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Herpes in gay and bisexual men

What is Herpes?

  • Genital herpes is a sexually transmitted infection caused by the Herpes simplex viruses – either type 1 (HSV-1) or type 2 (HSV-2)
  • This is the same family of viruses that causes cold sores on the lip.
  • The majority of men infected with herpes will have no symptoms or only very mild disease. Often the infection goes completely unrecognised.
  • Men with symptoms may typically notice one or more blisters on the foreskin or shaft of the penis or around the anus. These quickly break open leaving tender ulcers (sores) that take 1-2 weeks to heal.
  • Herpes outbreaks may recur but they are always much milder and shorter than the first.
  • The number of outbreaks usually decreases over a period of years.
  • Herpes increases the risk of catching HIV.
  • If you have herpes we recommend that you should have a full STI screen including a HIV test.  

How common is herpes?

  • Genital herpes infection is very common (an estimated 1 in 20 men in the UK have herpes)
  • It is more common in gay and bisexual men than heterosexual men.
  • Most men will be unaware of their infection.

How do you catch herpes?

  • From sexual contact with someone else that has herpes – but this person may not know they have herpes and may have never noticed anything wrong with themselves.
  • Herpes is usually caught through anal sex or sometimes just close genital contact.
  • Herpes simplex type 1 may be caught through oral sex with a partner that has cold sores.

What would I notice if I had herpes?

Most men with genital herpes would not notice anything wrong.

First episode herpes

In some men the first episode of herpes can be quite pronounced.

  • A man usually notices something within 2 weeks of catching the virus from his partner.
  • Symptoms may include:
    • tingling, pain, blisters and then sores at the site of infection
    • swelling and redness at the site of infection – usually the foreskin, head or shaft of the penis or around the anus
    • pain on passing urine
    • flu like symptoms
    • swollen glands in the groin
  • The sores usually take 2 weeks to heal.

Recurrent episodes

  • Men diagnosed with a first episode of herpes may expect to get a couple of recurrences over the next year or so.
  • Recurrences:
    • are much milder – usually only one or two blisters
    • last a shorter time – usually less than a week
    • occur less frequently with the passage of time 

How do I get tested for herpes?

  • Herpes can often be diagnosed on clinical examination by an experienced clinician but can only be reliably diagnosed by taking a viral culture or PCR swab from a blister or sore – it is best to attend a sexual health clinic as soon as possible after noticing anything wrong.
  • Tests will be unable to detect the virus once the sores have crusted or already healed. 
  • The result will be available in 7 to 10 days 

How is herpes treated?

  • First episodeherpes is treated with:
    • aciclovir tablets 200mg five times a day for 5 days
  • This is best started as soon as possible after the appearance of symptoms and preferably within 72 hours.
  • Treatment will shorten and reduce the severity of symptoms.
  • Recurrent episodes of herpes usually do not need treatment.
  • Other helpful tips:
    • Take regular pain killers e.g. paracetamol or ibuprofen
    • Bathe or soak in warm salty water – teaspoon to a pint or 3 tablespoons in a bath
    • Apply 5% lidocaine ointment to the sores (available over the counter from some pharmacies)
    • Drink plenty of water
  • All treatments from the Wolverton Centre are free and are given to you directly in the clinic.

What about my partner?

  • Herpes can be passed onto a partner through sexual contact – this is most likely to occur when you have a sore or break in the skin.
  • Sometimes you can pass herpes on to a partner even when there appears to be nothing wrong – this is called ‘asymptomatic shedding’ – active virus can be shed from normal looking skin intermittently during the year – so you can’t tell when it is happening.
  • For this reason it is always best to either discuss the problem with your partner or make sure you protect them by using a condom. Condoms can reduce the risk of transmission.
  • Sometimes it can be difficult to know whether your partner has herpes or not – particularly if they have never noticed anything wrong. Tests can only be done reliably if they have signs or symptoms. This can be discussed with the doctor.
  • Some couples choose to minimise the risk of transmission by avoiding sex or using a condom when they have a recurrence but take a small risk by having unprotected sex the rest of the time.
  • If your partner has herpes too and it is the same type (i.e. either type 1 or type 2) then you cannot re-infect them – if it is a different type then you could pass it on.
  • There are always choices but it is best to be open and honest with your partner so you can make the best choice for both of you – you can talk through the options with the doctor or nurse.

What problems can herpes lead to?

  • Once someone has caught herpes then it will stay in the body indefinitely.
  • The herpes viruses have a special property called ‘latency’ which enables them to become dormant in the sensory nerve cell roots – so for most of the time the infected person has no symptoms.
  • Occasionally the virus is reactivated and this will lead to a recurrence of symptoms (e.g. blisters and sores on the skin).
  • Some people never experience a recurrence – particularly if they are infected with herpes type 1.
  • A few people get frequent recurrences particularly if they have HSV type 2 – but they always reduce in frequency with time.
  • Recurrences in some people may be triggered by sunlight (avoid sun beds), trauma (use lube during sex) or by stress or being run down.
  • HIV positive men are more likely to have frequent recurrences
  • Herpes increases the risk of catching HIV.
  • If you have troublesome recurrences then discuss this with the doctor at the Wolverton as you may benefit from suppressive treatment with aciclovir for a while.
  • For many people the main problem with herpes is the psychological distress it may cause – the doctor or nurse at the Wolverton can help you with this or refer you to our clinical psychologist for further help.

Will herpes come back again after treatment?

  • Even if you are treated with aciclovir during your first episode of herpes it may still recur again at some point.
  • But for most men the symptoms are so mild that it does not bother them unduly.
  • Recurrences become less frequent and much milder with time.
  • Troublesome or frequent recurrences (e.g. every 6 to 8 weeks) may be managed with suppressive therapy using aciclovir – discuss this with one of the doctors at the Wolverton.

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