Genital herpes: symptoms, treatment and how long it lasts

NHS inform says most people with the herpes virus do not notice any symptoms and do not know they have it. If symptoms do appear, it usually takes 2 to 12 days after contact for them to appear, and some people do not get symptoms until months or sometimes years later. The NHS says blisters can take months or years to appear, so it is worth going to a sexual health clinic even if you have not had sex for a long time.

The NHS lists the symptoms as small blisters that burst to leave red, open sores around your genitals, anus, thighs or bottom (the sores may be less red on brown or black skin), tingling, burning or itching around your genitals, pain when you pee, and discharge that is not usual for you.

NHS inform says the first infection can also bring spots or red bumps, pain inside the vagina, head of the penis or anus, fever and flu-like symptoms, backache, headache and mild swelling of the lymph glands in the groin, armpits and neck.

The NHS says there is no cure for genital herpes. Symptoms clear up by themselves, but the blisters can come back, which is called an outbreak or recurrence. Treatment from a sexual health clinic can help.

For a first episode, the NHS says you may be prescribed antiviral medicine to stop the symptoms getting worse, which needs to be started within 5 days of symptoms appearing, and cream for the pain. If you have had symptoms for more than 5 days before you attend, you can still be tested to find out the cause.

For outbreaks that come back, the NHS says antiviral medicine may help shorten an outbreak by 1 or 2 days if you start it as soon as symptoms appear, but outbreaks usually settle by themselves, so you may not need treatment. People who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months, and if outbreaks continue during this time, you may be referred to a specialist.

The NHS lists the following things you can do yourself when you are having an outbreak:

• Keep the area clean using plain or salt water to prevent blisters becoming infected.

• Apply an ice pack wrapped in a flannel to soothe pain, and do not put ice directly on the skin.

• Apply petroleum jelly or a painkilling cream such as 5% lidocaine to reduce pain when you pee, and wash your hands before and after.

• Pee while pouring water over your genitals to ease the pain.

• Do not wear tight clothing that may irritate blisters or sores, and do not touch blisters or sores unless you are applying cream.

• Do not have vaginal, anal or oral sex until the sores have gone away.

NHS inform says the first episode may last from 2 to 4 weeks, and that repeated episodes are not usually as severe or as long as the first. You may never have a repeat episode. The NHS says that over time, outbreaks tend to happen less often and be less severe, and that some people never have outbreaks.

The virus itself is lifelong. The NHS says once you have it the virus stays in your body, stays in a nearby nerve and causes blisters in the same area, and will not spread in your body to cause blisters elsewhere.

The NHS says genital herpes is caused by a virus called herpes simplex. NHS inform says there are 2 types and both affect the genitals.

The NHS lists triggers that can sometimes be avoided: ultraviolet light on the affected area, such as from sunbathing or sunbeds, friction in the genital area (for example from sex or tight clothing; lubricant may help), smoking and drinking alcohol. Some triggers are unavoidable, including being unwell, stress, the menstrual cycle, surgery on the genital area and a weakened immune system, for example from chemotherapy.

The NHS says genital herpes is very easy to pass on from the first tingling or itching of a new outbreak, before any blisters appear, to when sores have fully healed. You may also be able to pass on the virus even if you do not have any symptoms, but the risk of passing it on is higher during the first 6 months of infection and is rare after 2 years.

The NHS and NHS inform say you can get genital herpes from skin-to-skin contact with the infected area (including vaginal, anal and oral sex), when there are no visible sores or blisters, if a cold sore touches your genitals, by transferring the infection on fingers, and by sharing sex toys with someone who has herpes. NHS inform adds that it can be passed on by kissing if the person has a cold sore on their face. The NHS says you cannot get genital herpes from towels, swimming pools, saunas or toilet seats.

To reduce the chance of passing it on, the NHS advises using a condom every time you have vaginal, anal or oral sex (although herpes can still be passed on if the condom does not cover the infected area), avoiding sex if you or your partner has blisters, sores or a tingle or itch that means an outbreak is coming, and not sharing sex toys. NHS inform says that as there is no screening test for herpes, partners should only have a test if they also have symptoms.

The NHS says a doctor or nurse at a sexual health clinic will ask about your symptoms and sexual partners and use a small cotton bud (swab) to take fluid from one of your blisters or sores for testing. The test cannot be done if you do not have visible blisters or sores, and it cannot tell you how long you have had herpes or who you got it from.

NHS inform says the swab tests are very reliable, although if the ulcer is too dry it may be less likely to find a positive result, and that the swab can also test for syphilis, another STI that causes blisters. If you have been diagnosed with herpes, NHS inform recommends testing for all STIs, including chlamydia, gonorrhoea, syphilis and HIV.

You can see a GP, but the NHS says they will probably refer you to a sexual health clinic. Many clinics offer a walk-in service, often get test results quicker than GP practices, and you do not have to pay a prescription fee for treatment.

The NHS says women who have had genital herpes before pregnancy can usually expect to have a healthy baby and a vaginal delivery. The risk of a baby developing a serious illness called neonatal herpes is higher if you have an outbreak when you give birth, or get genital herpes for the first time during pregnancy, and it is low if you have had genital herpes before. It is higher if you get it for the first time within the last 6 weeks of pregnancy. The NHS says neonatal herpes can be fatal but most babies recover with treatment.

You may be offered antiviral treatment to treat outbreaks in pregnancy, from week 32 to reduce the chance of an outbreak during birth, or from diagnosis until the birth if you first get herpes after week 28. Many women have a vaginal delivery, and you may be offered a caesarean depending on your circumstances. See your midwife or a GP if you think you have genital herpes in pregnancy.

The NHS adds that genital herpes can be a more serious condition for people with HIV, who will be referred to a genitourinary medicine (GUM) specialist.

The NHS says to go to a sexual health clinic as soon as possible if you have symptoms of genital herpes, ideally within 5 days of symptoms appearing so antiviral medicine can be started. NHS inform says to speak to your GP practice or midwife if you are pregnant and think you have genital herpes.

Neither source lists emergency warning signs. If you cannot pass urine or you feel very unwell, treat it like any other illness and use NHS 111 or urgent care.

NHS sexual health services are free to use and many offer walk-in appointments. NHS inform says you can get tested for free through your GP practice or your local sexual health service, and clinics treat problems of the genitals and urine system.

Private clinics also test for STIs, usually for a fee. The test is the same swab from a blister, so it is worth asking what is included and how results will reach your GP, particularly in pregnancy or if you have a weakened immune system.