Genital herpes is a sexually transmitted disease (STD) caused by either of the two herpes simplex viruses (HSV). HSV type 2 (HSV-2) is the usual cause of genital herpes. HSV type 1 (HSV-1) is the cause of herpes sores on the lips and in the mouth (often called fever blisters or cold sores), but it also causes up to 30% of genital herpes cases.
An estimated 25% of adult Americans (1 out of 4) have genital herpes. Each year, 500,000 to a million new infections are believed to occur. Studies show that most people with genital herpes do not realize they are infected; they either have never had symptoms or have not recognized their symptoms as herpes.
Symptoms of Genital Herpes
First outbreak:
The symptoms of a first outbreak of genital herpes usually appear 2 to 10 days after exposure to herpes and last an average of 2 to 3 weeks. Many people who are newly infected with herpes overlook their symptoms either because the symptoms are mild or because they are unaware of the possibility of herpes infection.
Symptoms of a first genital herpes infection vary widely and may include any of the following (listed from most common to least common):
- Blisters or other sores on the penis, vagina, cervix, anus, buttocks, or (rarely) elsewhere on the body. Small red bumps usually appear first, then develop into blisters, and then become painful, open sores. Over a period of days, the sores may scab over. Finally, they heal.
- Mild symptoms that may be mistaken for other problems (e.g., yeast infection or jock itch), such as itching, irritation, or scratch-like sores.
- Pain or discomfort around the genitals, buttocks, or legs.
- Swollen lymph nodes in the groin.
- Itching or burning during urination.
- Constipation or difficulty urinating.
- General symptoms, such as fever, headache or feeling rundown.
Not everyone has all these symptoms and some infected persons have no symptoms at all.
Latent infection:
During the first outbreak of symptoms, the virus travels to nerves that near the spine. The virus remains inside the nerve cells in a latent or dormant state. While the virus is dormant, a person has no symptoms.
Periodically, herpes becomes active once again, leading either to a recurrent outbreak or to subclinical shedding of the virus.
Recurrent outbreaks:
In most people with genital herpes, the virus reactivates from time to time and causes symptoms. The frequency and severity of the recurrent episodes vary greatly. Most persons have several outbreaks a year, but some-especially those with HSV-1 genital infections-may have only 1 or 2 outbreaks a year or none at all. In general, recurrent episodes occur most often in the first year after initial infection. Most persons with recurrent herpes due to HSV-2 have outbreaks 3 - 5 times a year.
Recurrent episodes usually are milder than those of the first episode and typically last about 1-2 weeks. Some people report that stress, other illness, or menstruation bring on an outbreak of genital herpes. However, research indicates that these factors, in fact, have little effect; recurrent outbreaks probably occur randomly. In any case, recurrent episodes usually are not predictable. In contrast, recurrences of oral herpes due to HSV-1 often are triggered by sunburn, injury, or other infections that might occur-hence the terms "fever blisters" and "cold sores".
The symptoms of recurrent herpes can vary.
- Some people have a "prodrome" of symptoms before the actual outbreak, with itching, tingling, numbness, or painful feelings in the area where the lesions will develop. Some have pain where lesions will not appear, such as the buttocks, back of legs or even lower back. The prodrome often usually starts a day or two before the actual an outbreak begins.
- Some people experience red bumps that become blisters then open sores as for the first episode of genital herpes. However, in recurrent outbreaks, there usually are fewer lesions and they don't last as long as the first outbreak; pain usually lasts for 3 - 5 days and healing usually occurs in 10 - 14 days.
- Recurrent lesions can occur anywhere on or near the genitals, but the most common sites are the penis in men; near the vaginal opening or on the labia in women; or near the anus or on the buttocks of either men or women. Recurrent outbreaks usually appear at the same location every time.
- Many recurrences are very mild; they may cause only a minor itch, irritation or a small painless sore.
Subclinical shedding:
Genital herpes can reactivate without causing noticeable bumps, blisters, or sores, or other symptoms. Sometimes symptoms are there, but are so mild that they aren't noticed. This is called subclinical shedding. During these times, herpes can be transmitted to an uninfected sex partner even though there are no symptoms. Subclinical shedding is most frequent in the first year after the initial infection, but it continues on and off for several years. Most new cases of genital herpes are caught from a person with subclinical shedding. This is because persons with genital sores often avoid sex, but those with subclinical shedding don't know it. As for recurrent outbreaks, subclinical shedding is more common due to HSV-2 than HSV-1.
How is herpes transmitted?
Herpes is spread by direct skin-to-skin contact. Genital herpes is acquired sexually. Most cases are acquired through vaginal or anal intercourse with a person who has genital HSV-2 infection. Some cases are acquired through oral sex; this probably is the main way persons get genital herpes due to HSV-1.
