herpes outbreak include menstruation, illness, sex and feeling run down, perhaps due to a lack of sleep. While you may be able to control some of these triggers, you probably won t be able to completely eliminate them from your life. For this reason it is important to maintain a balanced diet and a healthy lifestyle, to better manager stress and avoid getting run down. Most importantly though, speak with your doctor and develop an ongoing management plan, to help reduce future outbreaks. 17

Genital herpes, sex and transmission If you have been diagnosed with genital herpes and are sexually active, it s important that you try to minimise the risk of passing the virus on to your partner. This can be tricky as the virus can be transmitted at any time, not just when you have an outbreak. Condoms offer a degree of protection against the transmission of genital herpes, but do not provide 100% protection. Genital herpes can be transmitted from one person to another through any form of sexual contact. This includes vaginal, oral and anal sex. The reason that condoms do not provide 100% protection is because the genital herpes virus can literally shed from other parts of your genital region (not covered by the condom) onto your partner. This is called viral shedding. Viral shedding doesn t just occur when you have symptoms of an outbreak. It can happen at any time. This means there is a risk of passing on the virus even when you don t have any symptoms. It is recommended that you use a condom whenever you engage in sexual activity. 18

It is important to remember that genital herpes doesn t have to spell the end of a healthy sex life. It just means that you need to take some extra precautions. Condoms and suppressive therapy are the most effective way to reduce the risk of passing on genital herpes to your partner. Speak to your doctor about the treatment of genital herpes and the most effective way to protect your partner. 19

Genital herpes treatments While there is no cure for genital herpes, it can be effectively treated and managed with antiviral therapy and by practicing safe sex. Speak to your doctor about how antiviral therapy can be tailored to suit your needs. Generally medication can be used in two ways: Antiviral therapy targets the virus which causes genital herpes by stopping it from multiplying. This can reduce the length and severity of an outbreak, and can even reduce the chances of another outbreak from occurring. 20

Suppressive therapy Using daily antiviral medication on an ongoing basis is referred to as suppressive therapy. The aim of this treatment is to reduce the number and severity of genital herpes outbreaks, while also delaying the time between the first outbreak and recurrent outbreaks. An added benefit of suppressive therapy is that it reduces the risk of passing on the virus to your partner. In combination with the use of a condom, this is the most effective way to prevent transmission of genital herpes. Episodic therapy Episodic therapy refers to the temporary use of antiviral medication during a genital herpes outbreak (or episode ). By initiating antiviral therapy within 24 hours of the appearance of symptoms, you can reduce the length and severity of a genital herpes outbreak. For this reason, it is important to speak to your doctor and always make sure you have your treatment on hand. 21

Relieving the pain and discomfort Some people try over the counter products and home remedies to help manage the pain and discomfort of genital herpes symptoms. Examples of these include: While these remedies have not been proven to be effective in the treatment of genital herpes, some people find them beneficial at relieving some of the pain and discomfort during an outbreak. Over the counter pain relief (e.g. paracetamol) Pain relieving creams L-lysine Zinc and Echinacea Honey Warm showers or salt water baths Loose fitting cotton underwear Increased fluids to dilute urine 22

Specific groups and genital herpes GLBT No matter what your sexual orientation is, if you are sexually active then you are at risk of contracting genital herpes. Transmission of the virus via anal sex is more common amongst gay men, while transmission via oral sex is equally common amongst gay men and heterosexual couples. Genital herpes makes the body more susceptible to HIV, and vice versa. This is an important point for gay men, as the prevalence of HIV is highest amongst this group. Genital herpes is less common among lesbians than in heterosexual women. However, as the virus can be transmitted via oral sex, it is important to get tested regularly for sexually transmitted infections and practice safe sex. Immunocompromised individuals Most HIV infected persons are co-infected with the genital herpes virus, and many will experience frequent herpes outbreaks. Immunocompromised patients, including those with HIV, may have prolonged, severe, and more painful episodes of genital, perianal or oral herpes. As a result, they can require higher doses of antiviral therapy. Speak to your doctor about the right treatment strategy for you. 23

Genital herpes and pregnancy Genital herpes doesn t affect a woman s ability to conceive. However, there is a small chance that the virus may be passed on to the baby during birth if the baby is born vaginally. This is referred to as neonatal herpes. Neonatal herpes is very rare in Australia, occurring in only 8 out of every 100 000 births. Women who experience a first outbreak of genital herpes in the last trimester are at increased risk of transmitting the virus to their child and for this reason, are often considered for caesarean section delivery. Pregnant women with genital herpes may also benefit from suppressive antiviral therapy in the last weeks of pregnancy. Although rare, neonatal herpes is a serious condition which can be life threatening. If you have genital herpes and are pregnant or thinking of becoming pregnant, it is important to speak to your obstetrician about how to minimise the risk of your baby contracting neonatal herpes. 24

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