Herpes simplex infection on the genitals, most commonly herpes simplex-2 virus.
Alternative Names: Herpes - genital; Herpes simplex - genital; Herpesvirus 2; HSV-2.
Genital herpes is caused by a virus called herpes simplex (HSV). There are two different types of herpes virus that cause genital herpes — HSV-1 and HSV-2. Most forms of genital herpes are HSV-2. But a person with HSV-1 (the type of virus that causes cold sores or fever blisters around the mouth) can transmit the virus through oral sex to another person's genitals.
Genital herpes is a sexually transmitted disease (STD). It causes herpes sores in the genital area and is transmitted through vaginal, oral, or anal sex, especially from unprotected sex when infected skin touches the vaginal, oral, or anal area. Occasionally, it can cause sores in the mouth, and can be spread by secretions in saliva. Because the virus does not live outside the body for long, you cannot catch genital herpes from an object, such as a toilet seat.
Once you are infected, the virus stays in your body for the rest of your life. Some people never have another episode, and others have frequent recurrences. In most recurrences, no obvious trigger is identified. Many people, however, find that attacks of genital herpes occur with the following conditions:
- General illness (from mild illnesses to serious conditions, such as operations, heart attacks, and pneumonia).
- Immunosuppression due to AIDS or medication such as chemotherapy or steroids.
- Physical or emotional stress.
- Trauma to the affected area, including sexual activity.
HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be because male to female transmission is more efficient than female to male transmission. HSV-2 infection is also more common in blacks (45.9%) than in whites (17.6%). Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health such as poverty, access to quality health care, health-care seeking behavior, illicit drug use, and living in communities with high prevalence of STDs.
Genital herpes affects at least forty-five million people in the United States who are infected with the herpes simplex virus (HSV). According to the CDC, one out of five teenagers and adults is infected with genital herpes. Genital herpes is more common in women than in men affecting one woman out of every four. It's estimated that over 500,000 new cases of HSV occur every year. The good news is that the number of new cases of genital herpes is declining.
Since the late 1970s, the number of Americans with genital herpes infection (i.e., prevalence) has increased 30%. Prevalence is increasing most dramatically among young white teens; HSV-2 prevalence among 12- to 19-year-old whites is now five times higher than it was 20 years ago. And young adults ages 20 to 29 are now twice as likely to have HSV-2.
A pregnant woman can pass genital herpes on to her baby, so it's particularly serious during pregnancy. If you get infected near the end of pregnancy, the risk is highest. At least 30% and as many as 50% of newly infected pregnant women give the virus to their babies. For moms who were infected long before delivery, the risk is much lower. Less than 1% of babies born to mothers with an older genital herpes infection get the virus. Also, doctors usually will perform a cesarean section if a woman is having an outbreak at the time of delivery.
Someone who has been exposed to the genital herpes virus may not be aware of the infection and may never have an outbreak of sores. However, if a person does have an outbreak, the symptoms can cause significant discomfort.
For people with no prior contact with HSV-1 or HSV-2, initial infection involves both whole body (systemic) and local symptoms.
Generalized symptoms include:
Local symptoms include repeated eruptions of small, painful blisters filled with clear, straw-colored fluid on the genitals, around the rectum, or covering nearby areas of skin. Before these blisters appear, the person may experience increased skin sensitivity, tingling, burning, itching, or pain at the site where the blisters will appear.
When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 - 14 days.
Enlarged and tender lymph nodes in the groin may accompany an outbreak. Women also may develop vaginal discharge and painful urination. Men can develop painful urination if the lesion is near the opening of the urethra.
Once a person is infected, the virus hides within nerve cells, making it difficult for the immune system to find and destroy it. Within the nerve cells, the virus can remain dormant for a long period of time, which is called "latency."
The infection can reactivate at any time, at which point painful blisters again cover the genitals, anus, inner thigh, or mouth. A variety of events can trigger latent infection to become active, including:
- Decreased appetite.
- Muscle ache.
Attacks can recur as seldom as once per year, or so often that the symptoms seem continuous. Recurrent infections in men are generally milder and shorter in duration than those in women.
Causes and Risk factors:
Genital herpes can be caused by either the herpes simplex virus type 1 (HSV-1) or the herpes simplex virus type 2 (HSV-2). HSV-1 or HSV-2 can cause sores on the lips (cold sores) and sores on the genitals. HSV-1 more often causes cold sores. HSV-2 more often causes genital sores. HSV-1 causes up to 50% of primary genital herpes infections. Genital herpes caused by HSV-1 has a lower rate of recurrence than that caused by HSV-2.
The same virus that causes genital herpes also can cause cold sores (herpes labialis), so HSV can be spread from a genital sore to the lips or from a cold sore to the genital area. HSV can be spread to or from the genitals, anus, or mouth during sexual activities or through any direct contact with herpes sores. You become infected when the virus enters your body through a break in the skin or through moist areas (mucous membranes) such as the mouth, anus, and vagina. Even very small breaks in the skin allow the virus to infect the body.
Newborns can be infected with HSV at birth. This usually happens when a woman has her primary outbreak (the first time she is infected with HSV) close to the time of delivery and the baby is delivered through the vagina. Usually in these cases the woman either does not have symptoms or is unaware of symptoms. The chance of passing the virus to the baby is greatly reduced (less than 1% of the time) during recurrent outbreaks, which occur after a woman has been infected previously. 1 Babies infected with the virus at birth are at risk for serious health problems.
