Herpes and cold sores

Genital herpes is a very common viral infection caused by the herpes simplex virus (HSV). There are two types of HSV:

• HSV-1, which commonly causes facial herpes (cold sores) and can also cause genital herpes
• HSV-2, which usually just causes genital herpes.

Both types can cause genital herpes. Genital herpes does not cause cancer and does not affect fertility. For most people, it is a manageable condition, even though the diagnosis can feel upsetting at first. Facial herpes and genital herpes have the same symptoms and are managed in the same way.

Genital herpes is passed on through direct skin-to-skin contact. This can happen through kissing, oral sex, genital-to-genital contact, or vaginal or anal sex.

Herpes is most infectious when sores are present, or when a person can feel one starting. However, it can sometimes still be passed on when there are no symptoms. You are not always infectious, and most of the time the virus is inactive.

Herpes is not passed on from toilet seats, towels, swimming pools, bedding or sharing cups or cutlery.

Most people with genital herpes have no symptoms, or only very mild symptoms. Around 80% of people with genital herpes do not know they have it. Symptoms may appear within 2 to 14 days after contact, but some people do not notice symptoms until much later.

First episode

The first outbreak can be more uncomfortable and may include:

• Painful blisters, sores, or ulcers on or around the genitals
• Pain when peeing
• Flu-like symptoms such as fever, body aches, headache, or tiredness
• Swollen glands in the groin.

If untreated, the first episode can last up to 2-3 weeks, although antiviral treatment helps it settle more quickly.

Seek medical advice promptly if you have severe pain, cannot pee, or symptoms near your eyes.

Recurrences

Some people have repeat outbreaks. These are usually milder and shorter than the first episode. They may feel itchy, tingly, sore, or mildly painful. Genital herpes caused by HSV-1 tends to recur less often than genital herpes caused by HSV-2.

Although genital herpes has no cure, it can be easily managed and does not lead to other serious health problems. The emotional impact of a diagnosis is often far worse than the physical symptoms.

Herpes is not linked to cervical cancer, or infertility, and people with herpes can have normal pregnancies and vaginal deliveries.

A new herpes infection in pregnancy can be passed on to babies, which can be serious, but this is very rare. If you are pregnant and you or your partner has herpes, tell your midwife or healthcare provider.

There is no reliable test for herpes unless you have symptoms. The best test for herpes is a PCR swab taken from a sore or blister when symptoms are present. If you have symptoms, a nurse or doctor can examine the area and take a swab to confirm whether it is herpes.

Blood tests are not routinely recommended for most people, because they can be difficult to interpret and are often not helpful unless there is a specific reason to do one.

There is no cure for herpes, but antiviral medication can help a lot. A short course of antiviral treatment can:

• Shorten outbreaks
• Reduce pain and discomfort
• Help sores heal faster.

Some people choose to take antiviral medication every day. This is called suppressive therapy and can help prevent outbreaks and reduce the chance of passing herpes on.

You can help the blisters and sores to heal by keeping the affected area:

• Clean - bathe once a day with a saline (salt) wash (ratio = 1 cup water: 1/2 teaspoon salt). Don't use soap or rub the blisters or sores.
• Dry - after bathing, dry the affected area carefully.

To help with the pain, you could take paracetamol, or use a 2% lignocaine gel (you can get this from a pharmacy) on the area.

Condoms and dental dams reduce the risk of passing on herpes and also help protect against many other STIs. However, they do not cover all genital skin, so they do not give complete protection against herpes.

To reduce the risk of passing herpes on:

• Avoid sexual contact when sores are present or when you can feel early symptoms starting. After an outbreak, it is best to wait until the sores have healed and the skin feels back to normal before having sex again
• Use condoms or dams
• Consider suppressive treatment if outbreaks are problematic.

To reduce the risk of a recurrence keep your immune system strong, reduce stress, sleep well, eat well and keep active. Reduce or stop using cigarettes/vapes, alcohol and other drugs.

There is no single 'right' way or time to tell a partner you have herpes. Many people feel worried about rejection, but most people respond better than expected. Genital herpes is common, manageable, and does not stop you having relationships or sex.

Being open with a partner can reduce stress and make it easier to talk honestly about boundaries, protection, and care. In longer-term relationships, it can also be reassuring to know that herpes can be passed on by someone who did not know they had it, so a diagnosis does not necessarily mean anyone has been unfaithful.

If you are thinking about how to tell a partner, your doctor, nurse, or sexual health clinician can help you work out what feels right to say.