Misconceptions about genital herpes increase the stigma around this common sexual health issue and can make it difficult to navigate, particularly following a first outbreak and initial diagnosis. We dispel the myths and look at how to manage the condition effectively.
Genital herpes is caused by the herpes simplex virus (type 1 or 2). Herpes simplex type 1 (HSV-1) is the primary cause of oral/facial cold sores but can also be transmitted to the genitals; while HSV-2 is less likely to affect the facial area and more commonly affects the genitals. When active, the virus causes blisters that eventually heal. It then lies dormant in the body, although recurrent outbreaks may occur.
According to the Herpes Viruses Association (HVA), around 70% of the population will catch at least one type, although only one in three will have obvious symptoms and be medically diagnosed. Karin O'Sullivan, clinical lead for the sexual health charity FPA, is keen to bust misconceptions:
"Herpes is really common," she explains. "Lots of people have the virus without ever knowing it, because not everyone gets obvious symptoms. Viruses are common and normal - having a viral infection is nothing to be overly concerned about." It is important to remember this if you contract genital herpes, in order to work through difficult emotions that may arise.
Ella Dawson was diagnosed with genital HSV-1 in 2013, at the age of 21. Although the initial symptoms and diagnosis came as a shock, she now manages it successfully and speaks about her experience in a myth-busting TEDx talk:
"[On diagnosis] my overriding feeling was just total confusion, because I had been told my entire life that I was not the type of person that herpes and other STIs happened to," she says. "People with herpes, in my mind, were dishonest, irresponsible, promiscuous, unfaithful, and … I didn't consider myself any of those things. What I learned very quickly was that that deeply ingrained stereotype was the result of a very powerful social stigma …"
Dawson is now determined to break that stigma and blogs about what it is like to live, date and be sexually active with the condition.
Symptoms - what to look for
A genital herpes outbreak may start with itching, tingling, soreness and discomfort in the genital region which progresses to the formation of red bumps or blisters. These burst to form sores or raw spots which will eventually crust over and heal, usually leaving no scarring; there can also be general flu-like symptoms.
A first outbreak may last two to three weeks but any recurrences generally heal more quickly. First signs are likely to appear up to six days after exposure to the virus, although they may take up to two weeks to emerge. In some cases, it may take years before an infected person has an obvious outbreak, which can lead to confusion as to when and how they contracted the virus.
Where to get support
If you think you may have caught herpes, book an appointment with your local sexual health clinic, or visit your GP. The HVA provides comprehensive information about all aspects of the condition and runs a helpline offering support and advice. Ella Dawson's website also contains information from a personal perspective, including So you've just been diagnosed with herpes.
Transmission of the virus - the facts
The highest risk of transmission is during the blister phase, although some virus may be present just before or after an outbreak. Get as informed as you can about the condition and become aware of symptoms such as tingling that indicate you're about to have an attack. Abstain from sexual activity during an outbreak and consider using condoms and dental dams (for oral sex) at other times for added protection.
"This indicates they are likely to have contracted the virus through receiving oral sex from a partner with a cold sore," he explains. So it is also important to be aware of facial herpes outbreaks in the context of sexual health.
For most people who have been diagnosed, the risk of passing the virus on to someone else when they don't have any visible symptoms (asymptomatic shedding) is incredibly low, says O'Mahony.
"The issue with asymptomatic shedding has been blown out of all proportion. Some people will shed tiny amounts of virus in between outbreaks, but it's very unlikely there's enough present to cause an infection in somebody else."
Telling a sexual partner
Whether or not to tell a partner you have herpes when you are symptom-free is a point of controversy - for many people, the potential stigma is a greater cause of distress than coping with the physical symptoms.
Most sexual health clinics will advise you to tell your partner(s). When doing so, offer reassurance that you will inform them immediately if you experience signs of an impending outbreak, and that it is highly unlikely the virus will be transmitted unless you have visible blisters. It is also worth pointing out that as you're aware you have herpes, you can take precautions and are far less likely to pass it on than someone undiagnosed who has mild symptoms and doesn't know they have it!
O'Mahony comments: "People susceptible to facial cold sores don't feel they have to tell everyone they kiss that they had one six months ago; it's just that there's more stigma around genital herpes, which we need to deflate."
Triggers and treatments
The friction of sexual intercourse is a known trigger for outbreaks so it is important to use plenty of lubricant. Stress, illness, tight clothing, alcohol consumption and poor nutrition may also act as triggers in some people.
Used at the first sign of onset - the 'tingle' phase - topical antiviral creams (and oral tablets) containing aciclovir may reduce the severity and duration of the outbreak. During an attack, wearing loose clothing, taking a cool shower or salt bath, applying emulsifying ointment to the sores, or a local anaesthetic gel such as lidocaine, can be helpful.
FPA's Sexwise website explains how to manage the virus and any outbreaks, including triggers, treatments and self-help tips.