What Is Genital Herpes?

Genital herpes is a contagious viral infection that is most often acquired through sexual contact. The viruses that cause genital herpes are related to the group of viruses that include chicken pox and mononucleosis. Herpes Simplex Virus 1 (HSV1) most commonly causes sores around the mouth while Herpes Simplex Virus 2 (HSV2) is associated with sores on the genitals. However, either virus can cause sores around the mouth or on the genitals.

It is estimated that 45 million Americans have the HSV virus; this is one of every four Americans. As many as 75% of the people infected with genital herpes may not exhibit symptoms, however they can still pass the infection to their sexual partners.

Herpes is passed through skin-to-skin contact with someone who is infected. This generally occurs during sexual activity. HSV can be introduced to the genital area through oral sex. About 20% of the new outbreaks of genital herpes are the result of oral sex.

The virus does not survive long outside the human body. Therefore, the virus is spread rarely, if ever, through contact with bath towels, toilet seats or hot tubs.

The severity and length of herpes outbreaks varies from person to person. The outbreaks usually become less frequent over time.

What Are the Symptoms of Genital Herpes?

The classic symptom of a genital herpes outbreak is a cluster of painful ulcers on the labia and/or buttocks. However, as many as 2/3 of all men and women infected with herpes never have any symptoms, or have mild symptoms which they mistake for a rash or mosquito bite. The remaining 1/3 are not so lucky.

About 2 to 10 days after the herpes virus enters the body, flu-like symptoms may appear. These include swollen glands, fever, chills, muscle aches, fatigue and nausea. Additionally, ulcers that began as small red bumps change to painful fluid-filled blisters. These blisters rupture then ooze and bleed. After 3-4 days scabs form and the ulcers heal without scarring. The first episode usually lasts from 2 to 3 weeks.

After the initial outbreak heals, the virus remains in the body, hiding in the nerves at the base of the spinal cord in an inactive state. Periodically it can travel through the nerves to the skin at or near the site of the original outbreak. Once on the skin, the virus multiples and new sores erupt. The virus can also reactivate with no outward signs, infecting a sexual partner.

The recurrent episodes are generally milder than the initial outbreak and usually last about a week. Often there is a warning symptom, called a prodrome, that signals an outbreak. These warning symptoms may include a tingling sensation or itching at the site of infection, pain in the buttocks or down a leg. Sometimes only the prodrome appears with no visible sores or with very small, barely visible blisters. At other times open sores may develop, crust over and then go away.

Some people may recognize only one to two outbreaks in their lifetime; others may have several outbreaks a year. The number and pattern of outbreaks usually change over time. Researchers do not yet understand why some people have many outbreaks, or why others have so few. They do not yet know what makes the virus reactivate. It is thought the reoccurrences can be brought on by physical or emotional stress, menstruation or immunosuppression.

How Is Genital Herpes Diagnosed?

The most common methods used to diagnose genital herpes are a viral culture and a test for viral DNA. For either test, a swab of fluid is taken from an active lesion. The tests must be performed before the ulcers scab over.

A negative test result does not necessarily mean that herpes is not present. If the lesion clinically appears to be genital herpes, caution should be taken as though the test was positive. If another outbreak occurs, the ulcers should be tested at the earliest sign.

There are blood tests available to test for the presence of HSV-1 and HSV-2 antibodies. Because the body makes antibodies in response to infection, the blood test may not be positive until several weeks after exposure. The blood test is also not site specific, therefore, especially in the case of HSV-1, the test may be picking up cold sores.

How Is Genital Herpes Treated?

Although there is no cure for herpes, there are several prescription medications that can reduce the severity of the symptoms and decrease the length of the outbreak. These medications interfere with the ability of the virus to reproduce. The medications work best if taken at the first sign of an outbreak, during the prodrome.

People with recurrent infections (6 or more per year), or who will be delivering a baby soon, may want to take medication daily to help prevent outbreaks.

Any time there is an active herpes outbreak it is important to follow a few simple rules to help speed healing and prevent transferring the infection to other sites on the body (self inoculation) or to other people.

  • Keep the area clean and dry to prevent a secondary infection. A portable blow dryer can be used to dry the area after a shower or bath. Panties with a cotton crotch should be worn to allow air to circulate.
  • Avoid touching the sores and wash your hands after any contact with the sores.
  • Avoid sexual contact from the time the symptoms first are recognized until the sores are completely healed.

How Does Herpes Affect Pregnancy?

All women who are pregnant should tell their physician if she or her partner has a history of herpes. During pregnancy the initial or recurrent infections can be more severe.

Babies born to women during an HSV outbreak may become infected. Most infants who are infected came into contact with the virus as they passed through the birth canal. Infants who are infected with the herpes virus can have serious skin infections, damage to the nervous system, blindness, mental retardation or death.

The risk to the newborn is the highest if the infant is delivered during the mother’s primary outbreak. Usually if there are no active sores at the time of labor the baby can be delivered vaginally. If there is an active infection, a Cesarean section may be recommended.

Medication such as acyclovir is usually given during the last month of pregnancy to prevent an outbreak close to delivery.