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Genital Herpes

Genital Herpes

Topic Overview

What is genital herpes?

Genital herpes is one of the most common sexually transmitted infections (STIs). The infection can be bothersome.

Most people never have symptoms, or the symptoms are so mild that people don't know that they are infected. But in some people, the infection causes occasional outbreaks of itchy and painful sores in the genital area.

After the first outbreak, the herpes virus stays in the nerve cells below the skin and becomes inactive. It usually becomes active again from time to time, traveling back up to the skin and causing more sores. Things like stress, illness, a new sex partner, or menstruation may trigger a new outbreak. As time goes on, the outbreaks happen less often, heal faster, and don't hurt as much.

What causes genital herpes?

Genital herpes is caused by a virus—either the herpes simplex virus type 1 or the herpes simplex virus type 2. Either virus can cause sores on the lips (cold sores) and sores on the genitals. Type 1 more often causes cold sores, while type 2 more often causes genital sores.

What are the symptoms?

Symptoms can vary greatly from person to person. Most people never have any symptoms. Sometimes the symptoms are so mild that people may not notice them or recognize them as a sign of herpes. For people who do notice their first infection, it generally appears about 2 to 14 days after they were exposed to genital herpes.

Some people have outbreaks of itchy and painful blisters on the penis or around the opening of the vagina. The blisters break open and turn into oozing, shallow sores that take up to 3 weeks to heal. Sometimes people, especially women, also have flu-like symptoms, such as fever, headache, and muscle aches. They may also notice an abnormal discharge and pain when they urinate.

Genital herpes infections can be severe in people who have impaired immune systems, such as people with HIV.

How is genital herpes diagnosed?

Your doctor may diagnose genital herpes by examining you. He or she may ask you questions about your symptoms and your risk factors, which are things that make you more likely to get an infection.

If this is your first outbreak, your doctor may take a sample of tissue from the sore for testing. Testing can help the doctor be sure that you have herpes. You may also have a blood test.

How is it treated?

Although there is no cure, medicine can relieve pain and itching and help sores heal faster. If you have a lot of outbreaks, you may take medicine every day to limit the number of outbreaks.

After the first outbreak, some people have just a few more outbreaks over their lifetime, while others may have 4 to 6 outbreaks a year. Usually the number of outbreaks decreases after a few years.

Treatment works best if it is started as soon as possible after the start of an outbreak. This is especially true for outbreaks that come back again and again.

Finding out that you have herpes may cause you to feel bad about yourself or about sex. Counseling or a support group may help you feel better.

Can genital herpes be prevented?

The only sure way to keep from getting genital herpes—or any other sexually transmitted infection (STI)—is to not have sex. If you do have sex, practice safer sex.

  • Before you start a sexual relationship, talk with your partner about STIs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.
  • If you have symptoms of an STI, don't have sex.
  • Don't have sex with anyone who has symptoms or who may have been exposed to an STI.
  • Don't have more than one sexual relationship at a time. Having several sex partners increases your risk for infection.
  • Use condoms. Condom use lowers the risk of spreading or becoming infected with an STI.
  • Don't receive oral sex from partners who have cold sores.

Taking medicine for herpes may lower the number of outbreaks you have and can also prevent an episode from getting worse. It also lower the chances that you will infect your partner.

If you are pregnant, you should take extra care to avoid getting infected. You could pass the infection to your baby during delivery, which can cause serious problems for your newborn. If you have an outbreak near your due date, you probably will need to have your baby by cesarean section. If your genital herpes outbreaks return again and again, your doctor may talk to you about medicines that can help prevent an outbreak during pregnancy.

Cause

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.

How herpes is spread

You get 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. So herpes can be spread to or from the genitals, anus, or mouth during sexual activities or through any direct contact with herpes sores.

You are most likely to spread herpes when you have a herpes sore or blister. But many people have time periods (a week before and a week after an outbreak) when they can still spread the virus even though they don't have symptoms.

And some people spread the infection because they don't realize that they have a herpes sore. Or they may have different symptoms, such as painful urination, that they don't realize are part of an outbreak.

Symptoms

Most people never have any symptoms or have ones that are so mild they don't recognize them. But some people have painful and bothersome symptoms.

Sometimes the symptoms are confused with other common problems, like yeast infections or vaginosis.

The first herpes outbreak tends to last the longest and be the most severe. Symptoms of the first outbreak may include:

  • Flu-like symptoms, such as fever, headache, and muscle aches. These symptoms usually get better within a week.
  • Tingling, burning, itching, and redness at the site where an outbreak is about to occur.
  • Painful, itchy blisters on the penis, on the vulva, or inside the vagina. Blisters may also appear on the anus, buttocks, thighs, or scrotum, either alone or in clusters. They may be barely noticeable or as large as a coin.
  • Painful, oozing sores caused by blisters that break open.
  • Swollen and tender lymph nodes in the groin.
  • Painful urination.
  • Abnormal discharge from the vagina or penis.

