How is genital herpes diagnosed and treated?

An accurate diagnosis of genital herpes includes taking a history, doing a physical examination and taking a swab from the area affected, to test for herpes simplex virus (HSV). Diagnosis is easier if early ulcers or blisters are present. Treatments for genital herpes include simple pain relief measures and oral antiviral therapy, which can be used to control outbreaks or be taken long term, if necessary, to control recurrences.

For general information see Genital herpes - the facts

Laboratory confirmation needed

Because people’s experience of genital herpes varies so greatly and because the treatment of each sexually transmitted infection (STI) is distinctive and specific, accurate diagnosis is essential.

The usual procedure is for the doctor to take a swab from the area affected. A sample of the fluid from a blister or from ulcers is taken and sent away for analysis.

In order to confirm genital herpes it is necessary to prove the presence of herpes simplex virus types 1 or 2 (HSV-1 or HSV-2). The test can identify whether the virus infection is caused by HSV-1 or HSV-2.

Both HSV types can cause genital herpes

HSV-1 is the usual cause of cold sores (oral/facial herpes), and HSV-2 is the usual cause of genital herpes. However, up to 50% of genital herpes is caused by the oral cold-sore type (HSV-1), which is transmitted to the genitals by having oral sex when one partner has oral cold sores.

Because it is possible for a person with genital herpes to have another sexually transmitted infection at the same time, a full genital check for STIs should be made.

Blood tests

Commercial blood tests specific for HSV-1 and HSV-2 antibodies are now available but are not recommended for use in the general population as a routine screen. The time taken to develop antibodies is usually 2 to 6 weeks after infection, but it may be up to 6 months, and ‘false positives’ and ‘false negatives’ can occur in these tests.

Because of the limitations of a blood test to diagnose herpes, it is recommended you discuss the implications of the test with someone who has experience with requesting them and interpreting the results in light of your particular presentation.

Managing genital herpes - Treatment

Genital herpes is manageable. Over the years a number of treatments offering effective relief from symptoms of genital herpes have been developed.

Simple treatments for the relief of discomfort

The following treatments may alleviate the pain and discomfort of genital sores.

• Salt baths, used to wash the genital area, can clean, soothe and dry the sores. Use 1 teaspoon of salt in 600ml of water or a handful in a shallow bath.
• Pain relievers include simple analgesics (such as aspirin and paracetamol), ice (which can be soothing if applied directly to the sores) and creams with an anaesthetic component. Creams, however, can slow down drying and should, therefore, be used sparingly and only for pain relief.
• Loose underclothes, preferably cotton (not nylon), can help minimise discomfort and allow healing.

For anyone who is experiencing extreme pain when urinating, sitting in a warm bath or using a pump bottle full of water and spraying water on yourself while urinating can make the process less painful.

It is extremely important to drink plenty of fluids as this dilutes the urine.

Antiviral therapy

The standard, effective and specific treatment for genital herpes is antiviral therapy, which is usually in tablet form. Antiviral drugs work by stopping HSV from replicating in the body. The antiviral drug only works in body cells where the herpes virus is present, therefore making the drug safe and free from side effects. The treatment only works while you are taking the drug and cannot prevent future outbreaks once you stop taking it.

Antiviral treatments can:

• shorten the duration of a genital herpes outbreak and help speed healing
• reduce the number of outbreaks suffered – or prevent them completely.

Two ways to use antivirals

Antiviral medications can be used in two ways:

• To treat outbreaks as they happen – this is known as ‘episodic’ treatment. With episodic treatment, the aim is to shorten the time each outbreak lasts and to relieve symptoms. This works best in persons who experience symptoms some hours before blistering occurs.
• To prevent or reduce recurrences – this is known as ‘suppressive’ therapy. If your recurrent outbreaks are frequent or severe – or if you find them particularly problematic – your doctor may recommend that you take oral antiviral medication every day to help prevent recurrences happening. Suppressive therapy is taken continuously, ie. daily, for months or even years.

Suppressive antiviral therapy

Suppressive antiviral therapy has also been shown to reduce ‘viral shedding’ between episodes and therefore may help reduce the risk of transmitting the virus to sexual partners. Recent studies have shown suppressive treatment with valaciclovir (Valtrex) reduces transmission of symptomatic herpes by 75%

Oral antivirals currently available in New Zealand are:

• Aciclovir, which is available fully subsidised by prescription. Aciclovir is very safe and effective, even when taken for long periods of time.
• Valaciclovir (Valtrex), which is available fully subsidised by prescription from your doctor through a Special Authority application, for individuals with problematic recurrent herpes not responding to aciclovir.
  

Initial or first episode treatment

For people experiencing the initial or primary episode, a course of antiviral tablets (eg, aciclovir) can markedly reduce the duration of the episode and give effective relief from symptoms.

The tablets do not eliminate the herpes virus from the body and, therefore, a course of medication will not provide a ‘cure’, but assists in the management of the infection.

Recurrences

Many people prefer suppressive therapy for frequent or severe recurrences, or if causing psychological problems, suppressive therapy can be extremely effective and should be considered.

For those who experience less frequent recurrences, episodic (three to five-day course) therapy may be helpful if taken as soon as prodromal (warning) symptoms indicating a recurrence are experienced. Or some people choose not to take treatment for very mild recurrences.

Topical therapy
Topical antiviral creams are available over-the-counter but are not recommended as a treatment for first episode or recurrent genital herpes as they are of little benefit.

Counselling

If you have just found out that you have genital herpes, it is likely you will have a lot of questions. A diagnosis of genital herpes often comes as a shock. Adequate information about genital herpes and the implications for the future are an important part of the initial treatment.

Seeing a counsellor may be a good idea to discuss any concerns you may have. Counselling offers a way of dealing with your concerns.

Support groups

The experience and support of other people with herpes can be extremely valuable. Herpes support groups exist in some centres. These groups have the objective of providing support and education to people with herpes. The activities of the herpes support group include providing advice and literature and arranging seminars, workshops and social gatherings.

Original material provided by the New Zealand Herpes Foundation. Edited by everybody, August 2010.