Genital herpes is an infection caused by the herpes simplex virus or HSV. There are two types of HSV, and both can cause genital herpes. HSV type 1 most commonly infects the lips, causing sores known as fever blisters or cold sores, but it also can infect the genital area and produce sores. HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth. A person who has genital herpes infection can easily pass or transmit the virus to an uninfected person during sex.
Both HSV 1 and 2 can produce sores (also called lesions) in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin.
HSV remains in certain nerve cells of the body for life, and can produce symptoms off and on in some infected people. However, the number of outbreaks tends to decrease over the years.
According to the U.S. Centers for Disease Control and Prevention, 45 million people in the United States ages 12 and older, or 1 out of 5 of the total adolescent and adult population, are infected with HSV-2.
Nationwide, since the late 1970s, the number of people with genital herpes infection has increased 30 percent. The largest increase is occurring in young teens. HSV-2 infection is more common in three of the youngest age groups which include people aged 12 to 39 years.
Most people get genital herpes by having sex with someone who is having a herpes "outbreak." This outbreak means that HSV is active. When active, the virus usually causes visible lesions in the genital area. The lesions shed (cast off) viruses that can infect another person. Sometimes, however, a person can have an outbreak and have no visible sores at all. People often get genital herpes by having sexual contact with others who don’t know they are infected or who are having outbreaks of herpes without any sores.
A person with genital herpes also can infect a sexual partner during oral sex or close skin to skin contact The virus is spread only rarely, if at all, by touching objects such as a toilet seat or hot tub.
Unfortunately, most people who have genital herpes don’t know it because they never have any symptoms, or they do not recognize any symptoms they might have. When there are symptoms, they can be different in each person. Most often, when a person becomes infected with herpes for the first time, the symptoms will appear within 2 weeks. These first episodes of symptoms can last several weeks. Early symptoms of a genital herpes outbreak include:
- Tingling, itching or burning feeling in the genital or anal area
- Pain in the legs, buttocks, or genital area
- Discharge of fluid from the vagina
- Feeling of pressure in the abdomen
Within a few days, sores appear near where the virus has entered the body, such as on the mouth, penis, or vagina. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over several days, the sores become crusty and then heal without leaving a scar.
Other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.
If you have been infected by HSV 1 and/or 2, you will probably have symptoms or outbreaks from time to time. After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the lesions are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it’s inactive.
In most people, the virus can become active several times a year. This is called a recurrence. But scientists do not yet know why this happens. When it becomes active again, it travels along the nerves to the skin, where it makes more viruses near the site of the very first infection. That is where new sores usually will appear.
Sometimes, the virus can become active but not cause any sores that can be seen. At these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. You may not notice this shedding because it often does not cause any pain or feel uncomfortable. Even though you might not be aware of the shedding, you still can infect a sex partner during this time.
After the first outbreak, any future outbreaks are usually mild and last only about a week. An infected person may know that an outbreak is about to happen by a tingling feeling or itching in the genital area, or pain in the buttocks or down the leg. For some people, these early symptoms can be the most painful and annoying part of an episode. Sometimes, only the tingling and itching are present and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear.
The frequency and severity of recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight.
The healthcare provider can diagnose typical genital herpes by looking at the sores. Some cases, however, are more difficult to diagnose.
The virus sometimes but not always, can be detected by a laboratory test called a culture. A culture is done when the healthcare provider uses a swab to get and study material from a suspected herpes sore. You may still have genital herpes, however, even if your culture is negative (which means it doesn't show HSV).
A blood test called type-specific test can tell whether you are infected with HSV-1 or hSV-2. The type-specific test results plus the location of the sores will help your health care provider to find out whether you have genital infection.
How is genital herpes treated?
Although there is no cure for genital herpes, your health care worker might prescribe one of three medicines to treat it as well as to help prevent future episodes.
- Acyclovir (Zovirax)
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
Recently, the Food and Drug Administration approved Valtrex for use in preventing transmission of genital herpes. (See section below: How can I protect myself or my sexual partner?)
During an active herpes episode, whether the first episode or a repeat one, you should follow a few simple steps to speed healing and avoid spreading the infection to other places on the body or to other people.
- Keep the infected area clean and dry to prevent other infections from developing.
- Try to avoid touching the sores.
- Wash your hands after contact with the sores.
- Avoid sexual contact from the time you first feel any symptoms until the sores are completely healed, that is, the scab has fallen off and new skin has formed where the sore was.
Can genital herpes cause any other problems?
Usually, genital herpes infections do not cause major problems in healthy adults. In some people whose immune systems do not work properly, genital herpes episodes can last a long time and be unusually severe. (The body’s immune system fights off foreign invaders such as viruses.)
Occasionally people with normal immune systems can get herpes infection of the eye, called ocular herpes. Ocular herpes is usually caused by HSV-1 but sometimes by HSV-2. It can occasioanlly result in serious eye disease, including blindness.
A woman with herpes who is pregnant can pass the infection to her baby. A baby born with herpes might die or have serious brain, skin, or eye problems. Pregnant women who have herpes or whose sex partner has herpes should discuss the situation with her health care provider. together they can make a plan to reduce her or her baby's risk of getting infected. Babies who are born with herpes do better if the disease is recognized and treated early.
Genital herpes, like other genital diseases that produce lesions, increases a person’s risk of getting HIV, the virus that causes AIDS. This may be due to the open sores caused by the herpes infection or by other factors in the immune system. In addition, HIV-positive people may be more contagious for herpes.
How can I protect myself or my sexual partner?
If you have early signs of a herpes outbreak or visible sores, you should not have sexual intercourse or oral sex until the signs are gone and/or the sores have healed completely. Between outbreaks, using male latex condoms during sexual intercourse may offer some protection from the virus. When used with these precautions, Valtrex can also help prevent infecting your partner during heterosexual sex.
Where can I get help if I’m upset about having genital herpes or I have an infected partner?
Genital herpes outbreaks can be distressing, inconvenient, and sometimes painful. Concern about transmitting the disease to others and disruption of sexual relations during outbreaks can affect personal relationships. If you or your partner has genital herpes, you can learn to cope with and treat the disease effectively by getting proper counseling and medicine, and by using ways to prevent getting infected or infecting someone else, as mentioned above.
Where can I get more information?
National Herpes Resource Center and Hotline
American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
919-361-8488 (9 a.m. to 7 p.m. Eastern Time, Monday through Friday)
http://www.ashastd.org/hrc/index.html
National STD and AIDS Hotline
1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)
National Institute of Allergy and Infectious Diseases
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov
National Library of Medicine
MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657
http://medlineplus.gov
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228
http://www.cdc.gov
The American College of Obstetricians and Gynecologists
409 12th Street, S.W.
P.O. Box 96920
Washington, DC 20090-6920
202-863-2518
http://www.acog.org
Source:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Last Updated: September 22, 2009