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Understanding Genital Herpes

April 8, 2009


Overview

Genital herpes is a sexually transmitted infection (STI). According to the Centers for Disease Control and Prevention, in the United States, one of every five teenagers and adults is infected with genital herpes. Women are more commonly infected than men and it is estimated that one of every four women has herpes.

Although at least 45 million aged 12 and older in the United States have genital herpes infection, there has been a substantial decrease in cases from 21 percent to 17 percent, according to a 1999 to 2004 CDC survey. Much of the decrease was in the 14 to 19 year age group, and continued through the young adult group.

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NIAID Research on Genital Herpes

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.

More about NIAID Research on Genital Herpes


Cause

Genital herpes is caused by herpes simplex virus (HSV). There are two types of HSV.

  • HSV type 1 most commonly infects the mouth and lips, causing sores known as fever blisters or cold sores.
  • HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.


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 an asymptomatic (without symptoms) period. People who do not know they have herpes play an important role in transmission because they are unaware they can infect a sexual partner.

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 that area.
  • Do not have sexual contact (vaginal, oral, or anal) from the time of your first genital symptoms until your symptoms are completely gone.


Symptoms

Symptoms of herpes are called 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 (lesions) near the area where the virus has entered your body, such as on your genital or rectal area, on your buttocks or thighs. Occasionally, these sores may appear on other parts of your body where the virus has entered through broken skin. Sores also can appear inside the vagina and on the cervix (opening to the womb) 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 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 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.

Coping With Herpes

A diagnosis of genital herpes can have substantial emotional effects on you and your sexual partner, whether or not you have symptoms. Proper counseling and treatment can help you and your partner learn to cope with the disease, recurrent episodes, personal relationships, and fertility issues.


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

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

For updated information on treatment for genital herpes, read the CDC STD Treatment Guidelines.


Prevention

Because herpes can be transmitted from someone who has no symptoms, using the precautions listed below 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.

Do not have oral-genital contact if you or your sexual partner has any symptoms or findings of oral herpes.

Using barriers such as latex condoms during sexual activity may decrease transmission when you use them consistently and correctly, but transmission can still occur since condoms may not cover all infected areas.

You can get tested to find out if you are infected with the herpes virus.


Complications

Genital herpes infections usually do not cause serious health problems in healthy adults. In some people whose immune systems do not work properly, however, 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. A person infected with herpes may have a greater risk of getting HIV. 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.



  
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