Genital herpes (HSV): symptoms and treatments

How are genital herpes treated?
First attacks are usually treated with an oral antiviral drug such as acyclovir, famciclovir or valaciclovir, which help to reduce the duration of an attack and may help to suppress recurrences.

What if genital herpes recurs?
Once infected with HSV, around 50 per cent of people have no further problems. The remaining half develops one or more recurrences, in which the dormant virus becomes reactivated. The recurrence may occur weeks, months or even years after the initial infection. Some people only have one or two recurrences, while others get them regularly - occasionally as much as once a month or more.

Recurrent attacks are usually much less troublesome than the primary attack. Rather than several ulcers forming, only one or two small lesions tend to develop. These also heal more quickly - usually within five to seven days.

Warning signs: Known as a prodrome - of aching, tingling, gnawing or stabbing pains in the back or down the legs. Although recurrent ulcers tend to reappear in a similar site to the first attack, occasionally they appear elsewhere (for example, on another part of the labia, or even around the anus).

Triggers include:

• Stress
• Menstruation
• Ultraviolet light (don't use sun beds)
• Other infections (for example, viral illnesses such as the common cold)
• Vigorous sex

Treatment: Bathe the area with saline (salt water) in mild recurrences. More severe symptoms may require antiviral drugs - often applied as a cream rather than taken as oral tablets. If recurrences are frequent or severe, a course of an oral antiviral drug may be prescribed to help suppress recurrent attacks.

How does herpes affect pregnancy?
During pregnancy, if active genital herpes sores are present at delivery, there is a small chance (five to ten per cent) that the baby could acquire infection. This rarely causes widespread infection, such as viral meningitis or pneumonia. This is most likely to happen if it is a primary infection, however, as you won't have had time to develop antibodies that might help to protect your baby.

Tell your midwife/obstetrician if you've had genital herpes. They can advise on whether or not you might need a caesarean if active sores are present when labour starts. Some doctors don't recommend this as on the few occasions when a baby does become unwell, treatment with antiviral drugs is very effective.

If you're worried you have an STI or want to find out more, check out the symptoms, diagnosis and treatments for:

• Chlamydia
• Genital warts
• Gonorrhoea
• HIV and AIDS
• Pubic lice
• Scabies
• Syphilis
• Trichomonas