Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
How Common is Genital Herpes?
Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. Between the late 1970s and the early 1990s, the number of Americans with genital herpes infection increased 30 percent.
Genital 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 due to male-to-female transmissions being more likely than female-to-male transmission.
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 be broken or 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.
Symptoms
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 may never have sores, or they may have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
Most 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.
Complications
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can cause potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
Diagnosis
The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks. Blood tests, which detect HSV-1 or HSV-2 infection, may be helpful, although the results are not always clear-cut.
Treatment
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
Prevention
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.
Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.
References
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR 2002;51(no. RR-6)
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2002. Atlanta, GA: U.S. Department of Health and Human Service, October 2003.
Corey L, Wald A. Genital herpes. In: Holmes KK, Sparling PF, Mardh P et al (eds). Sexually Transmitted Disease, 3rd Edition. New York: McGraw-Hill, 1999, p. 285-312.
Corey L, Wald A, Patel R et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. New England Journal of Medicine 2004; 350:11-20.
Fleming DT, McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, St. Louis ME. Herpes Simplex Virus Type 2 in the United States, 1976 to 1994. NEJM 1997; 16:1105-1111.
Wald A, Langenberg AGM, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 2001;285: 3100-3106.
Wald A, Link K. Risk of human immunodeficiency virus infection in herpes simplex virus infection in herpes simplex virus type 2 – seropositive persons: A meta-analysis. J Infect Dis 2002; 185: 45-52.
Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health 2004; 36:6-10.
Steve, 43, works as a database administrator in Kentucky. He learned he had genital herpes three years ago. He has formed a social group, where people with herpes can meet each other.
What was your first sign that something was wrong? What symptoms did you experience?
I developed a sore on my penis. I had been out fishing about a week before and thought it was poison ivy. But three weeks later, I had another one. I went to the doctor, and he did a culture. It came back herpes. For the first six months, I had outbreaks every three to four weeks. Now I have an outbreak about once a year. Whenever I get sick with a cold, bingo, here it comes.
What was the diagnosis experience like?
I saw my primary care doctor, and he did not refer me to anyone. When I moved to another city, the first family practitioner I saw suggested I transfer to another doctor in the practice who specializes in family health for people with herpes. She provides one-stop medical care for all my health needs.
What was your initial and then longer-term reaction to the diagnosis?
It wasn’t the end of the world for me, although I know people who were devastated by the news. I asked myself, is my life over or what? How am I going to tell somebody? The first thing I did was get on the Internet and look it up. The longer you have herpes, the less of a problem it becomes. You have fewer outbreaks, and they are easier to deal with.
How do you manage your disease?
One of the things the doctor taught me was to take an aspirin a day, because studies show a daily aspirin lowers the odds of having an outbreak. During an outbreak, I don’t use any cream or drugs. I don’t like to put anything in my body that I don’t have to. The sores last about a week or two. It doesn’t hurt that badly. I wear my regular BVD briefs. I feel I’m very lucky that it’s usually mild. I abstain or wear a condom during an outbreak and for a week after the sore is gone. I will not initiate any sexual relations during those times, but some girls will start something even after being told I am having an outbreak.
Did you have to make any lifestyle or dietary changes in response to your illness?
I try to stay healthy. I play golf, ride a bike, and walk every day with my dog. I watch my diet. I eat foods high in lysine, like mushrooms, cheese, and vegetables. If you eat foods higher in the enzyme lysine than arginine, you are less likely to have an outbreak. Also your diet has a lot to do with how well you feel overall. I eat a balanced diet that includes all of the food groups. If I’m going to have a snack, I make it an apple, pear, or peach, not something with a lot of sugar. I tell women I am dating that I have herpes. A lot of people with herpes don’t tell anyone, but to me, honesty is the only way.
Did you seek any type of emotional support?
I instantly joined a support group. The counselor in the group helped us to talk through our feelings and to realize that it’s not the end of the world. I’ve found people to talk with over the Internet. It’s helpful to talk about herpes. I can unburden my story on somebody. And when you know someone else has what you do and it’s not the end of life, it gives you hope.
Our social group holds dinners, parties, and other activities. It’s a nice way to get out and meet people. We’re all trying to make new friends. It’s not a support group. But by having other people around, there’s support. By interacting with people you know have herpes, it puts you at ease. And you don’t feel like you’re hiding something. I don’t have to worry about how I am going to tell a new woman. Herpes is something we already have in common.
Did/does your condition have any impact on your family?
No. I’m single. If I’m not going to sleep with someone, why do they need to know?
What advice would you give to anyone living with this disease?
Learn to forgive and forget. If you can get yourself to forgive the person who gave you herpes, it’s better for moving on with your life.