Various complications are associated with herpes infection. The herpes virus is of special significance to women because research has found that it can cause cancer of the cervix. The risk increases when HSV is present in combination with human papilloma virus (HPV), the virus responsible for genital warts (condyloma).
For pregnant women, HSV-1 or HSV-2 on the outside of the genitals or in the birth canal is a threat to the infant. Infection of the newborn can lead to herpetic meningitis, herpetic viremia, chronic skin infection, and even death.
Herpes infection also poses a serious problem for people who have a weakened immune system because they have AIDS, are undergoing chemotherapy or radiation therapy, or take high doses of cortisone. These people may develop infections of various organs, including:
- Mechanical irritation.
Accurate testing is important for genital herpes. Being told you're infected when you're not, or the other way around, can be awful. Some people have lived decades under the false impression that they were infected because a doctor didn't test them for the virus. Instead, they were diagnosed by their symptoms alone. It's easy to mistake genital herpes symptoms for something else.
If you have sores on your genitals, a doctor can take a sample from a sore and look for the herpes simplex virus (HSV) in it. One test is called a cell culture. Any viruses in the sample are allowed to multiply so that they're easy to find under a microscope.
The direct fluorescent antibody test is another kind. A solution containing HSV antibodies and a fluorescent dye is added to the sample. Antibodies are proteins produced by the immune system in response to an infection. If the virus is present in the sample, the antibodies stick to it and glow when viewed under a special microscope.
These tests are good because they can tell the difference between the two types of HSV. It's important to know which type you have. If you're infected with type 2 (HSV-2), you may have outbreaks more often than would if you had type 1 (HSV-1). What's more, knowing which type you have gives a clue as to how you were infected. HSV-1 usually infects the genitals through oral sex, and HSV-2 usually is passed on during vaginal or anal sex. For help with these terms, see the Glossary.
These tests may give a false-negative result if the sores have begun healing, or if it's not the first time you've had symptoms. A positive result from one of these tests is very accurate, however.
Blood Tests for Genital Herpes: A blood test can detect HSV antibodies even when you have no symptoms. A false-negative result from a blood test is possible if you have been infected recently. It takes several weeks for HSV antibodies to show up in the blood.
False-positive test results are possible, too. If you test positive, but your risk for getting the virus is low, you may need to be tested again.
Tzanck and PCR Tests: Other ways to detect the herpes virus include the Tzanck test and the PCR test. A Tzanck test places a sample from a sore on a microscope slide and stains it with a dye. Cells that are infected with HSV look different from those that aren't. This test is not very accurate, so health experts don't recommend it.
The PCR (polymerase chain reaction) test looks for pieces of the virus' DNA. It's an accurate test, but doctors have not decided how it should be used to diagnose genital herpes, so it's not the preferred method.
- Encephalitis (rare).
- Herpetic esophagitis (herpes infection of the esophagus).
- Herpetic keratitis (herpes infection of the eye).
- Herpetic hepatitis (herpes infection of the liver).
- Persistent infection of the mucous membranes and skin of the nose, mouth, and throat.
- Pneumonitis (herpes infection of the lung).
- Recurrent disease.
- Spread of the virus to other organs of the body.
- Transverse myelopathy (damage that extends across the spinal cord).
Genital herpes cannot be cured. However, antiviral treatment can relieve the symptoms. Medication can quickly relieve the pain and discomfort during an outbreak, and can shorten healing time. Medications have been shown to speed healing and relieve symptoms in first attacks more than in recurrent episodes of genital HSV-1 and HSV-2 infections.
No drug can cure herpes simplex virus. The infection may recur after treatment has been stopped, and, even during therapy, a patient can still transmit the virus to another person. Drugs can, however, reduce symptoms and improve healing times.
If necessary, patients can use daily suppressive therapy, which may reduce the frequency of recurrence in patients with frequent genital herpes outbreaks.
For maximum benefit during recurrences, start therapy as soon as the tingling, burning, or itching begins, or as soon as you notice blisters.
Possible side effects from herpes medications include:
- Nausea and vomiting.
Some people need medication through a vein (intravenous) for severe herpes infections that can involve the brain, eyes, and lungs. These complications sometimes develop in people with a compromised immune system.
Warm baths may relieve the pain of genital lesions. Gentle cleansing with soap and water is recommended. If you develop a secondary infection of the skin lesions by bacteria, you can use a topical or oral antibiotic.
To reduce discomfort from herpes sores:
Medicine and medications:
- Take warm sitz baths or wash the area with warm water 3 or 4 times a day.
- In between sitz baths, keep the sores clean and dry.
- Using a hair dryer to dry off the sores may be more comfortable than using a towel.
- Wear cotton underpants, which absorb moisture better than those made from synthetic material.
Three drugs are approved to treat genital herpes:
- Acyclovir (Zovirax or generic).
- Valacyclovir (Valtrex).
- Famciclovir (Famvir).
Side Effects: Nausea and headache are the most common side effects, but in general these drugs are safe. Although there is some evidence these drugs may reduce shedding, they probably do not prevent it entirely. The use of condoms during asymptomatic periods is still essential, even when patients are taking these medications.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.