The herpes simplex virus (HSV) belongs to the family of herpes viruses that cause chickenpox, shingles and glandular fever. It is a delicate virus that needs direct skin-to-skin contact to spread. There are two types of HSV—type I and type II. About 95 per cent of ‘cold sores’ on the face are due to HSV I, and 70 per cent of ‘cold sores’ on the genitals are due to HSV II. Some overlap occurs.
Most of us are exposed to the HSV type I within the first five years of our lives, usually without any sign of infection as our bodies develop an immune response to the virus and prevent it from producing any illnesses. Sometimes, the first contact with the virus can produce multiple ulcers in the mouth and a general unwell feeling similar to that of a severe cold. This is known as a ‘primary attack’. The virus can be spread to other parts of the body by touching a virus-infected area. While this is not common it usually occurs on the fingers, but it can also occur on the buttocks and sometimes the genital area.
The virus always remains within the infected areas and can be reactivated in the future, for example with stress, before your periods, and sometimes by sunlight. These sores are what we know as ‘cold sores’. They often start as an area of itch or tingling or burning and then a group of small blisters develop. The blisters then dry and heal over. The whole process usually lasts 7 to 10 days.
A similar situation occurs with herpes virus infection in the genital area. Most genital herpes is acquired sexually, often with no symptoms or with symptoms so mild that the person doesn’t realise that they have herpes. A small number of people may develop multiple ulcers on the genital area or feel unwell—a primary attack. Most genital herpes is a reactivation of herpes acquired at some time in the past. This may just be a recurring irritated area or a split in the skin, or look like a typical cold sore. Recurrences occur in the same spot and this is an important clue to the diagnosis.
Some women can have genital herpes and shed the virus, yet feel perfectly well. The only time they realize they carry the infection is if their partner develops a primary attack.
Testing for herpes is done by taking a sample from an ulcer or split for culture. This is best done within the first 24 hours of its occurring. Blood testing is usually not helpful.
Women who have genital herpes can have children normally, but it is important to be tested to see if the virus is active when the baby is ready to be delivered. If it is, a Caesarian section may be done so the baby does not contact the infected area. If the virus is not active a normal delivery is possible.
There are many local treatments that can help soothe the attacks of herpes. Adopting a healthy lifestyle will also help. Although we cannot cure herpes, effective medicines are available to help suppress the virus in people who have multiple recurrences of genital herpes. With time, in otherwise healthy individuals, the attacks naturally become milder and less frequent.
As with genital warts, if you develop genital herpes it is recommended that you have a full screen for other sexually transmissible diseases.
Most major cities in Australia now have specialised clinics to deal with sexually transmitted diseases on a confidential basis. Specially trained medical and paramedical professionals are available to help patients with these problems. These centres are also a very good source of valuable information if you are concerned about any aspect of your sexual health.
