Episodic Genital Herpes Treatment

Genital herpes is a common sexually tranmitted infection (STI) that is caused by the herpes simplex virus (HSV). It is very contagious and is typically spread via skin-to-skin contact, kissing, vaginal and anal sex (genital contact), oral sex (mouth to genital contact) and sharing sex toys.

There are 2 different types of HSV that cause genital herpes, HSV type 1 and HSV type 2. These viruses can also cause cold sore lesions. HSV type 1 is now the most common cause of genital herpes due to transmission from cold sores and oral sex. HSV type 2 is now less common but is more likely to be associated with recurrent infections. 

Symptoms of genital herpes

Most people do not have any signs or symptoms of genital herpes. Others will experience pain, itching and sores in / around the genital area ranging from mild to severe. 

If previously infected, you can be contagious even if you have no visible sores/ blisters.The shedding skin will carry the virus and can infect another person.

Primary Infection 

The first time you are infected with HSV is known as the primary infection. Often, there are no symptoms and many people do not know they have it. If symptoms are present, you are more likely to feel generally unwell during the primary infection compared with recurrent episodes, which can last up to four weeks if not treated.

Symptoms include:

  • Fever & muscle aches and pains
  • Painful crops of blisters preceded by tingling/ burning pain.
  • Blisters are usually present on both sides of the body
  • Tender groin bi-laterally (due to swelling of lymph nodes in the groin area)
  • Pain passing urine
  • Vaginal or urethral discharge

All patients with a first known episode (symptoms) of HSV infection should attend their local GP or sexual health / GUM clinic for in-person assessment, confirmation of diagnosis and management. You should also have screening for other STIs at this time. A diagnostic swab for typing the virus will be taken at this time and does not need to be re-taken during any future flares.

For a list of Irish sexual health / GUM clinics please click here

(You do not need a referral letter to attend these clinics)

It is not appropriate for the initial infection to be managed via this online service as a diagnostic swab is needed.

Recurrent Infections

After the primary infection, the virus lies dormant in the nerve cells of your skin and has the potential to reactivate at any time.  

When the virus travels to the skin during reactivation, you are contagious; you may have painful skin lesions (symptomatic) or you may not have any visible lesions (asymptomatic).

Symptoms and presentation will often vary from person to person. For most people, the outbreaks become less frequent and severe over time, as your immune system dampens down the response to the virus, but it can last for several years.

In some cases, treatment is necessary to manage recurrent infections as these may be very frequent, extremely painful, or in places that can cause significant complications e.g. at the opening of the urethra, making it difficult to pass urine.

Where can the herpes lesions appear?

Men and women can develop sores on the:

  • Buttocks and thighs
  • Anus 
  • Mouth (cold sores)
  • Urethra (the tube that allows urine to drain from the bladder to the outside)

Women can also develop sores in or on the:

  • Vaginal area
  • External genitalia
  • Cervix

Men can also develop sores in or on the:

  • Penis
  • Scrotum

What can trigger a flare of genital herpes?

Some people find that certain things/ situations will trigger an outbreak of genital herpes.

  • Feeling unwell eg with a viral infection or fever
  • Stress
  • Fatigue
  • Changes to the immune system
  • Hormonal changes eg at the start of your period
  • Excess alcohol 

If you have identified a trigger, you should try and avoid this, where possible.

How do you stop the spread of genital herpes?

Genital herpes lesions are contagious from the moment of the first tingle until they have completely healed. To reduce the risk of passing the infection on to others:

  • Try not to pick or touch sores
  • Avoid sexual contact if you or your partner have an active genital herpes infection, until all blisters/ sores have healed. 
  • Avoid intimate contact if you or your partner have active cold sore lesions.
  • Consider using a condom during every sexual encounter
    • especially as you are a known carrier of this infection.  
    • you can be asymptomatic and carry the herpes virus for a very long time and pass it on without knowing.
    • Condoms do not provide complete protection, as they only cover the skin of the penis, but they do reduce the risk of transmission.
  • If you carry this virus, you should be open about this with any partner before sex.
  • Try to avoid triggers: the best way to avoid spreading cold sores is to avoid getting them.
  • If you get a warning sign, then act quickly: follow the advice above and consider antiviral medication treatment.

If you have any questions about this, you can speak with one of our GPs by booking a video consultation

What treatments can we provide?

We can arrange a prescription for antiviral tablets (aciclovir or valaciclovir) and an anaesthetic gel. 

Our service is limited to those who have previously been diagnosed with genital herpes by a healthcare professional, to treat a current outbreak, or in preparation for a future outbreak.

(Subject to clinical suitability) 

We are not able to offer prescriptions for other treatments via this service.

Antiviral tablets

Aciclovir and valaciclovir are antiviral medications used to treat HSV infection. 

They do not cure genital herpes but can reduce the severity and duration of the outbreak by preventing the virus from multiplying. This also helps to reduce the spread of the virus. 

