Genital Herpes

Facts on Genital Herpes

  • Genital herpes is a common sexually-transmitted disease caused by a virus that infects genital areas.
  • Herpes simplex virus (HSV) is the cause of genital herpes.
  • Genital herpes causes lesions in the form of blisters or groups of small ulcers (open sores) on and around the genitals in both men and women.
  • There is no cure for genital herpes, but medications are available that can treat outbreaks, minimize the symptoms, and decrease recurrences.
  • Genital herpes is highly contagious. Carriers can transmit the disease without having any symptoms of an active infection.
  • Signs of genital herpes develop within 3 to 7 days after contact with an infected person.
  • Most people with genital herpes have recurring outbreaks.

What Causes Genital Herpes?

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.
  • Although anyone can spread the disease, transmission from an infected male to a female partner is more common than spread from an infected female to a male partner.

Note: People with herpes may spread the disease even if they do not realize they have an infection. Furthermore, people with herpes can transmit the infection to others even while their disease appears to be inactive and no sores can be visibly seen.

  • Many people remember having an episode of genital herpes when it occurs. Many 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. In these individuals genital herpes is still contagious, and they may have additional outbreaks, nonetheless.

Genital Herpes in Women

Genital herpes facts:

  • There is no "safe" sex.
  • Condoms do not necessarily prevent sexually transmitted diseases.
  • Genital herpes is a viral infection that can cause painful genital sores and causes recurrent outbreaks.
  • Many people are infected with herpes virus and are not aware of the infection.
  • The herpes virus is spread by direct person-to-person contact.
  • An infected person may transmit the virus to others even if no symptoms are present.
  • There is no cure for genital herpes, but viral shedding and outbreaks can be reduced with antiviral medications.

Is Genital Herpes Contagious?

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.

What Are the Symptoms of Genital Herpes?

Early symptoms and signs of genital herpes tend to develop within 3 to 7 days of skin-to-skin contact with an infected person. This 3 to 7 day period is known as the incubation period. Genital herpes infections look like a rash composed of small blisters or ulcers (round areas of broken skin) on the genitals. Each blister or ulcer is typically only 1 to 3 millimeters (1/32 inch to 1/8th inch) 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, genital 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 and may not 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 genital herpes outbreak is usually the most painful, and the initial episode may last longer than later outbreaks. Symptoms may last for 2 to 4 weeks.

Some people develop other signs of genital herpes infection, particularly with the first episode, including:

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 early signs that an outbreak is about to begin. The condition is particularly contagious during this period, even though the skin still appears normal.

When to Seek Medical Care for Genital Herpes

With an initial outbreak, if an individual has signs or symptoms of a genital herpes infection, he or she should seek the care of a doctor as soon as possible, particularly if the diagnosis of genital herpes has not been previously established. Although genital herpes infections generally are not medical emergencies, treatment is more effective when it is started within the first few days of the outbreak.

Subsequent outbreaks rarely need immediate medical attention.

  • If an individual has had a genital herpes outbreak before, discuss options for preventing further outbreaks with a doctor.
  • People with severe underlying medical problems (particularly HIV or AIDS) are at higher risk of severe illness if the disease is untreated. These individuals should contact a doctor 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 an individual is experiencing an initial episode of genital herpes and cannot be seen by a regular doctor within the first few days of the illness, it is advisable go to a hospital's emergency department to have medical treatment started.

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

How Is Genital Herpes Diagnosed?

Many doctors will begin 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. A number of types of tests may be ordered to establish the diagnosis, including:

  • a culture of the virus;
  • polymerase chain reaction to demonstrate the genetic material of the virus; and
  • tests using antibodies to the genital herpes virus to demonstrate the presence of the virus in clinical specimens.

These types of tests generally require at least a few days for results to be obtained. In some cases, blood tests to confirm the presence of an immune response to the herpes virus may be ordered.

Are there Home Remedies for Genital Herpes?

Individuals infected with the genital herpes virus should:

  • avoid excessive heat or sunlight, which makes the irritation more uncomfortable;
  • not use perfumed or antibacterial soaps, feminine deodorant, or douches;
  • wear comfortable, loose fitting cotton clothing;
  • take aspirin, acetaminophen (Tylenol and others), or ibuprofen (Advil, Motrin, and Nuprin) if helpful; and
  • use cool cloths on the affected area if it soothes the pain.

What Are the Medications for Genital Herpes?

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.

  • There are similar antiviral drugs available for the treatment of genital herpes infection, These antiviral medications vary in cost and how often they should be taken. All should be taken for 7 to 10 days. The patient's doctor may extend the course of therapy if ulcers have not healed in 10 days. Examples of these antiviral medications include:
  • For preventing later genital herpes outbreaks, people with recurring infections also may benefit from the antiviral medications. Treatment is started when the recurrence first begins and continues for five days.
  • For continuous prevention, individuals who have frequent outbreaks (generally over six recurrences per year) can control the outbreaks 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 in those who have frequent recurrences, and many individuals taking this treatment report no symptomatic outbreaks.

What Is the Follow-up for Genital Herpes?

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 genital herpes infection.

How Do You Prevent Genital Herpes?

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. There is no vaccine available to prevent genital herpes infection.

What Is the Prognosis for Genital Herpes?

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

Reviewed on 5/17/2018

Medically reviewed by Joseph Palermo, MD; Board Certificate Internal Medicine/Geriatric Medicine

REFERENCES:

"Genital Herpes Fact Sheet." Centers for Disease Control and Prevention. 14 Oct. 2015.

Salvaggio, M. R., et al. "Herpes Simplex." Medscape. 18 Sept. 2015.

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