Genital Herpes

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2).

Genital herpes infection is common in the United States. Nationwide, 16.2 percent, or about one out of six, people aged 14 to 49 years have genital HSV-2 infection. Over the past decade, the percentage of persons with genital herpes infection in the United States has remained stable.

There are two types of HSV and both can cause the symptoms of genital herpes. HSV type 1 most commonly causes sores on the lips (known as fever blisters or cold sores), but it can cause genital infections as well. HSV type 2 most often causes genital sores, but it also can infect the mouth. The virus remains in certain nerve cells of the body for life, causing periodic symptoms in some people. Many people who are infected with HSV never develop any symptoms.

The infection is usually acquired by sexual contact with someone who has genital herpes. People with oral herpes can transmit the infection to the genital area of a partner during oral-genital sex. Herpes infections also can be transmitted by a person who is infected with HSV but has no noticeable symptoms. Such asymptomatic shedding of the virus may be fairly common, occurring from 5 percent to 20 percent of the time in infected individuals. HSV-1 can cause sores in the genital area and infections of the mouth and lips, so-called “fever blisters.” HSV-1 infection of the genitals is caused by mouth to genital or genital to genital contact with a person who has HSV-1 infection.

Transmission from an infected male to his female partner is more likely than from an infected female to her male partner. Because of this, genital HSV-2 infection is more common in women (approximately one out of five women aged 14 to 49 years) than in men (about one out of nine men aged 14 to 49 years).

Most individuals infected with HSV-1 or HSV-2 experience either no symptoms or have very mild symptoms that go unnoticed or are mistaken for another skin condition. Because of this, most people infected with HSV-2 are not aware of their infection. When symptoms do occur, they typically appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take two weeks to four weeks to heal. Experiencing these symptoms is sometimes referred to as having an “outbreak.” The first time someone has an outbreak they may experience flu-like symptoms such as fever, body aches and swollen glands.

Repeat outbreaks of genital herpes are common, especially during the first year of infection.

After invading the skin or mucous membranes, the virus that causes genital herpes travels to the sensory nerves at the end of the spinal cord. Even after the skin lesions have disappeared, the virus remains inside the nerve cells in a latent state. In most people, the virus reactivates from time to time. When this happens, the virus travels along the nerves to the skin, where it multiplies on the surface at or near the site of the original herpes sores, causing new lesions to erupt. It also can reactivate without any visible sores. At these times, small amounts of the virus may be shed at, or near, sites of the original infection, in genital or oral secretions, or from inapparent lesions. This shedding is infrequent, but it is sufficient to infect a sex partner.

The symptoms of recurrent episodes are usually milder than those of the first episode and typically last about a week. A recurrent outbreak may be signaled by a tingling sensation or itching in the genital area or pain in the buttocks or down the leg. These are called prodromal symptoms and, for some people, they can be the most painful and annoying part of a recurrent episode.

Sometimes no visible sores develop. At other times, blisters appear that may be very small and barely noticeable or may break into open sores that crust over and then disappear. The frequency and severity of the recurrent episodes vary greatly. While some people recognize only one or two recurrences in a lifetime, others may experience several outbreaks a year. The number and pattern of recurrences often change over time for an individual. Scientists do not know what causes the virus to reactivate. Although some people with herpes report that their recurrences are brought on by other illness, stress exposure to sunlight or menstruation, recurrences often are not predictable.

Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical. Providers can take a sample from the sore(s) and test it. Sometimes, HSV infections can be diagnosed between outbreaks with a blood test. A person should discuss such testing options with their health care provider.

During an active herpes episode, whether primary or recurrent, it is important to follow a few simple steps to speed healing and to avoid spreading the infection to other sites of the body or to other people:

• Keep the infected area clean and dry to prevent secondary infection from developing.
• Try to avoid touching the sores; wash hands after contact with the sores. 
• Avoid sexual contact from the time symptoms are first recognized until the sores are completely healed, that is, until scabs have fallen off and new skin has formed over the site of the lesion.

There is no treatment that can cure herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy (i.e., daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.

Oral acyclovir markedly shortens the course of a first episode and limits the severity of recurrences if taken within 24 hours of onset of symptoms. People who have very frequent episodes of the disease can take oral acyclovir daily for up to one year to suppress the virus’ activity and prevent most recurrences. Acyclovir does not cure herpes, but it interferes with the virus’ ability to reproduce itself. Other new drugs – famciclovir and valacyclovir – now work in a similar manner.

Genital herpes can cause painful genital sores in many adults and can be severe in people with suppressed immune systems. If a person with genital herpes touches their sores or the fluids from the sores, they may transfer herpes to another part of the body. This is particularly problematic if it is a sensitive location such as the eyes. This can be avoided by not touching the sores or fluids. If they are touched, immediate and thorough hand-washing make the transfer less likely.

Some people who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. It is best to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it is a manageable condition. Since a genital herpes diagnosis may affect perceptions about existing or future sexual relationships, it is important to understand how to talk to sexual partners about STDs. There are also potential complications for a pregnant woman and her unborn child.

It is crucial that pregnant women infected with HSV-1 or HSV-2 go to prenatal care visits and tell their doctor if they have ever experienced any symptoms of, been exposed to, or been diagnosed with genital herpes. Sometimes genital herpes infection can lead to miscarriage or premature birth. Herpes infection can be passed from mother to child resulting in a potentially fatal infection (neonatal herpes). It is important that women avoid contracting herpes during pregnancy.

A woman with genital herpes may be offered antiviral medication from 36 weeks gestation through delivery to reduce the risk of an outbreak. At the time of delivery a woman with genital herpes should undergo careful examination. If herpes symptoms are present at delivery, a cesarean delivery (also called a ‘C-section’) is usually performed.

Genital herpes can cause sores or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum). The genital sores caused by herpes can bleed easily. When the sores come into contact with the mouth, vagina or rectum during sex, they increase the risk of HIV transmission if either partner is HIV-infected.

Correct and consistent use of latex condoms can reduce the risk of genital herpes, because herpes symptoms can occur in both male and female genital areas that are covered or protected by a latex condom. However, outbreaks can occur in areas that are not covered by a condom.

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.

Persons with herpes should abstain from sexual activity with partners when sores 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 and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.

Counseling and help for those who have genital herpes is often available from local health departments. The American Social Health Association (ASHA) maintains a HerpesResourceCenter. For information on its programs, send a self-addressed stamped envelope to the center at: 

P.O. Box 13827
Research Triangle Park, NC27709

ASHA also has a herpes hotline, 919-361- 8488, that operates Monday through Friday, 8 a.m. to 6 p.m.

IDPH HIV/STD Hotline 800-243-2437 (TTY 800-782-0423)

• US Centers for Disease Control and Prevention
• American Sexual Health Association