Genital herpes is an infection caused by the herpes simplex virus (HSV). It causes blisters and sores on your genitals and surrounding areas. There are two types of HSV: type 1 (HSV 1) and type 2 (HSV 2). HSV 1 is the same virus that causes cold sores.

Genital herpes can be caused by both types, and they look the same and are managed in the same way.

How do you get genital herpes and how common is it?

Genital herpes is transmitted by skin-to-skin contact with someone who has the infection. This could happen during vaginal, anal, or oral sex. If you have sex with someone who has herpes symptoms (including oral sex while your partner has a cold sore), you could become infected. The virus enters your body through the skin of the genital tract, anus or mouth. It then enters the nerves, where it remains inactive but can reactivate from time to time. You could also be infected by someone who has no symptoms due to asymptomatic shedding. Many people don’t know they have HSV.

What are the symptoms of genital herpes?

Some people with genital herpes do not have any symptoms and do not know they have the virus. Some people will have symptoms within 7 days after being exposed to the virus. For some people, symptoms may not occur for months or even years after being exposed to the virus.

First episode:

Symptoms are often worse with your first episode of genital herpes. These symptoms can include:

• a tingling or itching sensation in your genital or anal region or down your leg, which sometimes starts in the 24 hours before blisters and sores appear (this is called a “prodrome”)
• painful blisters or sores in the genital and anal areas
• an increase in vaginal discharge
• pain passing urine or with bowel movements
• headache
• fever
• general aches and pains.

Further episodes (recurrence):

After the initial infection, the virus stays in your nervous system and can reactivate at another time causing further episodes when it travels along the nerves to the genital skin. This is more likely to happen in the first year of infection or if you have HSV 2. Recurrences may be triggered by illness, sunlight, fatigue, skin damage, and alcohol, or there may be no clear trigger.

Recurrences are usually less severe than a first episode as your immune system produces protective antibodies in response to the first infection. Over time, recurrences become less frequent and less severe.

How do I know when I acquired genital herpes?

As there can be a delay between being exposed to the virus and having your first symptoms, it is often not possible to know when infection first occurred.

How is genital herpes diagnosed?

Genital herpes is diagnosed when you have symptoms. It is important to see your health professional as soon as you notice symptoms. To diagnose HSV, a swab is taken from a blister or sore and sent to a laboratory for testing.

HSV blood tests are not routinely recommended because they cannot show where or when the infection happened and can give unclear results. In some situations, such as when a partner is pregnant, a specialist doctor may suggest a blood test.

Is there treatment for genital herpes?

Yes. There are several antiviral medicines that can be used to manage genital herpes symptoms. Antivirals work by stopping the virus from multiplying. Treatment works better the earlier it is started during an episode.

Treatment for first episode:

• Antiviral medicine may be taken for 5-10 days to reduce the severity of symptoms

Treatment for episodic HSV symptoms:

• A short course (5-7 days) of antiviral medicine will reduce the severity and length of symptoms
• Treatment is most effective if taken within the first 24 hours of symptoms starting.

Treatment to stop you having recurrences:

• If you have frequent recurrences, you may be given antiviral medicine to take daily (“suppressive therapy”)

What can happen if genital herpes is not treated?

It is okay not to treat herpes if the symptoms do not worry you or your partner as they usually resolve without treatment.

How can I protect my sexual partner(s) from getting genital herpes?

When you have any symptoms of herpes, avoid any sexual activity that involves contact between the site of your symptoms and your partner’s skin. Condoms have been shown to reduce the transmission of genital herpes from the penis by preventing skin contact, and they also provide protection from other sexually transmissible infections. The virus can be transmitted if it is present in other genital areas not covered by a condom.

HSV stays in the nerves under the skin, and the virus may travel down these nerves and be present on the skin with no symptoms. This is called asymptomatic shedding of the virus, and you cannot predict or know when it happens. HSV can be passed to someone when you have no symptoms, and your skin looks and feels normal.

You can seek further medical advice to discuss management options to reduce transmission to your partner.

Should I tell partners about genital herpes?

If you have been told you have genital herpes we recommend letting current and future partners know. This helps them understand they may have or be at risk of getting HSV and help them look after their health. Your partner(s) do not need testing for HSV unless they develop symptoms. If your partner is worried about the risk of acquiring genital herpes, encourage them to talk to a health professional with knowledge of sexual health. More information on how to tell a sexual partner of your diagnosis can be found on the New Zealand Herpes Foundation website. More people have acquired herpes than those who have not, and most people do not have symptoms. Many people find that their sexual partners are often aware and understanding of herpes and may have already had their own experience of symptoms.

To be safe, telling your sexual partners ensures you have received expressed informed consent before you have sex with them. Talking openly can build trust with your partner and help you both make choices about sexual activity. When seeking consent to have sex with a future partner we recommend informing them of HSV so they understand the potential risks of HSV transmission and can make an informed decision. In the ACT consent laws emphasise communication and informed decision-making with sexual experiences. It is important to understand that in some situations, there may be legal consequences related to disclosure and consent.

Where can I get more information and support?

If you need more information or have any questions, please contact the Canberra Sexual Health Centre on (02) 5124 2184 or talk to your GP.

Other resources:

• The New Zealand Herpes Foundation - https://www.herpes.org.nz/
• For information in other languages see https://www.staystifree.org.au/get-the-facts/herpes
• Other information - https://youngdeadlyfree.org.au/factsheets/
• Consent laws in ACT have changed and these other resources are not specific to ACT. Seek state/territory specific information as needed

References:

Albrecht, M., (2024) https://www.uptodate.com/contents/genital-herpes-beyond-the-basics

STI Guidelines Australia https://sti.guidelines.org.au/sexually-transmissible-infections/genital-herpes-simplex-virus-hsv/