Genital Herpes
Genital herpes is an infection caused by
the herpes simplex virus or HSV. There are two types of HSV, and both can
cause genital herpes. HSV type 1 most commonly infects the lips, causing
sores known as fever blisters or cold sores, but it also can infect the
genital area and produce sores. HSV type 2 is the usual cause of genital
herpes, but it also can infect the mouth. A person who has genital herpes
infection can easily pass or transmit the virus to an uninfected person
during sex.
Both HSV 1 and 2 can produce sores (also called lesions) in and around
the vaginal area, on the penis, around the anal opening, and on the
buttocks or thighs. Occasionally, sores also appear on other parts of the
body where the virus has entered through broken skin.
HSV remains in certain nerve cells of the body for life, and can
produce symptoms off and on in some infected people.
According to the U.S. Centers for Disease Control and Prevention, 45
million people in the United States ages 12 and older, or 1 out of 5 of
the total adolescent and adult population, are infected with HSV-2.
Nationwide, since the late 1970s, the number of people with genital
herpes infection has increased 30 percent. The largest increase is
occurring in young teens. HSV-2 infection is more common in three of the
youngest age groups which include people aged 12 to 39 years.
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Most people get genital
herpes by having sex with someone who is having a herpes "outbreak." This
outbreak means that HSV is active. When active, the virus usually causes
visible lesions in the genital area. The lesions shed (cast off) viruses
that can infect another person. Sometimes, however, a person can have an
outbreak and have no visible sores at all. People often get genital herpes
by having sexual contact with others who don't know they are infected or
who are having outbreaks of herpes without any sores.
A person with genital herpes also can infect a sexual partner during
oral sex. The virus is spread only rarely, if at all, by touching objects
such as a toilet seat or hot tub.
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Unfortunately, most people who have genital
herpes don't know it because they never have any symptoms, or they do not
recognize any symptoms they might have. When there are symptoms, they can
be different in each person. Most often, when a person becomes infected
with herpes for the first time, the symptoms will appear within 2 to 10
days. These first episodes of symptoms usually last 2 to 3 weeks.
Early symptoms of a genital herpes outbreak include
- Itching or burning feeling in the genital or anal area
- Pain in the legs, buttocks, or genital area
- Discharge of fluid from the vagina
- Feeling of pressure in the abdomen
Within a few days, sores appear near where the virus has entered the
body, such as on the mouth, penis, or vagina. They also can occur inside
the vagina and on the cervix in women, or in the urinary passage of women
and men. Small red bumps appear first, develop into blisters, and then
become painful open sores. Over several days, the sores become crusty and
then heal without leaving a scar.
Other symptoms that may go with the first episode of genital herpes are
fever, headache, muscle aches, painful or difficult urination, vaginal
discharge, and swollen glands in the groin area.
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If you have been infected by HSV 1 and/or 2,
you will probably have symptoms or outbreaks from time to time. After the
virus has finished being active, it then travels to the nerves at the end
of the spine where it stays for a while. Even after the lesions are gone,
the virus stays inside the nerve cells in a still and hidden state, which
means that it's inactive.
In most people, the virus can become active several times a year. This
is called a recurrence. But scientists do not yet know why this happens.
When it becomes active again, it travels along the nerves to the skin,
where it makes more viruses near the site of the very first infection.
That is where new sores usually will appear.
Sometimes, the virus can become active but not cause any sores that can
be seen. At these times, small amounts of the virus may be shed at or near
places of the first infection, in fluids from the mouth, penis, or vagina,
or from barely noticeable sores. You may not notice this shedding because
it often does not cause any pain or feel uncomfortable. Even though you
might not be aware of the shedding, you still can infect a sex partner
during this time.
After the first outbreak, any future outbreaks are usually mild and
last only about a week. An infected person may know that an outbreak is
about to happen by a tingling feeling or itching in the genital area, or
pain in the buttocks or down the leg. For some people, these early
symptoms can be the most painful and annoying part of an episode.
