Genital Herpes: What It Means for Partners

Your partner has genital herpes. Your support may be very important in helping him or her to deal with this condition, which can also directly affect you. When your partner goes back to the doctor, you may wish to go too, so that you can find out more about the infection. In the meantime, here are answers to some questions you may have.

What is genital herpes?

Genital herpes is a common infection generally transmitted through sexual contact. It is caused by one of two members of the herpesvirus family, which also includes the viruses causing chickenpox and shingles, and glandular fever.

Usually, genital herpes is caused by infection with herpes simplex virus type 2 (HSV-2), and studies suggest that in some countries, up to one in five people are infected with this virus. Genital herpes can also be caused by HSV-1, the virus which more usually causes facial herpes, including cold sores on the lips.

Genital herpes, for most people, is an occasionally recurrent, sometimes painful condition for which effective treatment is now available. Generally, it is not life-threatening and has no long-term repercussions on one's general physical health.

Anyone who is sexually active is at risk of catching genital herpes, regardless of their gender, race or social class.

How has my partner caught genital herpes?

Genital herpes can be transmitted through direct contact with an infected blister or sore, usually through sexual contact. It can also be transmitted when there are no symptoms present. HSV-2 infection is usually passed on during vaginal or anal sex. HSV-1 is usually transmitted by oral sex (mouth to genital contact).

If your partner has only just been diagnosed as having genital herpes, this does not necessarily mean that he or she has been unfaithful to you, or sexually promiscuous in the past.

Your partner may have caught genital herpes from you. It is possible that you carry the virus without knowing that you have it, since up to 80% of people, who are infected with HSV-2, show no signs of the infection. So it is very easy for you to have unwittingly transmitted the infection to your partner.

The symptoms of the infection vary greatly between individuals - it might be totally unnoticeable in you, but cause severe blistering in your partner.

Since the genital herpes virus can be transmitted through oral sex as well as vaginal sex, it is also possible that he or she caught the virus from a cold sore on your mouth or face. Remember, it is possible you can pass the virus on even if you didn't have a cold sore present at the time of contact.

Alternatively, your partner may have contracted the virus from a previous sexual partner, perhaps even several years ago. The virus can remain inactive in the body for long periods, so this may be the first time it has caused symptoms.

How will genital herpes affect our relationship?

Because of the stigma wrongly attached to genital herpes, it has probably taken a great deal of courage for your partner to tell you that he or she has the infection. Telling you shows that your partner cares about you and, if you don't already have the infection, wants to protect you from it.

You may find that the honesty and trust brought about by discussing genital herpes strengthens your relationship and brings you closer together. In addition, your support and understanding can help to overcome much of the anxiety that your partner may be feeling about genital herpes. If you are not clear about any aspect of the infection, ask him or her to explain again and/or ask your doctor to provide further information.

If you feel you can't accept being in a relationship with someone who has genital herpes, ask yourself if you are simply using it as an excuse to end a relationship which you already had doubts about.

What are the symptoms?

If your partner is having a first episode of genital herpes, he or she is likely to feel generally unwell and have fever, headache, and general joint and muscle aches, as well as irritation in the genitals. This may last for several days, during or after which reddened areas may appear on the genitals. These may develop into painful blisters. The blisters then burst, generally to leave sores which gradually heal, usually without scarring.

The severity of this first episode varies between individuals, but for some people it may be severe and last for up to three weeks if not treated. These symptoms should quickly resolve with treatment. The doctor has probably given your partner a course of antiviral treatment. This is an effective medicine which, although it does not cure genital herpes, can speed recovery and reduce the severity of the episode. There are also other steps which your partner can take to relieve the pain.

However, for many people who have genital herpes, the physical consequences of the infection are far outweighed by the emotional feelings it evokes. There are many misconceptions about genital herpes, including the belief that it is associated with promiscuity, and these have given it a reputation which may cause your partner to feel angry and shocked by the diagnosis. He or she may feel betrayed by you, or by a previous partner who may have transmitted the infection. Anxiety, guilt, loss of assertiveness and fear of rejection are also common emotions. Your support can be very important in helping your partner to deal with these feelings and to minimize the effect of genital herpes on his or her life.

