Doctor's Notes on Genital Herpes
Genital herpes is an infection of the genital area in men or women caused by the herpes simplex (HSV) viruses. Genital herpes is more commonly caused by the HSV type 2 (HSV-2) than HSV-1, which more often causes cold sores of the mouth.
Genital herpes causes symptoms that occur in outbreaks and recur over time. The virus remains dormant in the body between outbreaks. It is possible to be infected with genital herpes and not show symptoms at a given time. When symptoms (outbreaks) do occur, these include a red, blistering, intensely painful rash on the genitals. Other symptoms can include ulcer formation after the blisters burst and a tingling, itching, or burning sensation in the skin prior to an outbreak.
Genital Herpes Symptoms
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.
The 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:
- muscle aches,
- headaches (may be severe),
- vaginal discharge or painful urination, and
- swollen and tender lymph nodes in the groin (these 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 the 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.
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.
- 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.
It's not necessary to have sexual intercourse to get a sexually-transmitted disease (STD). The human papillomavirus (HPV) that causes genital warts can be transmitted by close skin-to-skin contact. Some types of HPVs cause cervical or anal cancer, and vaccines are available to protect against the most dangerous types. Other HPV types cause genital warts, which can be raised, flat, or cauliflower-shaped. HPV infection can occur in people who have no symptoms or visible warts.
- Genital warts can be big or small, flat or raised. They generally appear as a small bump or group of bumps in the genital region, and may be shaped like a cauliflower.
- A vaccine to prevent HPV is given in three shots. The second shot is given a month or two after the first shot. The third shot comes six months after the first shot.
- The Centers for Disease Control recommends boys and girls be vaccinated at ages 11 or 12.
- If they did not get the HPV vaccine as children, women can get the HPV vaccine through age 26. Men can get it through age 21. The CDC recommends HPV vaccination for men through age 26 for men who have sex with men or men with compromised immune systems, including HIV.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.