*Welcome to the OutUK series looking at gay men and their health brought to you in association with the NHS* website.**
	Each week we'll tackle a different topic in our A to Z of Gay Health. We'll have features and advice on everything from relationships, sexual health, mental and physical conditions and how to stay fit. You can follow any of links provided below for more information direct from the NHS website, or see this week's feature M: MRSA.

Genital Herpes

Genital herpes is a sexually transmitted infection (STI) passed on through vaginal, anal and oral sex. Treatment from a sexual health clinic can help. Symptoms clear up on their own but can come back.

Check if you have genital herpes

Symptoms of genital herpes include:

small blisters that burst to leave red, open sores around your genitals, anus, thighs or bottom - the sores may be less red on brown or black skin
tingling, burning or itching around your genitals
pain when you pee
discharge that is not usual for you

Go to a sexual health clinic as soon as possible if:

you have symptoms of genital herpes

Go even if you have not had sex for a long time, as blisters can take months or years to appear.

Why you should go to a sexual health clinic

You can see a GP, but they'll probably refer you to a sexual health clinic if they think you might have genital herpes.

Sexual health clinics treat problems with the genitals and urine system.

Many sexual health clinics offer a walk-in service, where you do not need an appointment.

They'll often get test results quicker than GP practices and you do not have to pay a prescription fee for treatment.

Find a sexual health clinic

What happens at a sexual health clinic

The doctor or nurse at the sexual health clinic will:

ask about your symptoms and your sexual partners
use a small cotton bud (swab) to take some fluid from 1 of your blisters or sores for testing

The test cannot:

be done if you do not have visible blisters or sores
tell you how long you've had herpes or who you got it from

Symptoms might not appear for weeks or even years after you're infected with the herpes virus.

Treatment for genital herpes

There's no cure for genital herpes. Symptoms clear up by themselves, but the blisters can come back (an outbreak or recurrence).

Treatment from a sexual health clinic can help.

Treatment the first time you have genital herpes

You may be prescribed:

antiviral medicine to stop the symptoms getting worse - you need to start taking this within 5 days of the symptoms appearing
cream for the pain

If you've had symptoms for more than 5 days before you go to a sexual health clinic, you can still get tested to find out the cause.

Treatment if the blisters come back

Go to a GP or sexual health clinic if you've been diagnosed with genital herpes and need treatment for an outbreak.

Antiviral medicine may help shorten an outbreak by 1 or 2 days if you start taking it as soon as symptoms appear.

But outbreaks usually settle by themselves, so you may not need treatment.

Recurrent outbreaks are usually milder than the first episode of genital herpes.

Over time, outbreaks tend to happen less often and be less severe. Some people never have outbreaks.

Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months.

If you still have outbreaks of genital herpes during this time, you may be referred to a specialist.

How to deal with outbreaks yourself

There are things you can do if you've been diagnosed with genital herpes and you're having an outbreak.

Do

keep the area clean using plain or salt water to prevent blisters becoming infected
apply an ice pack wrapped in a flannel to soothe pain
apply petroleum jelly (such as Vaseline) or painkilling cream (such as 5% lidocaine) to reduce pain when you pee
wash your hands before and after applying cream or jelly
pee while pouring water over your genitals to ease the pain

Don't

do not wear tight clothing that may irritate blisters or sores
do not put ice directly on the skin
do not touch your blisters or sores unless you're applying cream
do not have vaginal, anal or oral sex until the sores have gone away

How genital herpes is passed on

Genital herpes is very easy to pass on (contagious) from the first tingling or itching of a new outbreak (before any blisters appear) to when sores have fully healed.

You may also be able to pass on the virus even if you do not have any symptoms.

You can get genital herpes:

from skin-to-skin contact with the infected area (including vaginal, anal and oral sex)
when there are no visible sores or blisters
if a cold sore touches your genitals
by transferring the infection on fingers from someone else to your genitals
by sharing sex toys with someone who has herpes

You cannot get genital herpes:

from objects such as cutlery or cups - the virus dies very quickly when away from your skin

Protecting against genital herpes

You can reduce the chances of passing on genital herpes by:

using a condom every time you have vaginal, anal or oral sex - but herpes can still be passed on if the condom does not cover the infected area
avoiding vaginal, anal or oral sex if you or your partner has blisters or sores, or a tingle or itch that means an outbreak is coming
not sharing sex toys - if you do, wash them and put a condom on them

Why genital herpes comes back

Genital herpes is caused by a virus called herpes simplex. Once you have the virus, it stays in your body.

It will not spread in your body to cause blisters elsewhere. It stays in a nearby nerve and causes blisters in the same area.

If you can, avoid things that trigger your symptoms.

Triggers can include:

ultraviolet light - for example, from sunbathing or sunbeds
friction in your genital area - for example, from sex (lubricant may help) or tight clothing
smoking
drinking alcohol

Some triggers are unavoidable, including:

being unwell
stress
during the menstrual cycle
surgery on your genital area
a weakened immune system - for example, from having chemotherapy for cancer

Genital herpes and HIV

Genital herpes can be a more serious condition for people with HIV.

If you have HIV and herpes, you'll be referred to a genitourinary medicine (GUM) specialist.

Genital herpes and pregnancy

Women who have had genital herpes before pregnancy can usually expect to have a healthy baby and a vaginal delivery.

However, if you have genital herpes during pregnancy, there's a risk your baby could develop a serious illness called neonatal herpes.

This can be fatal, but most babies recover with antiviral treatment.

The risk of your baby getting neonatal herpes is low if you've had genital herpes before.

It's higher if you get genital herpes for the first time within the last 6 weeks of your pregnancy.

Important

See your midwife or a GP if you think you have genital herpes in pregnancy.

Genital herpes treatment in pregnancy

You may be offered antiviral treatment:

to treat outbreaks in pregnancy
from week 36 of pregnancy to reduce the chance of an outbreak during birth
from diagnosis until the birth if you first get herpes after week 28 of pregnancy

Many women with genital herpes have a vaginal delivery. You may be offered a caesarean, depending on your circumstances.

OutUK's A to Z of Gay Health continues and you can read this week's feature M: MRSA. We have covered many subjects in this series and you can catch up with all of our Previous A to Z Features. If you want to find out more about this particular topic you can visit the Original article on the NHS website. If you are worried by any aspect of your health make sure you go and see your doctor or book an appointment at your local clinic.
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