Symptoms of later outbreaks are usually limited to blisters, sores, and swollen lymph nodes. The blisters may take up to three weeks to heal.

What Happens

When genital herpes symptoms appear, it's usually 2 to 14 days after a person is exposed to the virus.

And sometimes people get their first symptoms months or even years after being infected.

The herpes virus stays in your body for the rest of your life. After the first outbreak, it becomes inactive. Then, in most people, it gets active again from time to time, causing blisters and sores.

Repeated outbreaks

Some people have many outbreaks each year, while others have only a few or none at all. People who have symptoms average 5 outbreaks a year during the first few years. Most have fewer outbreaks after that.

People report that certain things may trigger outbreaks, such as:

  • Emotional stress.
  • Fatigue.
  • Other infections, such as a cold or the flu.
  • Physical injury, such as irritation, of the genital area.
  • New sex partners.
  • Menstruation.
  • Any condition that weakens the immune system.

About half of the people who have repeated outbreaks can feel one coming a few hours to a couple of days before it happens. They may feel tingling, burning, itching, numbness, tenderness, or pain where the blisters are about to appear.

Other problems

People who have an impaired immune system are more likely to have longer and/or more severe outbreaks of genital herpes than people whose immune systems are healthy.

Although it's rare, genital herpes can cause other health problems—some of them serious—if the virus travels to other parts of the body.

In rare cases, a newborn is infected with the herpes virus during delivery. Because their immune systems aren't fully developed, newborns with herpes infection can have serious health problems affecting many body systems. It may take up to 3 weeks after a newborn is infected before he or she becomes ill.

If the mother has a genital herpes blister or sore at the time of labor and delivery, a cesarean section is usually done. Cesarean section may be recommended if a woman has tingling or pain suggesting an impending outbreak.

What Increases Your Risk

Things that increase your risk of getting genital herpes include:

  • Having more than one sex partner.
  • Having a high-risk partner or partners (partner has more than one sex partner or has herpes-infected sex partners).
  • Having unprotected sexual contact (not using condoms).
  • Starting sexual activity at a young age. The younger people are when they start having sex, the greater their risk is of getting genital herpes.
  • Having a weakened immune system.
  • Being a woman. Women are more likely than men to become infected when exposed to genital herpes. And their symptoms tend to be more severe and longer-lasting. Women also are at a greater risk of having complications from a genital herpes infection.

Having herpes, especially if you have open sores, also increases your risk for becoming infected with HIV if you are exposed to HIV.

Any child with genital herpes needs to be evaluated by a doctor to see if it is the result of sexual abuse. For more information, see the topic Child Abuse and Neglect.

When should you call your doctor?

If you haven't been diagnosed with genital herpes, call your doctor if you have:

  • Painful blisters or sores in the genital or pelvic area.
  • Burning or pain while urinating, or you can't urinate.
  • Abnormal discharge from the vagina or penis.
  • Reason to think you've been exposed to genital herpes.

If you have been diagnosed with genital herpes, call your doctor if you are having frequent outbreaks or if you can't pass urine or are constipated.

If you are pregnant and have genital herpes, or if you think you have genital herpes, tell your doctor.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you have only occasional outbreaks of genital herpes and are comfortable with home treatment, watchful waiting may be all you need.

Exams and Tests

Your doctor may be able to diagnose genital herpes from your medical history and a physical exam, especially if the herpes sores are typical in appearance. Your doctor may ask you the following questions:

  • Do you think you were exposed to genital herpes or another sexually transmitted infection (STI)? How do you know? Did your partner tell you?
  • What are your symptoms?
    • Do you have sores in the genital area or anywhere else on your body?
    • Do they usually come and go?
    • Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
    • If you have discharge from the vagina or penis, does it have any smell or color?
  • What method of birth control do you use? Did you use condoms to protect against STIs?
  • What are your sexual practices and your partner's sexual practices?
  • Have you had an STI in the past? How was it treated?

If this is your first outbreak of suspected genital herpes, further testing may be done to confirm the diagnosis.

Treatment Overview

Treatment can't cure genital herpes. But it can provide relief from the discomfort of herpes sores and can speed up healing.

Treatment works best if it is started as soon as possible after an outbreak begins. This is especially true for outbreaks that come back again and again.

Treatment includes:

  • Medicines to make blisters and sores less painful and heal faster or to help prevent outbreaks. For more information, see Medications.
  • Home treatment, such as taking warm sitz baths and wearing cotton underwear, to help sores heal. For more information, see Home Treatment.
  • Taking steps to prevent the spread of genital herpes. These include avoiding any sexual contact if you (or your partner) have symptoms or are being treated for genital herpes. For more information, see Prevention.

Prevention

You can take steps to help keep from getting genital herpes—or any other sexually transmitted infection. You can also take steps to keep from giving herpes to your sex partner(s).

Practice safer sex

Preventing a sexually transmitted infection (STI) is easier than treating an infection after it occurs.

