Genital Herpes
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Definition
Genital herpes is a sexually transmitted infection. It causes small, painful, fluid-filled blisters. These blisters break open and leave an indented sore or ulcer. The blisters can be found on the genitals, buttocks, or thighs. However, they can also spread to other parts of the body (such as, the mouth, face, or eyes).

Genital Herpes

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About 16% of people aged 14-49 years have herpes simplex type 2 genital infection.

Causes
Genital herpes is usually caused by the herpes simplex 2 virus. The herpes simplex 1 virus causes cold sores most often, but it can also cause genital herpes.

The virus enters the body through genital areas, the mouth, or a break in the skin. After the first outbreak, the virus moves to nerve endings at the base of the spine. It will remain there until the next outbreak.

The virus can be spread with:

  • Direct contact with an infected person—such as having contact with the vagina, penis, anus, or mouth (can include sexual or non-sexual contact)
  • Fluid from herpes blisters that gets on other parts of the body
  • Pregnancy or childbirth—an infection can pass from mother to her child
The virus is most easily spread when there are blisters. However, the virus may still spread to others when there are no visible skin sores.

Risk Factors
The strongest risk factor for genital herpes is having unprotected sex with an infected partner. Other risk factors include:

  • High number of sexual partners
  • History of sexually transmitted infections
  • Starting to have sex at an early age
Certain factors can trigger an outbreak of blisters. These factors include:

  • Stress
  • Fever
  • Illness or infection
  • Menstruation
The exact cause of an outbreak is rarely known.

Symptoms
Symptoms depend on whether or not this is your first episode. The virus remains quiet between outbreaks. During this time, you may not have visible symptoms, but the virus may still be shedding. This means the virus can be spread during sex.

The number of outbreaks varies. They may decrease over time.

Primary Infection
Primary infection is when you are first exposed to the virus. You may not have any symptoms or you may feel like you have the flu . This can include fever, muscle aches, and swollen glands. Blisters may appear in the genital area or other areas.

It may take about 2-6 weeks for the primary infection to resolve.

Recurrent Infection
A recurrent infection happens when the virus is reactivated in your body. The severity of the outbreak, how long it lasts, and how much is shed all vary.

In most cases, recurrent infections are shorter and less severe. They will also tend to produce smaller and fewer ulcers. The blister or ulcer area may have pain, tingling, burning, or itching.

Diagnosis
The doctor will ask about your symptoms and medical history and perform a physical exam. If you have visible blisters and ulcers, the doctor will examine these. To help with the diagnosis, your doctor may:

  • Open a blister to take a sample of it
  • Have blood tests done—Your doctor will do tests to find out if you have herpes simplex type 1 virus or herpes simplex type 2 virus.
Lesions inside the urinary tract, vagina, or cervix may not be easily seen. Your doctor may do additional tests to examine these areas.

If you are diagnosed with genital herpes, you may be tested for other sexually transmitted infections , including HIV .

Treatment
Getting treatment as soon as possible is important. Early treatment decreases the chance that you will infect others. It will also help you recover faster from an outbreak. However, it is important to keep in mind that the virus remains in your body. There are no treatments that will rid your body of the virus. There are medicines to decrease the chance that you will have an outbreak.

Medications
Antiviral medicines are used to treat genital herpes. Examples of these medicines include:

  • Acyclovir (Zovirax)
  • Valacyclovir (Valtrex)
  • Famciclovir (Famvir)
These medicines are used to treat a primary infection or a recurrent infection. If you have a recurrent infection, the medicine is most effective when it is taken as soon as possible. The medication is best when taken as soon as you notice symptoms.

If you have recurrent infections, your doctor may have you take antiviral medicine every day to prevent an outbreak. This is called suppressive therapy.

Counseling
It is important to learn about genital herpes and how to avoid spreading it to sex partners. Your doctor will provide you with information about the virus.

Other Treatments
To manage discomfort, your doctor may recommend that you:

  • Take over-the-counter pain medicine
  • Take lukewarm baths
Treatment for Sexual Partners
It is important that your sexual partner be tested for genital herpes and receive counseling. If your partner does have an active infection, he or she should also receive treatment.

Prevention
Prevention strategies include:

  • Use latex condoms
  • Avoid oral, anal, or genital sex if your partner has herpes blisters
  • Avoid touching blisters to prevent spreading to other parts of the body
If you are pregnant and have herpes, tell your doctor. Steps can be taken to help prevent your newborn from getting the infection.




RESOURCES:
The American Congress of Obstetricians and Gynecologists

International Herpes Alliance

CANADIAN RESOURCES:

Sex Information and Education Council of Canada

References:
Berkow R. The Merck Manual of Medical Information . New York, NY: Pocket; 2000.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR. 2010;59(No. RR-12):1-110.

Centers for Disease Control and Prevention Seroprevalence of herpes simplex virus type 2 among persons aged 14-49 years--United States, 2005-2008. MMWR Morb Mortal Wkly Rep. 2010;59(15):456-459.

Genital herpes: lifestyle tips. National Women's Health Resource Center, Inc. (NWHRC) website. Available at: http://www.healthywomen.org/condition/genital-herpes . Updated October 20, 2010. Accessed October 7, 2012.

Genital herpes. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/genitalHerpes/understanding/Pages/transmission.aspx . Updated January 26, 2011. Accessed October 7, 2012.

Corey L, Bodsworth N, et al. An update on short-course episodic and prevention therapies for herpes genitalis. Herpes . 2007;14:Suppl 1:5A-11A.

Herpes genitalis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated June 2008. Accessed October 7, 2012.

Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/herpes-simplex/who-gets-causes/herpes-simplex-who-gets-and-causes . Accessed October 7, 2012.

6/14/2012 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Centers for Disease Control and Prevention (CDC). Neonatal herpes simplex virus infection following Jewish ritual circumcisions that included direct orogenital suction—New York City, 2000-2011. MMWR Morb Mortal Wkly Rep. 2012;61:405-409.

Last Reviewed September 2012



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