Getting back to intimacy after being diagnosed with herpes
As with any sexually transmitted disease, a herpes diagnosis can cause feelings of significant distress and shame. However, with recent data suggesting that 70% of people carry some form of the herpes virus by the age of 25, it’s actually very common, and a fairly “normal” thing to have.1
Herpes is caused by a virus called herpes simplex (HSV). There are two types of herpes simplex; type 1 which normally causes cold sores, and type 2 which usually causes genital herpes. Type 2 is less common, but it is possible for the two types to cross over areas. This does mean you catch genital herpes from a cold sore or vice versa.
There is no way of knowing from appearance alone whether this is type 1 or 2, but blood tests are able to distinguish between the two types. Herpes can lie dormant in the body for months or years at a time, without displaying any symptoms. Only one fifth of people with herpes even know that they have it.2
What are the symptoms of herpes?
The symptoms associated with type 2 HSV can be severe with painful blisters appearing on the vagina and vulva. This can be accompanied by swelling of the area, vaginal discharge, pain when passing urine and a flu like illness. Taking an antiviral drug, such as aciclovir, can reduce the length of symptoms in each episode. If you notice any symptoms you should go to your doctor or local GUM clinic for a diagnosis and treatment.
Once herpes has been acquired it cannot be “cured” as such, and continues to live in the body for life. Symptoms can recur after the initial episode and this is more common in the first year, where people will have four episodes, on average. However, episodes reduce in subsequent years, in which the average is one episode per year.3
How do you catch and pass on herpes?
Genital herpes is acquired by contact with infective blisters or cold sores on the mouth, genitals or anus. It is also possible to get an infection from other lesions such as a herpetic whitlow; a lesion on the finger or thumb.
If you currently have any genital lesions, you should avoid having intercourse, as the virus is very infective at this time. Using a condom or femidom will not protect a sexual partner as it does not cover all genital surfaces, so there is still risk of infection as uncovered surfaces come into contact.
If you have lesions elsewhere on the body, such as the mouth or fingers, intercourse is possible but great care must be taken for these lesions not to come into contact with the genitalia if you wish to avoid genital herpes.
It is possible for genital herpes to be acquired from a cold sore, so you should avoid giving oral sex to your partner if you currently have one.
During the initial episode of blisters, you should also take care to wash your hands thoroughly after touching any lesions, and avoid sharing towels or underwear. There are no need to take such precautions after the first episode has cleared.
Herpes can also be transmitted when there are no signs of infection. Once an individual has been infected, the virus lives in nerve tissue called ganglia, under the skin. Every so often it undergoes a process called shedding where the virus travels to the surface of the tissue and bits of the virus are spread.
We don’t know exactly how often this happens, but we do know the frequency of this reduces in the years following the initial episode.4 There is no way of knowing whether you are currently shedding as the process is invisible.
If a person has caught the virus from another via the shedding process described above, the virus may lie dormant for several weeks or months. Symptoms often present when someone’s immune system is weakened, such as during a period of illness or pregnancy.
Women may worry that their partners have cheated on them, however, this is rarely the case. It is possible to only have sex with one person in your entire life and still contract genital herpes.
A condom or femidom will not prevent the virus being transferred by the shedding process, but it will significantly reduce the risk. One study found that the risk of transmission was reduced by 30% when condoms were used consistently.5 Antiviral drugs can also reduce the risk of shedding by around 80-90%.6
It is particularly important to avoid herpes infection during pregnancy. Sex with a partner who has been diagnosed with the herpes virus should always take place with a condom and avoided completely if lesions are present.
How can I tell my partner I have herpes?
Telling a partner about a herpes diagnosis is never easy. Having an open and honest discussion, explaining the statistics, should help them to understand the diagnosis and how normal it really is. It is possible that your partner is already a carrier of the herpes virus, but may be unaware, due to a lack of symptoms.
Even in a short term relationship it is best to be open and honest about the diagnosis and use a condom to reduce the risk. Ideally both partners should get STI tested prior to intercourse but this is not always possible. Early disclosure can help to build trust in any relationship and avoid making the conversation more difficult at a later date.
If you are struggling to have this discussion, it may be worth seeing your GP, or a genito-urinary doctor or nurse, as a couple. Such professionals are experienced in counselling couples about the condition. Your local GU clinic can also contact your partner directly, if you feel unable to inform them in person.
Most people wouldn’t think twice about kissing a partner who had previously had a cold sore, so having sex after an episode of genital herpes should be no different. Use of a condom or antivirals will significantly lower the risk of transmission.
A diagnosis of herpes should not prevent you being able to enjoy being intimate with your partner and should not prevent you maintaining a happy and healthy sex life.
As genital lesions are very tender it is advisable to avoid any contact with this area at this time. The lesions can be very painful and you may feel generally unwell during an outbreak. You should not feel under any pressure to be intimate at this time. There is no risk associated with kissing or cuddling with genital herpes, so this can help maintain feelings of intimacy.
Some women may find it hard to relax during sex after a herpes diagnosis, even after symptoms have cleared. There is no “one size fits all” approach to getting through this. Psychosexual counselling is available privately, and on the NHS in some areas. This can help to deal with intrusive feelings and anxieties. There are also herpes support groups available for those who may prefer to discuss their feelings with a group.
- BASHH, ‘Herpes Simplex’, Patient Information Leaflet, [available online], https://www.bashhguidelines.org/media/1039/hsv-pil-2015-screen-friendly.pdf, (accessed 10/2/18).
- W. Phipps et al., ‘Persistent genital herpes simplex virus-2 shedding years following the first clinical episode’, Journal of Infectious Diseases, Vol. 15, No. 203(2), 2011, pp. 180-7.
- R. Patel et al., ‘2014 UK national guidelines for the management of anogenital herpes’, International Journal of STD & AIDS, Vol. 0, No. 0, 2015, pp.1-14 2015: 0(0) 1-14.
- E. T. Martin et al., ‘A pooled analysis of the effect of condoms in preventing HSV-2 acquisition’, Arch Intern Med, Vol. 13, No. 169(13), 2009; pp. 1233–1240.
- W. Phipps et al., ‘Persistent genital herpes simplex virus-2 shedding years following the first clinical episode’, 2011.