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Genital herpes is a sexually transmitted infection usually caused by the Herpes simplex virus type 2 (HSV-2). However, nowadays almost a third of infections are caused by the Herpes simplex virus type 1 (HSV-1). Oral herpes infections can be transmitted to the partner’s genital area during oral sex. About 20% of Finns carry HSV-2, but only a small number have symptoms. After transmission, the Herpes simplex virus remains latent in the neural ganglia.

Symptoms

The symptoms of genital herpes appear within about 4 to 14 days after transmission. The first symptoms include vulvar burning and itching, followed by blisters in the genital area. The blisters then become sores and finally form scabs. The first herpes outbreak is usually more severe and often involves difficulty urinating. General symptoms may include fever, headache and muscle pain. The symptoms last for 2 to 3 weeks. The first herpes outbreak does not always cause symptoms.

Herpes recurs in about 80% of people who’ve had their first outbreak (primary herpes). In this case, there are usually no general symptoms. The first symptoms include itching and burning, followed by blisters and sores that are usually one-sided. The symptoms ease within about a week. New outbreaks may occur after physical or psychological stress, often in connection with menstruation.

Diagnosing herpes

Vulvar blisters and sores that appear at the acute stage help to confirm the diagnosis. Laboratory examinations are therefore not usually required. You should still contact a healthcare professional to be certain. Laboratory examinations are performed in unclear cases as well as during pregnancy and when considering long-term medication for herpes. The Herpes simplex virus can be detected direct from a blister or fresh sore by a culture or nucleic acid amplification. Both methods distinguish the HSV types 1 and 2. Blood antibody tests can detect the antibodies against both types (i.e. that the person is a carrier of the virus) but not the where the infection originated from.

When should you seek treatment?

Symptoms can be alleviated and infectivity reduced with antiviral medicines. If the symptoms are mild, antiviral medication is not required. If the symptoms are severe, you should see a doctor.

There are three medicinal agents against herpes: aciclovir, its derivative valaciclovir, and famciclovir. They differ in dosing frequency and price. During the first herpes outbreak (primary herpes), the medication shortens the virus release time, alleviates pain and accelerates healing. Recurrent herpes outbreaks should be treated immediately when the symptoms appear. The treatment is similar to that for primary herpes but shorter in duration and can accelerate healing. Topical antiviral cream can be applied to an individual blister.

If herpes recurs often, preventive treatment with aciclovir should be considered. The aciclovir treatment is lengthy, lasting at least 6 months. However, there are no medicines available that could remove the virus entirely from the neural ganglia.

Prevention

The herpes virus is particularly infectious during the symptomatic stage. The risk of transmission is greater from a man to a woman than from a woman to a man. Transmission may occur as a result of vaginal intercourse, anal intercourse or oral sex. However, half of the infections are passed on by a partner who has no symptoms or who is unaware of the infection. Condoms significantly reduce the risk of transmission but do not give full protection. You cannot get the virus through a condom, but you may get it from the skin and mucosa outside the condom. You should always use a condom in casual sex, as herpes can be transmitted during asymptomatic periods too. Oral herpes can be transmitted to the genital area during oral sex.

Information sources: The Finnish Medical Society Duodecim: Terveysportti, Lääkärin tietokanta database

FSHS General Practitioner / 09 January 2020



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