What is Genital Herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2.

Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum.

The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak.

Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

How do people get Genital Herpes?

HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to have a sore. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called “fever blisters.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.

Causes

Persons infected with HSV remain infected for life. The virus can be transmitted through direct contact with infected skin on genitals or other mucus membrane (mouth, anus, rectum)

Currently more than 50 million adults in the U.S. have genital herpes; there are 1.6 million new infections each year

How Is Genital Herpes Passed On?

Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sex. The virus affects the areas where it enters the body. This can occur during:

  • Vaginal sex
  • Anal sex
  • Oral sex (HSV-1 or HSV-2)
  • Kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact.

Symptoms

Many people with genital herpes never have sores, or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.If signs and symptoms do occur during the first outbreak, they can be quite severe. This first outbreak usually happens within 2 days to 2 weeks of being infected.General symptoms may include:

  • Decreased appetite
  • Fever
  • General sick feeling (Malaise)
  • Muscle aches in the lower back, buttocks, thighs, or knees
  • Swollen and tender lymph nodes in the groin during an outbreak

Genital symptoms include the appearance of small, painful blisters filled with clear or straw-colored fluid. They are usually found:

  • In women: on the outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks
  • In men: on the penis, scrotum, around the anus, on the thighs or buttocks
  • In both sexes: on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body
  • Before the blisters appear, the person may feel the skin tingling, burning, itching, or have pain at the site where the blisters will appear
  • When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 – 14 days or more

Other symptoms that may occur include:

  • Painful urination
  • Women may have vaginal discharge or, occasionally, be unable to empty the bladder and require a urinary catheter

A second outbreak can appear weeks or months later. It is usually less severe and goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.Once you have HSV-2, the virus hides within nerve cells and remains in the body. It can remain “asleep” (dormant) for a long time.The virus can “wake up” (reactivate) at any time. This may be triggered by:

  • Fatigue
  • Genital irritation
  • Menstruation
  • Physical or emotional stress
  • Injury

Some people have genital herpes attacks only once a year, while others have them so often the symptoms never seem to go away. Repeated attacks are generally milder in men.

How is genital herpes diagnosed?

The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be diagnosed between outbreaks by the use of a blood test.

All infected persons periodically reproduce HSV and silently shed the virus in their genital tracts. During these shedding episodes, they can transmit HSV to a sex partner.

What are the complications of genital herpes?

Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.

In addition, genital HSV can lead to potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.

Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.

“A genital herpes infections increases the risk of becoming infected with HIV by up to 3 times in both men and women.”

Treatment

Herpes is not curable, but antiviral drugs can partially control the duration and severity of episodes.

 

Sources

Centers for Disease Control “Genital Herpes – CDC Fact Sheet”, http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm

Corey, L., and Wald, A. (1999). “Genital Herpes.” In Sexually Transmitted Diseases, 3rd edition, eds. K. Holmes, P. Mardh, P. Sparling et al. New York: McGraw-Hill.

http://www.avert.org/herpes/htm

http://www.nlm.nih.gov/medlineplus/genitalherpes.html