Everything you need to know about genital herpes

Genital herpes is a common sexually transmitted infection. Most often than not, it goes undiagnosed or gets confused with other problems. For example, a number of women complain of getting pimples, cuts, ulcers, boils, unresponsive yeast infection around their menstrual bleeding time; that are all characterised by pain. Most of these women think it is a bad reaction to sanitary towels, a stubborn/severe form of yeast infection, a weird form of boils et cetera. In almost all these situations, it turns out to be genital herpes. 

What is genital herpes?
This is a viral sexually transmitted infection that can affect both men and women. The common presentation is pain and small sores around the genital area. It’s is caused by herpes simplex virus (HSV).

How does one get genital herpes?
It is spread by having vaginal, oral or anal sex with someone who has the infection. The infected person may have herpes ulcer/sore in the genital area or mouth and you get in contact with it.  Note that genital herpes can be spread from an infected person even when the person does not have any herpes symptoms and probably is unaware that they are infected. Genital herpes can also be spread to a new-born if the mother has herpes infection during pregnancy, especially if they have the genital ulcers/sores at the time of delivery.  There is no risk of getting genital herpes after exposure to environmental surfaces such as beddings, doors, toilet seats and chairs. 

How do I know I have genital herpes? 
Many people with genital herpes have no symptoms. Genital herpes is a lifelong infection, once infected, it lives in your body forever. One may experience symptoms on and off in the course of their life. 

Some of the symptoms are blisters or pimples that become painful ulcers - usually small in size but multiple and shallow, swollen, painful lymph nodes in the groin area, flu-like symptoms such as fever, body aches, headache, painful or difficulty passing urine and pain or itching around genital area.

How do I know when I got infected or who infected me?
Unfortunately, this may be quite difficult to know because the first time you get the herpes, symptoms may not necessarily mean that you recently got infected. Symptoms may occur from days to months or years later. It is possible that you already had your first episode of symptoms but the disease was too mild to take notice of, or even asymptomatic. It is therefore hard to tell when or who gave you the infection, especially if you have had more than one sexual partner. Remember that a sexual partner may infect you when they don’t have any symptoms or even without knowledge that they have the infection. 

How is genital herpes diagnosis made?
Diagnosis is done through assessment by your health provider based on the symptoms and lab tests. When you have the genital ulcers, a swab is taken direct from the ulcers (blisters/sores) and this is specifically tested for herpes virus. If the sores are not present, a blood test may be taken to check for herpes antibodies (proteins produced by your body to fight a specific infection). However, the blood test can only be positive several months after getting infected. If done too soon after suspected infection, it will most likely be negative, which does not necessarily mean that you don’t have the infection. Routine screening for herpes is not recommended for asymptomatic individuals. 

How is genital herpes treated?
There’s no cure for genital herpes. The infection can be managed by antiviral drugs and self-care measures. 
Antiviral drugs are given when you have symptoms. 

They however, do not clear the virus from your body. 
The antiviral treatment can also be given as suppressive treatment for individuals with frequent recurrences (over six genital herpes episodes in a year), or individuals with weakened immune system or to individuals in a sexual relationship with a non-infected partner to reduce chances of transmitting the virus to the partner.
Sitting in warm water (sitz-bath) may be helpful and soothing for herpes genital ulcers. Avoid wearing tight or irritating underwear during periods of active genital symptoms. Keep the genital area dry and clean and avoid soaps and bubble baths. Some pain killers may also be helpful to manage the pain.

Self-care measures help to reduce recurrence of genital herpes symptoms. 
If someone does not have any symptoms or has very mild symptoms, treatment is not necessary. 

How is genital herpes prevented?
Avoid high-risk sexual partners (one who has multiple sex partners or other risk factors) and embrace condom use, especially if involved with multiple partners.  For individuals who have been diagnosed with genital herpes, you can still enjoy healthy and safe sex by using condoms. 

If pregnant, start antenatal visits early and inform your obstetrician about the herpes diagnosis. Genital herpes can be passed to your baby but good news is that there are ways of mitigating this such as treatment and caesarean delivery options in select cases.

Does genital herpes increase risk of getting HIV? 
When you have genital or mouth sores/ulcers, they provide an easy passage for HIV virus transmission. 

Even without the visible ulcers, herpes increases the number of immune cells in the genital lining which are targeted by HIV.  This puts you at increased risk of getting HIV infection.  Having Herpes and HIV also increases the chance of spreading HIV to others. 

Dr Okemo is a consultant obstetrician gynaecologist at Aga Khan University Hospital, Nairobi