Herpes in women
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 women infected with herpes will have no symptoms or only very mild disease. Often the infection goes completely unrecognised.
- Women with symptoms may typically notice one or more blisters on the vulva or around the bottom.
- 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 can increase the risk of catching HIV or passing it on to your partner.
- 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 – 1 in 10 women attending antenatal clinics have evidence of genital herpes.
- Most women 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 vaginal or anal sex or sometimes just close genital contact.
- Herpes simplex type 1 may be caught through oral sex with someone that has cold sores – about 50% women catch genital herpes this way.
What would I notice if I had herpes?
Most women with genital herpes would not notice anything wrong.
First episode herpes
- In some women the first episode of herpes can be quite pronounced.
- A woman usually notices something within 2 weeks of catching the virus from her partner.
- Symptoms may include:
- tingling, pain, blisters and then sores at the site of infection
- swelling and redness of the vulva
- Pain on passing urine
- flu like symptoms
- swollen glands in the groin
- The sores usually take 2 weeks to heal.
- Women diagnosed with a first episode of herpes may expect to get a couple of recurrences over the next year or so.
- 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 the clinic as soon as possible after noticing anything wrong.
- Tests will be unable to detect the virus if 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, 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 help to prevent 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 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 – 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 rundown.
- If you have troublesome recurrences then discuss with the doctor at the Wolverton as you may benefit from suppressive treatment with aciclovir for a while.
- Herpes increase the risk of catching HIV or passing it on to a partner.
- 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.
Herpes in pregnancy
- Herpes caught for the first time in late pregnancy (after 24 weeks gestation) may lead to a severe infection in the baby during vaginal delivery.
- In the UK this is a very rare event – only 10 cases per year.
- If you catch herpes for the first time in pregnancy it is important that you inform your doctor and seek specialist advice from a consultant at the Wolverton centre.
- Women who have recurrences of herpes during pregnancy (and were first infected before pregnancy) are not at risk of infecting their baby – this is because they have protective antibodies that they pass onto their baby across the placenta.
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 women 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.