Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
Causes:
Genital herpes affects the skin or mucous membranes of the genitals. It caused by the herpes simplex virus (HSV). HSV is spread from one person to another during sexual contact.
- HSV-2 most often causes genital herpes. HSV-2 can be spread through secretions from the mouth or genitals.
- HSV-1 usually affects the mouth and lips and causes cold sores or fever blisters. However, it can spread from the mouth to the genitals during oral sex. For more information on HSV-1.
You may become infected with herpes if your skin, vagina, penis, or mouth comes into contact with someone who already has herpes.
You are most likely to get herpes if you touch the skin of someone who has herpes sores, blisters, or a rash. However, the herpes virus can still be spread even when no sores or other symptoms are present. Sometimes, the person does not even know they are infected.
Genital HSV-2 infections are more common in women than men.
Symptoms:
- Many people with genital herpes never have sores, or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.
- If signs and symptoms do occur during the first outbreak, they can be quite severe. This first outbreak usually happens within 2 days to 2 weeks of being infected.
General symptoms may include:
- Decreased appetite
- Fever
- General sick feeling (Malaise)
- Muscle aches in the lower back, buttocks, thighs, or knees
- Swollen and tender lymph nodes in the groin during an outbreak
- Genital symptoms include the appearance of small, painful blisters filled with clear or straw-colored fluid. They are usually found:
- In women: on the outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks
- In men: on the penis, scrotum, around the anus, on the thighs or buttocks
- In both sexes: on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body
Before the blisters appear, the person may feel the skin tingling, burning, itching, or have pain at the site where the blisters will appear
When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 – 14 days or more
Other symptoms that may occur include:
- Painful urination
- Women may have vaginal discharge or, occasionally, be unable to empty the bladder and require a urinary catheter
- A second outbreak can appear weeks or months later. It is usually less severe and goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.
Once you have HSV-2, the virus hides within nerve cells and remains in the body. It can remain “asleep” (dormant) for a long time.
The virus can “wake up” (reactivate) at any time.
This may be triggered by:
- Fatigue
- Genital irritation
- Menstruation
- Physical or emotional stress
- Injury
Some people have genital herpes attacks only once a year, while others have them so often the symptoms never seem to go away. Repeated attacks are generally milder in men.
Complications:
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can lead to potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
Genital herpes cannot be cured; the virus will always be in your body. But the antiviral drugs acyclovir, valacyclovir, and famciclovir can shorten outbreaks and make them less severe, or stop them from happening. Valacyclovir (brand name Valtrex) also can lower your risk of passing the infection to someone else.
Diagnosis And Tests:
The diagnosis of genital herpes is based on an individual’s medical history, their signs and symptoms, and the results of tests. It is important to distinguish genital herpes from other sexually transmitted diseases, particularly those that also produce genital ulcers, such as syphilis and chancroid.
Several diagnostic tests may also be used to diagnose genital herpes. These tests can usually confirm infection and identify which virus (HSV-1 or HSV-2) is responsible. The choice of testing will depend on your symptoms and whether you have any blisters or ulcers at the time you see your doctor.
Culture test — A culture test determines if herpes simplex virus is present in blisters or ulcers. However, a herpes culture detects the virus in only about 50 percent of individuals with genital ulcers. The culture is more likely to detect the virus when ulcers are new and open, as compared to when they are older and healing. Therefore, it is important to see a healthcare provider within 48 hours of the first symptoms. The test is also more sensitive in individuals experiencing an initial episode of genital herpes than in individuals experiencing a recurrent episode.
Blood test — Blood tests are often used when a person believes he or she may have been exposed to the herpes virus in the past, but has no visible ulcers. A blood test can detect antibodies (proteins that are produced by the body in response to a foreign substance) to HSV type 1 and type 2. Having a positive test for these antibodies indicates that the person was infected with the virus at some time in the past, although it is usually not possible to know when or from whom the virus was transmitted.The results of antibody testing may be negative early on during the initial episode of infection since antibody formation takes a few weeks. The antibody test remains positive for life.Blood tests may be helpful for couples if one person has a history of genital herpes and the other does not. If the partner has not been infected, then it is important to discuss ways to prevent transmission.
Polymerase chain reaction (PCR) test — The polymerase chain reaction (PCR) test is a very sensitive test for identifying the herpes virus in cells and secretions from the urinary and genital tracts. The PCR test is more sensitive than the culture test, but is not routinely used due to its higher cost.
Treatments:
Depending on your needs, your doctor can give you drugs to take right after getting outbreak symptoms or drugs to take on a regular basis to try to stop outbreaks from happening. Talk to your doctor about treatment options.
During outbreaks, these steps can speed healing and help keep the infection from spreading to other sites of the body or to other people:
- Keep the infected area clean and dry.
- Try not to touch the sores.
- Wash hands after contact.
- Avoid sexual contact from the time you first notice symptoms until the sores have healed.
Alternative remedies include:
- Taking warm sitz baths.
- Wearing only cotton underwear, to promote healing.
- Avoiding any sexual contact.
- Topical application of acyclovir or Zovirax ointment.