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Genital Herpes
OVERVIEW
Genital herpes is an infection of the genitals, buttocks, or anal area caused
by herpes simplex virus (HSV). There are two types of HSV.
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HSV type 1 most commonly infects the mouth and lips, causing sores known as
fever blisters or cold sores. It is also an important cause of sores to the
genitals.
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HSV type 2 is the usual cause of genital herpes, but it also can infect the
mouth.
According to the Centers for Disease Control and Prevention, 1 out of 5
American teenagers and adults is infected with HSV-2. Women are more commonly
infected than men. In the United States, 1 out of 4 women is infected with
HSV-2.
Since the late 1970s, the number of people with genital herpes infection has
increased 30 percent nationwide. The largest increase has been among teens and
young adults.
TRANSMISSION
If you have genital herpes infection, you can easily pass or transmit the
virus to an uninfected partner during sex.
Most people get genital herpes by having sex with someone who is shedding the
herpes virus either during an outbreak or during a period with no symptoms.
People who do not know they have herpes play an important role in transmission.
You can transmit herpes through close contact other than sexual intercourse,
through oral sex or close skin-to-skin contact, for example.
The virus is spread rarely, if at all, by objects such as a toilet seat or
hot tub.
Reduce your risk of spreading herpes
People with herpes should follow a few simple steps to avoid spreading the
infection to other places on their body or other people.
Avoid touching the infected area during an outbreak, and wash your hands
after contact with the area. Do not have sexual contact (vaginal, oral, or anal) from the time of first
genital symptoms until symptoms are completely gone.
TREATMENT
Although there is no cure for genital herpes, your health care provider might
prescribe an antiviral medicine to treat your symptoms and to help prevent
future outbreaks. This can decrease the risk of passing herpes to sexual
partners. Medicines to treat genital herpes are
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Acyclovir (Zovirax)
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Famciclovir (Famvir)
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Valacyclovir (Valtrex)
SYMPTOMS
Symptoms of herpes are called outbreaks.
Genital warts also occur in outbreaks. The first outbreak appears within 2
weeks after you become infected and can last for several weeks. These symptoms
might include tingling or sores near the area where the virus has entered the
body, such as on the genital or rectal area, on buttocks or thighs, or
occasionally on other parts of the body where the virus has entered through
broken skin. 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 small blisters, and then become itchy, painful sores that might
develop a crust and will heal without leaving a scar.
Sometimes, there is a crack or raw area or some redness without pain,
itching, or tingling.
Other symptoms that may accompany the first (and less often future) outbreak
of genital herpes are fever, headache, muscle aches, painful or difficult
urination, vaginal discharge, and swollen glands in the groin area.
Often, though, people don't recognize their first or subsequent outbreaks.
People who have mild or no symptoms at all may not think they are infected with
herpes. They can still transmit the virus to others, however.
Recurrence of herpes outbreaks
In most people, the virus can become active and cause outbreaks several times
a year. This is called a recurrence, and infected people can have symptoms. HSV
remains in certain nerve cells of your body for life.
When the virus is
triggered to be active, it travels along the nerves to your skin. There, it
makes more virus and sometimes new sores near the site of the first outbreak.
Recurrences are generally much milder than the first outbreak of genital
herpes. HSV-2 genital infection is more likely to result in recurrences than
HSV-1 genital infection. Recurrences become less common over time.
Symptoms from recurrences might include itching, tingling, vaginal discharge,
and a burning feeling or pain in the genital or anal area. Sores may be present
during a recurrence, but sometimes they are small and easily overlooked.
Sometimes, the virus can become active but not cause any visible sores or any
symptoms. During 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. This is called asymptomatic (without symptoms)
shedding. Even though you are not aware of the shedding, you can infect a sexual
partner during this time. Asymptomatic shedding is an important factor in the
spread of herpes.
DIAGNOSIS
Your health care 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 your health care 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 does
not show HSV).
A blood test cannot show whether you are having a herpes outbreak, but it can
show if you are infected with HSV. Newer blood tests, called type-specific
tests, can tell whether you are infected with HSV-1 or HSV-2. Blood tests cannot
tell between genital and other herpes infections. Health experts assume,
however, that if you are positive for HSV-2, you have had genital infection.
Coping with herpes
A diagnosis of genital herpes can have emotional effects whether or not
symptoms are present. If you have genital herpes, you are probably concerned
about the effect of your disease on personal relationships. In addition, your
sexual partner may be concerned about their risk of infection. Proper counseling
and treatment can help you and your partner learn to cope with the disease.
PREVENTION
Because herpes can be transmitted from someone who has no symptoms, using
these precautions is not enough to prevent transmission. Recently, the Food and
Drug Administration approved Valtrex for use in preventing transmission of
genital herpes. It has to be taken continuously by the infected person, and
while it significantly decreases the risk of the transmission of herpes,
transmission can still occur.
COMPLICATIONS
Genital herpes infections usually do not cause serious health problems in
healthy adults. In some people whose immune systems do not work properly,
genital herpes outbreaks can be unusually severe and long lasting.
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 occasionally 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 cause sores, is important in
the spread of HIV infection.
RESEARCH
The National Institute of Allergy and Infectious Diseases (NIAID) supports
research on genital herpes and HSV. Studies are currently underway to develop
better treatments for the millions of people who suffer from genital herpes.
While some scientists are carrying out clinical trials to determine the best way
to use existing medicines, others are studying the biology of HSV. NIAID
scientists have identified certain genes and enzymes (proteins) that the virus
needs to survive. They are hopeful that drugs aimed at disrupting these viral
targets might lead to the design of more effective treatments.
Meanwhile, other researchers are devising methods to control the virus'
spread. Two important means of preventing HSV infection are vaccines and topical
microbicides.
Several different vaccines are in various stages of development. These
include vaccines made from proteins on the HSV cell surface, peptides or chains
of amino acids, and the DNA of the virus itself. NIAID and GlaxoSmithKline are
supporting a large clinical trial in women of an experimental vaccine that may
help prevent transmission of genital herpes. The trial is being conducted at
more than 35 sites nationwide. For more information, click here
Herpevac Trial for Women or go to herpesvaccine.nih.gov.
Topical microbicides, preparations containing microbe-killing compounds, are
also in various stages of development and testing. These include gels, creams,
or lotions that a woman could insert into the vagina prior to intercourse to
prevent infection.
An NIAID-supported clinical trial demonstrated that once-daily suppressive
therapy using valacyclovir significantly reduces risk of transmission of genital
herpes to an uninfected partner. This is the first time an antiviral medication
had been shown to reduce the risk of transmission of an STI. This strategy may
contribute to preventing the spread of genital herpes.
MORE INFORMATION
National Library of Medicine
MedlinePlus
8600 Rockville Pike
Bethesda, MD 20894
1-888-FIND-NLM (1-888-346-3656) or 301-594-5983
http://medlineplus.gov
Centers for Disease Control and Prevention
CDC-INFO
1600 Clifton
Road
Atlanta, GA 30333
1-800-CDC-INFO (1-800-232-4636)
1-888-232-6348 TTY
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
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
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