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Genital Herpes (HSV)

Genital herpes is a common, highly infectious disease caused by a virus. It is transmitted from one person to another during sexual activity. Genital herpes causes blisters or groups of small ulcers (open sores) on and around the genitals in both men and women. It cannot be cured, only controlled.

  • Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms themselves of active infection.
  • As many as 50 million Americans are infected with the genital herpes virus, with about one million new infections each year. As many as 80%-90% of those infected fail to recognize herpes symptoms or have no symptoms at all.
  • The highest rates of infection are seen among the poor, those with less education, those using cocaine, and those with many sexual partners.

Genital Herpes Causes

Genital herpes is caused by the herpes simplex virus (HSV). There are two types: HSV-1 and HSV-2. Most genital herpes infections are caused by HSV-2. HSV-1 is the usual cause of what most people call “fever blisters” in and around the mouth and can be transmitted from person to person through kissing. Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores caused by either virus look the same.

  • Genital herpes is spread by direct contact with an infected person. Sexual intercourse and oral sex are the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is capable of spreading herpes.
    Note: People with herpes may spread the disease even if they do not realize they have an infection. Furthermore, there is strong evidence that people with herpes can transmit infection even while their disease appears to be inactive and no sores can be seen.
  • Many people remember having an episode of genital herpes when it occurs. But as many as 90% of those infected fail to recognize the symptoms or have no symptoms at all. It is not clear whether these people never had an initial herpes outbreak or whether they never noticed a mild infection. They are contagious and may have additional outbreaks, nonetheless.

Genital Herpes Symptoms

Signs of herpes tend to develop within 3-7 days of skin-to-skin contact with an infected person. Herpes infections look like small blisters or ulcers (round areas of broken skin) on the genitals. Each blister or ulcer is typically only 1-3 millimeters in size, and the blisters or ulcers tend to be grouped into “crops.” Usually the blisters form first, then soon open to form ulcers. Herpes infections may be painless or slightly tender. In some people, however, the blisters or ulcers can be very tender and painful.

Location of genital herpes

  • In men, herpes sores (lesions) usually appear on or around the penis.
  • In women, the lesions may be visible outside the vagina, but they commonly occur inside the vagina where they can cause discomfort or vaginal discharge but cannot be seen except during a doctor’s examination.
  • The ulcers or blisters may also be found anywhere around the genitals (the perineum) and in and around the anus.

First outbreak of genital herpes

  • The first herpes outbreak is usually the most painful, and the initial episode may last longer than later outbreaks.
  • Some people develop other signs of herpes infection, particularly with the first episode.�
    • Fever
    • Muscle aches
    • Headaches (may be severe)
    • Vaginal discharge or painful urination
    • Swollen and tender lymph glands in the groin (these glands swell as the body tries to fight the infection)

Later outbreaks of genital herpes

  • If the disease returns, later outbreaks generally have much less severe symptoms. Many people with recurrent disease develop pain or a tingling sensation in the area of the infection even before any blisters or ulcers can be seen. This is due to irritation and inflammation of the nerves leading to the infected area of skin.
  • These are signs that an outbreak is about to start. You are particularly contagious during this period, even though the skin still appears normal.

When to Seek Medical Care

With an initial outbreak, if you have signs or symptoms of a genital herpes infection, you should seek the care of a doctor as soon as possible, particularly if you have never been diagnosed with herpes before. Although genital herpes infections generally are not emergencies, treatment is more effective when it is started within the first few days of the outbreak.

Later outbreaks rarely need immediate medical attention.

  • If you have had a herpes outbreak before, discuss options for preventing further outbreaks with your doctor.
  • People with severe underlying medical problems (particularly HIV or AIDS) are at higher risk of severe illness if the disease is untreated. They should contact their doctors immediately upon noticing genital herpes sores.
  • A pregnant woman with signs or symptoms of genital herpes must inform her doctor as soon as possible. Prompt medical therapy may reduce the risk of transmitting the disease to newborn children by exposure in the birth canal.

In otherwise healthy people, genital herpes outbreaks rarely require hospital visits. If you are experiencing an initial episode of herpes and cannot be seen by your regular doctor within the first few days of the illness, go to a hospital’s emergency department to have medical treatment started.

  • Some people can become quite ill from herpes infections. If you have a high fever, severe headache, shortness of breath, or extreme fatigue, go to the hospital for evaluation.
  • People with severe medical illnesses (particularly HIV or AIDS) may become very ill from herpes infections. The herpes virus may quickly spread to the brain, lungs, and other organs. If this is your situation, seek prompt medical attention for herpes outbreaks. Go to a hospital if there is any sign of illness other than sores on the genitals.

Exams and Tests

Many doctors will start treatment based only on the appearance of the sores, if the sores seem typical of herpes. Doctors may also take a swab of the sore and send the swab to the laboratory to see if the virus is present. This test generally takes a few days.

Genital Herpes Treatment

Self-Care at Home

  • Avoid excessive heat or sunlight, which makes the irritation more uncomfortable.
  • Do not use perfumed or antibacterial soaps, feminine deodorant, or douches.
  • Wear more comfortable, loose cotton clothing.
  • For pain, you may take aspirin, acetaminophen (Tylenol), or ibuprofen (Advil).
  • Cool cloths on the affected area may soothe the pain.

Medications

Treatment with medication is effective in shortening the initial outbreak of the infection, lowers the chance that the infection will come back, and makes any later outbreaks less severe.

  • For treating the genital herpes infection, three similar medications are available. These antiviral medications vary in cost and in how often they should be taken. All should be taken for 7-10 days. Your doctor may extend the course of therapy if ulcers have not healed in 10 days.�
    • acyclovir (Zovirax)
    • famciclovir (Famvir)
    • valacyclovir (Valtrex)
  • Creams or ointments that are placed on the sores are not effective for initial herpes outbreaks.
  • For preventing later outbreaks, people with recurring genital herpes infections also may benefit from the antiviral medications. Treatment is started when the recurrence first begins and continues for five days.
  • For continuous prevention, a few people who have fre
    quent outbreaks can only control the outbreaks (generally over six recurrences per year) by taking medication every day. Acyclovir, famciclovir, and valacyclovir are all used to treat recurrent disease. This is known as suppressive therapy. Suppressive therapy has been shown to decrease the frequency of genital herpes recurrences by 70%-80% in those who have frequent recurrences, and many people taking this treatment report no symptomatic outbreaks.

Next Steps

Follow-up

Anyone diagnosed with genital herpes must disclose their diagnosis with sexual partners. These partners should be advised to seek medical attention if they develop any signs of the illness. Generally, nothing needs to be done if the partner has no signs of developing a herpes infection.

Prevention

People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any sexual contact when sores are present. Even the use of a condom does not prevent the spread of disease because not all sores are covered by the condom.

Although the chance of spreading disease is greatest when sores are present, people who have had genital herpes may always be contagious to some degree, even if they have received medical treatment. The virus can become active and be transmitted to a sexual partner even when the skin appears completely normal. For this reason, safe sex practices (use of a condom) should be used between disease outbreaks to lessen the chance of spreading disease to a sexual partner.

Outlook

Treatment of genital herpes does not cure the disease. The virus usually lives (in an inactive form) in an infected person forever. Most people (85%) with genital herpes will have recurring outbreaks – sometimes 6 to 10 a year. Recurrences are likely to have less severe symptoms. Sores usually last a shorter period of time.

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