Genital Herpes Overview
There are five types of herpesvirus. Herpes simplex-1 (HSV-1) and herpes simplex-2 (HSV-2, the most common type) are considered sexually transmitted diseases. Herpesvirus can be transmitted from a mother to her developing fetus, which may impair neurological development and can be fatal.
HSV-1 causes cold sores and fever blisters on the mouth and has been found in genital lesions as well. HSV-2, commonly called genital herpes, causes internal and external genital sores and blisters.
Herpes is a lifelong, incurable disease but can be managed with antiviral drugs and safer sex practices. The virus resides deep in nerve cells and it may never produce symptomatic disease or may actively recur throughout a person's lifetime. The latent nature of the virus contributes to its insidious spread.
Incidence and Prevalence of Genital Herpes
According to the Centers for Disease Control and Prevention (CDC), about 45 million people in the United States over the age of 12 are infected with HSV-2. Genital herpes is more common in women (approx. 1 out of 4) than men (approx. 1 out of 5) and more common in African Americans (46%) than Caucasians (18%). Men who have sex with men have a higher incidence of HSV-2 infection than heterosexual men.
Incidence of genital herpes in the United States has increased 30% over the past 20 years. The largest increase has occurred in Caucasians between the ages of 12 and 19 (5 times more common) and ages 20–29 (twice as common). About 1 million new cases occur each year.
Genital herpes can be managed with antiviral drugs and safer sex practices. Transmission to a developing fetus can impair neurological development and can be fatal.
Causes and Risk Factors for Genital Herpes
Genital herpes is transmitted when an active herpes lesion or its secretion comes into direct contact with a break in the skin or the moist membranes of the mouth, penis, vagina, urethra, anus, or cervix. Stress on the immune system, emotional or physical stress, illness, fatigue, menstruation, and even exposure to sunlight are associated with recurrence of the disease.
Genital herpes is highly contagious when sores are present. Patients can re-infect themselves by touching an active herpes sore and scratching or rubbing another area of broken skin on the body.
Pregnant women infected with genital herpes should consult a physician for advice on precautions to take during pregnancy and labor.
Signs and Symptoms of Genital Herpes
Most people infected with herpesvirus remain asymptomatic. Others notice symptoms in 2 to 20 days. Initially, there may be flu-like symptoms, including swollen lymph nodes, chills, fever, body aches, fatigue, and nausea.
Small (2 5 mm), fluid-filled lesions on the genitals, buttocks, anus, and adjacent areas are the telltale sign of infection. They are painful and often occur in clusters. They can also develop inside the vagina, on the cervix (where they cause inflammation), or in the rectum. Lesions break open and ooze for a few days before crusting over and healing.
Other herpes symptoms may include:
- Abdominal pressure
- Burning or tingling
- Localized tenderness
- Pain in the groin or inner thighs
- Painful urination (particularly in women)
- Vaginal discharge
- Unexplained urethral discharge in men
The first symptoms (primary infection) can last 3 weeks and are usually severe. Symptoms disappear as the virus retreats to the nerve cells near the sacral region of the spine and becomes latent until reactivated by a trigger. The virus then travels down the nerve cell to the skin, where new sores erupt. Many people experience itching, tingling, or heightened sensitivity and tenderness in the area of the original infection a few hours before the sores appear. Some experience pain in the buttocks or knees.
Recurrent symptoms may be frequent and severe, lasting about a week. Most people experience a decrease in the intensity of symptoms and duration of outbreaks over time.
Genital Herpes Diagnosis
Though herpes lesions can be seen with the naked eye, a specimen swabbed or scraped from a lesion is cultured and examined with a microscope to distinguish the virus from other disease-causing microorganisms (e.g., syphilis, chancroid). A blood test can distinguish between HSV-1 and HSV-2 infection and detect proteins that fight infection to the virus (antibodies), which are present during outbreak.
Treatment for Genital Herpes
Systemic antiviral drugs, such as acyclovir (Zovirax®), famciclovir (Famvir®), and valacyclovir (Valtrex®), are taken daily to control outbreaks, prevent the virus from multiplying, and reduce recurrence. Side effects include nausea, headache, and vomiting.
Sores should be kept clean and dry, and antiviral ointment may be applied to reduce pain. Loose-fitting cotton underwear decreases moisture in the infected areas, allowing the sores to dry and heal. Tight-fitting clothing, such as pantyhose, should be avoided. Patients are advised to be aware of subtle symptoms, which may include irritation or pain near the site of previous outbreaks.
Genital Herpes Prevention
Sex partners should be examined and tested as soon as symptoms of primary herpes appear.