NHS - GUM

WHAT IS GENITAL HERPES ?

Genital herpes is an infection caused by the herpes simplex virus, which is also responsible for cold sores. Following infection, the virus lies dormant in the nerves and some people may experience further attacks. The herpes simplex virus is unique in that it tends to affect parts of the body where two different types of skin meet :-

The angles of the mouth (cold sores)
The genital area (genital sores)
The rectum or anus (perianal sores)
The eye (herpetic conjunctivitis)

It is rare for the virus to affect parts of the body other than these.

HOW IS THE INFECTION SPREAD ?

Infection is spread mainly through direct skin contact with an infected blister or sore :-

Sexual intercourse with someone who has active genital herpes
Oral-genital contact with someone who has active cold or genital sores
Self infection may occur, --. the virus may be transferred to other parts of the body, such as the eye

There is a risk of passing on the virus when no sores are present. Barrier methods such as the condom, give extra protection against herpes but are unreliable when sores are present. If you have sores, do not have sex until sores have healed.

WHAT ARE THE SYMPTOMS OF A PRIMARY / FIRST INFECTION ?

You may experience flu-like symptoms such as fever, tiredness, headache, aches and pains in the lower back and down the leg or in the groin
Small blisters then appear in the genital area. These quickly burst to leave tiny, red, punched out ulcers which are painful and tender. Several crops of blisters may appear one after the other.
Passing urine may be painful if it comes into contact with the ulcers

HOW DO IT TREAT IT ?

Your doctor may prescribe an oral antiviral drug. This treatment can lessen the symptoms and allow the condition to heal more quickly.

WHAT CAN I DO ?

Take paracetamol or an equivalent painkiller if the pain is severe
Apply ice-packs to the sores occasionally (iwrap ice-cubes in a piece of clean cloth)
Keep the sores dry (do not overwash them as this may delay healing). Keeping them exposed to the air will help.
Bathe the affected area in a salt solution (one teaspoon of salt to one pint of tepid water repeated two to four times a day)
Add a handful of salt to the bathwater

HOW TO AVOID SPREADING THE VIRUS

Not kissing when you or your partner have cold sores
Not having oral sex when you or your partner have cold sores or genital sores
Not touching each other;s genital areas when you or your partner has genital sores
Washing your hands with soap and water if you have touched your sores
Not sharing towels or face flannels

MINIMISING THE RISK OF FURTHER EPISODES

Not everyone will have another infection after the first one. About half the people who have an initial infection do not have a second. There are, however, certain times when you might be more likely to get a recurrence :-

When feeling run down or stressed
When menstruating
When other infections / illnesses are present
When exposed to ultra-violet light

There are measures that will not only help minimise the risk of further infections but also improve general quality of life :-

Try to avoid worry and stress
Get plenty of rest
Eat a well balanced and healthy diet
Avoid smoking and excessive alcohol
Avoid direct sunlight on the affected area
Take extra care around the menstrual period

More information on genital herpes is available from...

Herpes Viruses Association
www.herpes.org.uk
Phone: 0845 123 2305

BEHÇET’S

Most genital ulcers in the UK are caused by Herpes but it can be difficult to be certain sometimes. Behçets is an autoimmune condition - the body's immune system unfortunately attacks some areas of the body. It usually affects the genital skin and the oral area. Patients get large ulcers in these areas that can be difficult to treat. It is not sexually transmitted.

You can find more information on BEHÇET’S SYNDROME by visiting the behcets-society website - CLICK HERE

or contact them directly at the following address.....

Behçet’s Syndrome Society
3 Church Close
Lambourn
HUNGERFORD
Berks
RG17 8PU

Tel - 01488 71116
Email - info@behcets-society.fsnet.co.uk
(Please put Behçet’s or BD in the message header or the email will be treated as junk mail and be deleted unread)

ADDITIONAL INFORMATION FOR DOCTORS ABOUT THE MANAGEMENT OF ACUTE HERPES.

MANAGEMENT OF ACUTE GENITAL HERPES
Acute genital herpes is an extremely painful condition. The patients initially present with intense dysuria over several days. They then develop pain, blisters, discharge and can go into urinary retention. The urinary retention is a direct consequence of the extreme pain and is not thought to be neurological, so relief of pain can overcome this. It is caused by Herpes Simplex Type 1 or Type 2, and can develop in a perfectly stable monogamous relationship, so although sexually transmissible, is not always sexually transmitted and suspicion of partner infidelity can add distress and is often unfounded.

MANAGEMENT
Diagnosis is by history and appearance. There are multiple shallow ulcers that are intensely painful. Clinic website has pictures www.chestersexualhealth.co.uk There is usually inguinal adenopathy. The patient is often feverish with muscle aches and pains, typical of any systemic viral illness. If there is a possibility of doing a viral swab from one of the ulcers, that should be done, but treatment should not be delayed whilst this is being organised. The sooner anti-viral drugs are taken, the better. There is no advantage of intravenous over oral, so oral Acyclovir should be initiated as soon as possible. Most cases presenting to A&E and Gynaecology are at the severe end of the spectrum and in this situation it is best to double up the dose, ie. 400mg of Acyclovir (Zovirax) orally 5 times a day for 5 days. This will slowly stop the virus multiplying over about twelve hours. There usually is extreme discomfort passing urine and EMLA or Lignocaine gel can be applied to the area a few minutes prior to passing water, in the hope of relieving this. Having a pee in the bath or an upturned shower is also helpful, as it immediately dilutes and dissipates the urine away from the painful ulcerated areas. Sometimes intramuscular Pethidine is needed.

CATHETERISATION OR NOT
This is a grey area. Traditionally a suprapubic catheter was put in, but this is a cumbersome procedure, not without its consequences. A urethral catheter in theory may push the virus up the urethra into the bladder. However, most clinicians agree that if the patient has already taken some Zovirax at least half an hour beforehand, then with lots of local anaesthetic a urethral Jaques or in/out rigid catheter, just to drain the bladder once, can be used. Hopefully, by the time the bladder has refilled the situation will have resolved enough to allow the patient to urinate spontaneously.

PREGNANCY
Severe acute genital herpes in pregnancy can cause enough systemic illness to even induce an abortion, so it is appropriate to treat severe cases with oral medication during pregnancy. Obviously, all drugs are avoided whenever possible in the first trimester. Acyclovir has been around for over 20 years now with no evidence of teratogenicity in any trimester. Indeed, many units use Acyclovir in the last month of pregnancy in women who have chronic frequent recurrences in the hope of avoiding the presence of recurrences around the time of delivery.

REFERRAL
Patients should, of course, be referred down to the next available GUM / Sexual Health Clinic - Clinic Extension Number 3091 or Nurse base on Ext.3090. Finally, should a Senior GUM opinion be required, contact Switchboard, as there is a GUM Consultant available by mobile phone on a permanent basis. If too embarrassed to attend a packed GUM clinic a private consultation can be arranged. Phone 01244-363097.

Dr O’Mahony Nov 2006

Please remember that using a condom offers good protection against all sexually transmitted infections, including the HIV virus.

Please Click here for Clinic Times .....