Genital herpes is a highly contagious infection usually spread through intercourse with a person with infected sores, but it can be passed through oral or anal sex as well. It may also be spread even when sores are not visible.
Genital herpes can also be transmitted (spread) to a newborn during birth if the mother has an active infection.
What Causes Genital Herpes?
Genital herpes is a disease caused by the herpes simplex virus (HSV), of which there are two types. Type 1 (HSV-1) usually causes oral herpes, an infection of the lips and mouth. Symptoms are commonly known as cold sores or fever blisters. In the past, HSV-1 was not known to cause genital herpes, but that is changing, especially among people who begin having sex at a young age. Still, in most cases, genital herpes is caused by the second type of herpes virus (HSV-2).
HSV-2 lives in the nerves. When it's active, it travels to the surface of the infected area (skin or mucous membrane) and makes copies of itself. This is called "shedding" because these new viruses can, at this time, rub off on another person. Then the virus travels back down the nerve to a ganglion (mass of nerve tissue), usually at the base of the spine, where it lies dormant for a while.
How to Get Genital Herpes?
HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to have a sore. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called "fever blisters." HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.
Signs and Symptoms of Genital Herpes
Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection never have sores, or they have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
People diagnosed with a first episode of genital herpes can expect to have several (typically four or five) outbreaks (symptomatic recurrences) within a year. Over time these recurrences usually decrease in frequency. It is possible that a person becomes aware of the "first episode" years after the infection is acquired.
How Can Genital Herpes Be Prevented?
Using a latex barrier (a condom or dental dam) during sex may protect you or your partner, but only if it covers the area where the virus is shedding. You should avoid having sex if you or your partner has visible sores on the genitals, and you shouldn't receive oral sex from someone who has a sore on his or her mouth.
It's important to know that HSV can be contagious even when no symptoms are visible.
Usually, this infection is caused by the herpes simplex virus-2 (HSV-2) although herpes simplex virus-1 (HSV-1), the virus responsible for cold sores, may occasionally cause this disease. It can be spread by an infected partner who does not have any sores and may not even know they have the disease.
How Common Is Genital Herpes?
At least 45 million American adults and adolescents have genital herpes -- that's 1 out of every 4 to 5 people, making it one of the most common sexually transmitted diseases. Since the late 1970s, the number of Americans with genital herpes infection has increased 30%, mostly in teens and young adults.
Genital herpes is more common in women than in men.
How Do I Know If I Have Genital Herpes?
Most people infected with genital herpes have very minimal or no signs or symptoms of their disease. The first attack of herpes usually follows this course:
- Skin on or near the sex organ becomes inflamed. Skin may burn, itch or be painful.
- Blister-like sores appear on or near the sex organs.
- Sores open, scab over, and then heal.
Symptoms that may also be present when the virus first appears include:
- Swollen glands
- Burning when passing urine
- Muscle aches
The first outbreak of herpes can last for several weeks. After the outbreak, the virus retreats to the nervous system, where it remains inactive until something triggers it to become active again.
Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first episode. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
How Often Do Outbreaks Happen?
How often outbreaks occur depends on the person. On average, people with herpes experience about four outbreaks a year. The first outbreak usually is the most painful and takes the longest to heal. The pain and recovery time often decrease with each outbreak.
What Triggers an Outbreak?
It depends on the person. Some commonly reported triggers include:
- Vigorous sex
- Monthly period
How Are Genital Herpes Diagnosed?
Your doctor can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s). But, HSV infections can be difficult to diagnose between outbreaks. Your doctor may check for ulcers internally -- on the cervix in women and the urethra in men. Blood tests that detect HSV-1 or HSV-2 infection may be helpful, although the results are not always easy to interpret.
How Is Genital Herpes Treated?
There is no cure for genital herpes, but your doctor can prescribe anti-virus medicines, in pill or ointment form, that may help the sores heal faster.
Over-the-counter painkillers may help with the discomfort.
If recurrences of your genital herpes are frequent, your doctor may prescribe an antiviral medication (Famvir, Valtrex and Zovirax) to take on a regular basis to help suppress the outbreaks.
Does genital herpes cause problems during pregnancy?
Yes. If the mother is having her first outbreak while she is pregnant, she is more likely to pass the virus to her baby. If the outbreak is not the first one, the baby's risk of getting the virus is very low. Babies born with herpes may be premature or may die, or they may have brain damage, severe rashes, or eye problems. Doctors may do a C-section to deliver a baby if the mother has herpes lesions near the birth canal to help prevent passing the virus. Also, acyclovir can help babies born with herpes if they are treated right away.
It is not yet known if all genital herpes drugs are safe for pregnant women to take. Some doctors may recommend acyclovir be taken either as a pill or through an IV (a needle into a vein) during pregnancy. Let your doctor know if you have genital herpes, even if you are not having an outbreak. He or she will help you manage it safely during pregnancy.
Can Herpes Be Cured?
There is no cure for herpes. Once a person has the virus, it remains in the body. The virus lies inactive in the nerve cells until something triggers it to become active again. These herpes "outbreaks," which can include the painful herpes sores, can be controlled with medication.
What Can I Do If I Have Herpes?
Many people who find out that they have herpes feel depressed knowing that they will always have the virus and can give it to others. But you are not alone. If you have herpes, you should learn all that you can about herpes. Information will help you to manage your disease and feel better about yourself. It also helps to talk about your illness with a trusted friend.
If you have herpes, you can still have sex, if you use a condom (and/or have your partner use a condom), and you tell your partner about your illness. You also can still have children.