  • Talk with your partner about STIs before beginning a sexual relationship. Find out whether he or she is at risk for an STI. Remember that it is quite possible to have an STI without knowing it. Some STIs, such as HIV, can take up to 6 months before they can be detected in the blood.
  • Be responsible.
    • Avoid sexual contact if you have symptoms of an STI or are being treated for an STI.
    • Avoid sexual contact with anyone who has symptoms of an STI or who may have been exposed to an STI.
  • Don't have more than one sexual relationship at a time. Your risk for an STI increases if you have several sex partners.

For more information, see the topic Safer Sex.

Use condoms

Using condoms lowers your chances of getting or spreading herpes and other STIs, even if you are already using another birth control method to prevent pregnancy.

Condoms must be in place before the start of sexual contact. Use condoms with a new partner until you are certain that he or she doesn't have an STI. You can use either male condoms or female condoms.

Don't have sex, even with condoms, while you're having herpes symptoms.

Take antiviral medicine

Taking daily valacyclovir, an antiviral medicine, can prevent spread of genital herpes to your sexual partner even when you do not have an active outbreak.

Take care during pregnancy

A woman who gets genital herpes while she is pregnant could pass the infection to her baby during delivery. Herpes can make newborns seriously ill.

If you are pregnant, follow these steps:

  • Tell your doctor if you have been exposed to genital herpes or have had an outbreak in the past.
  • Let your doctor know if you are currently having an outbreak, especially if you are in the last part of your pregnancy.
  • Avoid unsafe sex. Herpes is often transmitted by people who don't know they are infected and don't have symptoms. Use condoms.
  • Avoid receiving oral sex from partners who have cold sores. Herpes in newborns can be caused by HSV-1, the virus that most commonly causes cold sores. Most experts advise pregnant women not to receive oral sex in the last 3 months of their pregnancy. It increases their risk of genital infection with HSV-1.

Antiviral medicine can be used safely in pregnancy to reduce the risk of an outbreak at the time of delivery. This lower risk, in turn, makes it less likely that delivery by cesarean section will be needed.

Wash your hands

If you are having a genital herpes outbreak, wash your hands after using the bathroom or having any contact with blisters or sores. This is especially important for people who are caring for babies.

Home Treatment

To reduce discomfort from herpes sores:

  • 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.
  • Letting the sores air dry may be more comfortable than using a towel.
  • Wear cotton underpants, which absorb moisture better than those made from synthetic material.

Ask your doctor if you can take nonprescription medicines, such as acetaminophen (Tylenol) and ibuprofen (Advil). They may reduce the pain and fever from genital herpes.

To lower the risk of recurrent outbreaks, reduce or avoid things that trigger outbreaks, such as fatigue, stress, overexposure to sun, and irritation of the genital area.

Coping with your feelings

Finding out that you have genital herpes may cause you to have negative thoughts or feelings about yourself or about sex, such as:

  • Feeling ashamed or embarrassed.
  • Being afraid of the consequences of the infection.
  • Being angry at the person who infected you.
  • Feeling frustrated with treatment or recurrent outbreaks.
  • Feeling scared to have sex.

A counselor or support groups for people with herpes may be helpful.

Medications

Antiviral medicines are the recommended treatment for genital herpes. They can relieve the pain and discomfort of blisters and sores and speed healing.

These medicines also decrease the number of days you can spread the virus (are contagious).

Medicine choices

  • Antiviral medicines, such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), are recommended for treating primary genital herpes outbreaks. This medicine can be taken when an outbreak occurs. It can also be taken every day to help prevent outbreaks.
  • Nonprescription medicines, such as ibuprofen (Advil) and acetaminophen (Tylenol), may reduce the pain and fever from genital herpes. Be safe with medicines. Read and follow all instructions on the label.

Taking antiviral medicines

Antiviral medicines work best when they are taken as soon as symptoms are noticed. For that reason, people with herpes should keep a supply of the medicine on hand.

If you have 6 or more outbreaks a year or have severe outbreaks, you may benefit from taking antiviral medicine every day. It may reduce the number of outbreaks by about 1 or 2 episodes a year.

If you take antiviral medicine every day, you may want to talk to your doctor about not taking the medicine for a short period each year. This can show whether your outbreaks are starting to occur less frequently. Then you can decide whether to keep taking the medicine.

People with impaired immune systems may be more likely to:

  • Need daily antiviral medicine to prevent recurrent outbreaks.
  • Develop a resistance to some antiviral medicines. For these people, other medicines are available, but they must be given through a vein (intravenously, or IV) and can have dangerous side effects.

References

Other Works Consulted

  • American College of Obstetricians and Gynecologists (2007, reaffirmed 2009). Management of herpes in pregnancy. ACOG Practice Bulletin No. 82. Obstetrics and Gynecology, 109(6): 1489–1498.
  • Cernik C, et al. (2008). The treatment of herpes simplex infections: An evidence-based review. Archives of Internal Medicine, 168(11): 1137–1144.
  • Johnston C, et al. (2010). Genital herpes. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 169–185. Philadelphia: Saunders.

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