Do the symptoms return?

The symptoms of genital herpes may reappear from time to time. This is because once the virus infection is acquired, it stays permanently in the body. Most of the time the virus remains inactive, but every so often it may reactivate and cause another outbreak.

Each individual is different - some people never have a recurrence. Others may have recurrences several times a year. However, recurrent outbreaks are usually shorter and less severe than the first episode.

Certain events or situations can trigger recurrences, and you may be able to help your partner avoid or reduce the trigger factors, which may include stress at work or home, fatigue, ill health, loss of sleep, friction due to sexual intercourse, and menstruation in women.

If your partner has frequent or severe episodes of genital herpes, or if the recurrent outbreaks are causing a lot of anxiety for your partner, then he or she may benefit from suppressive therapy, which prevents or reduces the frequency of recurrences.

What can we do to reduce my chances of getting the infection?

If you take the necessary precautions, the chances of getting the virus from your partner are small. Genital herpes does not necessarily mean abstinence from sex or a reduced enjoyment of sex.

The risk of transmitting the virus may possibly be reduced if you use condoms. The continued use of condoms in a long-term relationship is a personal decision that only the couple can make. Most find that as the importance of the HSV infection in their relationship is seen in perspective, that condom use becomes less relevant if this is the only reason condoms are being used. However, couples should try to avoid sexual intercourse during an active episode of herpes, because this is when the virus is most likely to be transmitted. This period includes the time from when your partner first has warning signs of an outbreak, such as a tingling or burning in the genitals, until the last of the sores has healed. Also, sexual activity prolongs the healing of the episode.

Transmission risk is increased if there are any breaks in the skin, for example, if you have thrush or small abrasions from sexual intercourse, often due to insufficient lubrication. It can be helpful to use a lubricant specifically for sexual intercourse and avoid sex if you have thrush. Sexual lubrication is helpful right at the start of sexual activity.

Sores in other areas - such as the buttocks and thighs - can be just as contagious as those in the genital area, and care should be taken to avoid direct contact with such sores during sex.

At other times, there is still a small risk of transmitting the infection, even if your partner is showing no signs of genital herpes. If you or your partner has a cold sore, it is advisable to avoid oral sex as this can spread the virus to the genitals.

You cannot catch genital herpes by sharing cups, towels or bath water, or from toilet seats. Even during an outbreak, it is only skin to skin contact with the parts of your partner's body - which have the sores - which you need to avoid. You can still cuddle, share a bed, or kiss.

How do I know if I have genital herpes?

If you too have genital herpes, you may show similar symptoms to those of your partner. However, signs of infection vary greatly between individuals and it is possible for you to show only mild symptoms that are not so easily recognizable as being genital herpes. These may include itching in the genital area, small cracks in the skin around the genitals, or reddened patches of skin in the genital area, thighs or buttocks, or you may have no symptoms at all.

If you think you might be showing signs of the infection, consult your doctor. Until recently, diagnosis could only be made by clinical symptoms and swabs to detect the virus during an active episode. However, blood tests are becoming commercially available that can distinguish between HSV-1 and HSV-2 antibodies. The time taken to develop antibodies after initial infection is normally 8 to 12 weeks. It is also important to know that false positives and false negatives can occur with these tests.

Blood tests cannot definitively diagnose herpes, they can only tell you whether or not you are infected with HSV-1 and/or HSV-2 - they cannot identify the site of infection. A swab taken from a genital site test is also required; if this tests positive - that is, virus is detected - the diagnosis of genital herpes is confirmed. It is recommended you discuss the implications of tests for genital herpes with someone who has experience with them.

Where can I get more information and advice?

After you have read this information and discussed genital herpes with your partner, you might have specific questions or concerns. Your doctor or your partner's doctor should be able to answer such questions or recommend other experts who can provide advice and support.

Continue to go back to your doctor until all your queries about genital herpes are answered.

In some areas, there are local genital herpes support groups that can be a valuable source of information and support. Ask your doctor if there is such a group in your area.

If you want further information regarding herpes treatment, you can:

• See your own doctor
• See a doctor at your local sexual health clinic

Acknowledgements:
This information has been realised in collaboration with the New Zealand Herpes Foundation (NZHF).