How do you take these medications?

Aciclovir: take 2 tablets (400mg) three times a day for 3-5 days

Valaciclovir: take one tablet (500mg) twice daily for 3-5 days 

Take this medication as soon as possible after the start of the genital herpes episode. Please note, your prescription will be for 5 days treatment. Complete the first 3 full days of the medication; if your symptoms have settled then you can stop, if not take the additional medication to complete a 5 day course of treatment. 

This information will be on the label that is affixed to the medication by the pharmacist.

Please note these instructions are different to those on the patient information leaflet that comes with these medications. 

  • You can take these tablets with or without food.
  • If you forget to take a dose, take it as soon as you remember and then continue as before. (Do not take two doses at the same time to make up for a missed dose). 
  • Complete this course of treatment, even if all your symptoms have resolved.
  • Drink plenty of water to avoid dehydration and keep your kidneys working well. 
  • As your skin can become more sensitive to sunlight when taking this medication, avoid strong sun and sunbeds. Use a high protection sun factor.

What are the potential side effects of aciclovir & valaciclovir?

  • nausea/ vomiting, diarrhoea or stomach aches
  • Headache
  • Skin rash, itching or feeling hot
  • Dizziness
  • Fatigue
  • Photosensitivity (more sensitive to sunlight)

These symptoms are usually mild and settle quickly. If you are concerned about any of these symptoms, or you develop other symptoms which you feel may be related to this medication, please stop the medication and speak with your pharmacist or doctor for advice.

Instillagel

Instillagel is a gel that contains the local anaesthetic lidocaine (5%). It comes in a 6ml syringe. When applied to the skin, it works quickly to numb the area and ease pain, but does not have any affect on duration or severity of lesions. It is used only for symptom control.

Instillagel is not licensed in Ireland for this specific indication, but it is often used to help with these symptoms. 

How do you use Instillagel? 

Apply a small amount of this gel (1-2mls) the affected area as needed.You should not use more than one third of a syringe in 24 hours. 

Ideally apply using a cotton bud or wearing gloves to avoid numbing your fingers and to avoid direct contact with the lesions.

It is for external use only.

Make sure to wash your hands well after applying this gel. 

Are there any side effects?

Side effects are uncommon as it is applied to small areas of skin.

Reported side effects include:

  • Localised irritation: redness, burning or swelling of the skin where the gel has been applied
  • Rarely systemic side effects can occur (usually if very frequent application to a large area of skin): dizziness, palpitations, headache, drowsiness.

If you experience any of the above side effects, stop using the gel or reduce how much and how often you are applying it.

  • Very occasional increased blistering of skin has been observed when using Instillagel. If this happens, stop Instillagel immediately, wash off the area  and seek medical assessment.

When should I see a doctor in person?

There are some occasions when you should see a doctor in person (your local GP or sexual health clinic):

  • If you are pregnant (it is important to discuss this with your antenatal team)
  • If you are feeling generally unwell (e.g fever, headache, malaise)
  • If you have a weakened immune system 
  • If your lesions have been present for more than 10 days
  • If you are concerned that your lesions are getting worse, with or without treatment

A more detailed clinical assessment is essential in these cases.

Who Is This Service For?

This service is suitable if you :

  • Are 17 years of age or older 
  • Have been previously diagnosed with genital herpes by a healthcare professional 
  • Require treatment for a current flare of genital herpes or in preparation for future significant flare 
  • Have lesions located on/ around your genitals only.

This service is NOT suitable for you if:

  • You are requesting this treatment for another person (that is a person other than the named person on this account)
  • You are pregnant (or suspect you could be pregnant) or breastfeeding
  • This is the first time you have had genital herpes

In this situation you should attend your local sexual health clinic or GP for assessment , advice and follow-up.

  • You require a prescription for a medication other than aciclovir or valaciclovir tablets
  • You need a prescription for suppression therapy (a longer course of treatment to help prevent flares)

If you want to discuss this further, please speak with your local GP or book a video consultation

  • You are feeling unwell / have a high temperature
  • You have severe kidney disease
  • You are immunocompromised (have a weakened immune system because of certain medical conditions, or medications you are taking)

Please book a video consultation or speak with your regular doctor as a more detailed clinical history is essential so appropriate treatment is provided; the required medication dose /duration is different to that available via this service.  

You should speak with your local GP/ sexual health clinic or  book a video consultation

  • All the herpes lesions are not located on/ around the genitals. 

Please attend your local GP or sexual health clinic for assessment.

How Does It Work?

  • Online consultations with Irish based doctor.
  • Our doctors issue a prescription if medically safe and suitable
  • Valid in any Irish pharmacy to buy your medication
  • Prescription sent to your chosen pharmacy via secure email (Healthmail) within minutes of approval

The accuracy of the information you provide is very important for the safe prescribing of the most suitable type of medication. 

The information that you provide is treated with the same patient-doctor confidentiality as in a normal face-to-face consultation.