Sometimes, only the tingling and itching are present and no visible sores
develop. At other times, blisters appear that may be very small and barely
noticeable, or they may break into open sores that crust over and then
disappear.
The frequency and severity of recurrent episodes vary greatly. While
some people have only one or two outbreaks in a lifetime, others may have
several outbreaks a year. The number and pattern of repeat outbreaks often
change over time for a person. Scientists do not know what causes the
virus to become active again. Although some people with herpes report that
their outbreaks are brought on by another illness, stress, or having a
menstrual period, outbreaks often are not predictable. In some cases,
outbreaks may be connected to exposure to sunlight.
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Because the genital herpes sores
may not be visible to the naked eye, a doctor or other health care worker
may have to do several laboratory tests to try to prove that symptoms are
caused by the herpes virus. A person may still have genital herpes,
however, even if the laboratory tests do not show the virus in the body.
A blood test cannot show whether a person can infect another with the
herpes virus. A blood test, however, can show if a person has been
infected at any time with HSV. There are also newer blood tests that can
tell whether a person has been infected with HSV 1 and/or 2.
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Although there is no cure for
genital herpes, your health care worker might prescribe one of three
medicines to treat it as well as to help prevent future episodes.
- Acyclovir (Zovirax)
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
Recently, the Food and Drug Administration approved Valtrex for use
in preventing transmission of genital herpes.
During an active herpes episode, whether the first episode or a repeat
one, you should follow a few simple steps to speed healing and avoid
spreading the infection to other places on the body or to other
people.
- Keep the infected area clean and dry to prevent other infections
from developing.
- Try to avoid touching the sores.
- Wash your hands after contact with the sores.
- Avoid sexual contact from the time you first feel any symptoms until
the sores are completely healed, that is, the scab has fallen off and
new skin has formed where the sore was.
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Usually, genital
herpes infections do not cause major problems in healthy adults. In some
people whose immune systems do not work properly, genital herpes episodes
can last a long time and be unusually severe. (The body's immune system
fights off foreign invaders such as viruses.)
If a woman has her first episode of genital herpes while she is
pregnant, she can pass the virus to her unborn child and may deliver a
premature baby. Half of the babies infected with herpes either die or
suffer from damage to their nerves. A baby born with herpes can develop
serious problems that may affect the brain, the skin, or the eyes. If
babies born with herpes are treated immediately with acyclovir, their
chances of being healthy are increased.
If a pregnant woman has an outbreak, which is not the first episode,
her baby's risk of being infected during delivery is very low. In either
case, if you are pregnant and infected with genital herpes, you should
stay in close touch with your doctor before, during, and after your baby
is born.
If a woman is having an outbreak during labor and delivery and there
are herpes lesions in or near the birth canal, the doctor will do a
cesarean section to protect the baby. Most women with genital herpes,
however, do not have signs of active infection with the virus during this
time, and can have a normal delivery.
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Genital herpes, like other genital diseases that produce
lesions, increases a person's risk of getting HIV, the virus that causes
AIDS. Also, prior to better treatments for AIDS, persons infected with HIV
had severe herpes outbreaks, which may have helped them pass both genital
herpes and HIV infection to others.
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If you have early
signs of a herpes outbreak or visible sores, you should not have sexual
intercourse or oral sex until the signs are gone and/or the sores have
healed completely. Between outbreaks, using male latex condoms during
sexual intercourse may offer some protection from the virus. When used
with these precautions, Valtrex can also help prevent infecting your
partner during heterosexual sex.
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Genital herpes outbreaks can be distressing,
inconvenient, and sometimes painful. Concern about transmitting the
disease to others and disruption of sexual relations during outbreaks can
affect personal relationships. If you or your partner has genital herpes,
you can learn to cope with and treat the disease effectively by getting
proper counseling and medicine, and by using ways to prevent getting
infected or infecting someone else, as mentioned above.
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National Herpes Resource Center
and Hotline
National Institute of Allergy and Infectious Diseases
National Library of Medicine
Centers for Disease Control and Prevention
The American College of Obstetricians and Gynecologists
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