Oral herpes (cold sores) probably are acquired mostly by kissing or other kinds of by nonsexual personal contact. Oral herpes is due almost entirely to HSV-1, almost never HSV-2.
If you have genital herpes, you are very infectious whenever you are having an outbreak (either initial or recurrent). However, you can also transmit herpes during periods of subclinical shedding of the virus, when you don't have any symptoms.
As described above, many cases are passed during an episode of subclinical shedding. Therefore, it is very important for infected persons to recognize even very mild symptoms and avoid sex when they are present.
Sexual intercourse and oral sex are the only ways genital herpes is transmitted; it is not transmitted by sitting on contaminated toilet seats, by hot tubs or swimming pools, or through other kinds of non-intimate contact.
Treatment for Genital Herpes
There is no cure for genital herpes infection, but certain antiviral medications (valacyclovir, famciclovir, or acyclovir) are very effective in speeding healing and in helping prevent recurrent outbreaks.
Initial genital herpes
The first episode of genital herpes is almost always treated with an antiviral drug, which markedly speeds healing. Treatment for first episode herpes usually is taken for 7-10 days.
Episodic therapy for recurrent genital herpes
Some people with recurrent genital herpes take antiviral medication during each recurrent outbreak to speed healing. Treatment must be started at the very first sign of an outbreak, preferably during the prodrome (if one is present). The medicine is continued for 3-5 days. Although episodic treatment speeds healing, for most persons outbreaks are shortened only by one or two days. If you and your health care provider choose episodic therapy, fill your prescription ahead of time and have it ready before an outbreak so you can begin treatment immediately.
Suppressive therapy for recurrent genital herpes
Some people with recurrent herpes take antiviral medication daily to prevent outbreaks. Suppressive therapy can lower the number of outbreaks and, for many persons, prevent them altogether. Suppressive therapy also reduces (but does not eliminate) subclinical shedding, and recent research shows that one antiviral drug helps reduce sexual transmission of herpes. However, prevention is not complete; even if you are taking suppressive therapy, you must inform your partner that you have herpes and continue to take precautions to protect your uninfected sex partner(s).
Pain Relief
During an outbreak, there are different ways to relieve pain. These are especially helpful in initial genital herpes.
- Take warm baths. After bathing, carefully dry affected areas gently with a soft, clean towel, or use a hair dryer set on low.
- Wear loose cotton clothes to prevent chafing.
- Keep the area dry by sprinkling cornstarch in underwear.
- Hold cool compresses to the sores a few minutes several times.
- Hold ice packs to the sores a few minutes several times.
- Take aspirin, acetaminophen, or ibuprofen to relieve pain and fever.
Herpes and Pregnancy?
Herpes infection of the newborn (neonatal herpes) is extremely serious; many babies die and those who survive may have severe, lifelong disabilities. Neonatal herpes usually results from exposure of the baby to the virus during delivery. A few cases may result from being kissed by someone with oral herpes.
Fortunately, neonatal herpes is rare. The highest risk occurs when the mother first catches genital herpes during the last 3 months of pregnancy. Therefore, the main way to prevent neonatal herpes is for pregnant women without genital herpes to avoid exposure to HSV near the end of pregnancy. A pregnant woman without herpes must not have intercourse with anyone with genital herpes. Similarly, she should not permit oral sex by a partner with oral herpes.
Women with longstanding recurrent genital herpes are at low risk for transmitting the virus to their babies. To be safe however, a cesarean section often is done if a woman with recurrent herpes has an outbreak when she goes into labor. (A cesarean section delivers the baby by surgery, so the infant does not pass through the vagina.)
Any pregnant woman with genital herpes, or whose partner has either genital or oral herpes, should inform the doctor or other clinician providing care for the pregnancy. In some cases, a type-specific herpes blood test of the woman and her partner can help determine the risk and reduce the chance of neonatal herpes.
If you're pregnant and you have herpes:
- Tell your doctor or health care provider about your infection.
- Notify your provider if you think you have herpes symptoms when you go into labor.
- Remind your provider to check for herpes lesions when you go into labor, even if you haven't noticed symptoms.
- If you have active herpes during delivery, you may have a cesarean section.
- If you do not have active symptoms during delivery, you will probably be able to give birth vaginally.
- Ask your provider about whether you should take an antiviral medicine during the last month of pregnancy to prevent an outbreak.
If you're are pregnant and don't have genital herpes but your partner does:
- Avoid contracting herpes; specifically, avoid sex with your infected partner during the last 3 months of pregnancy.
- If your partner has oral herpes, avoid receiving oral sex during the last 3 months of pregnancy.
- Don't risk giving herpes to your baby. A first episode during late pregnancy and delivery may make your baby very sick.
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