What is Genital Herpes (GH)?
Genital Herpes is a sexually transmitted disease (STD) caused by either of the two herpes simplex viruses (HSV).HSV type 2 (HSV-2) is the usual cause of Genital Herpes. HSV type 1 (HSV-1) is the cause of herpes sores on the lips and in the mouth
(often called fever blisters or cold sores), but it also causes up to 30% of genital herpes cases.
How many Americans have GH?
An estimated
25% of adult Americans (1 out of 4) have Genital Herpes. Each year, 500,000 to a million new infections are believed to occur. Studies
show that most people with Genital Herpes do not realize they are infected; they either have never had symptoms or have not recognized
their symptoms as Herpes.
What are the symptoms of GH?
First outbreak:
The symptoms of a first outbreak of Genital Herpes usually appear
2 to 10 days after exposure to herpes and last an average of 2 to 3 weeks. Many people who are newly infected with Herpes overlook
their symptoms either because the symptoms are mild or because they are unaware of the possibility of Herpes infection.
Symptoms of
a first genital Herpes infection vary widely and may include any of the following (listed from most common to least common):
· Blisters
or other sores on the penis, vagina, cervix, anus, buttocks, or (rarely) elsewhere on the body. Small red bumps usually appear first,
then develop into blisters, and then become painful, open sores. Over a period of days, the sores may scab over. Finally, they heal.
· Mild
symptoms that may be mistaken for other problems (e.g., yeast infection or jock itch), such as itching, irritation, or scratch-like
sores.
· Pain or discomfort around the genitals, buttocks, or legs.
· Swollen lymph nodes in the groin.
· Itching or burning
during urination.
· Constipation or difficulty urinating.
· General symptoms, such as fever, headache or feeling rundown.
Not
everyone has all these symptoms and some infected persons have no symptoms at all.
Latent infection:
During the first outbreak of symptoms,
the virus travels to nerves that near the spine. The virus remains inside the nerve cells in a latent or dormant state. While the
virus is dormant, a person has no symptoms.
Periodically, Herpes becomes active once again, leading either to a recurrent outbreak
or to subclinical shedding of the virus.
Recurrent outbreaks:
In most people with Genital Herpes, the virus reactivates from time to
time and causes symptoms. The frequency and severity of the recurrent episodes vary greatly. Most persons have several outbreaks a
year, but some especially those with HSV-1 genital infections may have only 1 or 2 outbreaks a year or none at all. In general, recurrent
episodes occur most often in the first year after initial infection. Most persons with recurrent herpes due to HSV-2 have outbreaks
3 - 5 times a year.
Recurrent episodes usually are milder than those of the first episode and typically last about 1-2 weeks. Some
people report that stress, other illness, or menstruation bring on an outbreak of genital herpes. However, research indicates that
these factors, in fact, have little effect; recurrent outbreaks probably occur randomly. In any case, recurrent episodes usually are
not predictable. In contrast, recurrences of oral herpes due to HSV-1 often are triggered by sunburn, injury, or other infections
that might occur—hence the terms "fever blisters" and "cold sores".
The symptoms of recurrent herpes can vary.
· Some people have
a "Prodrome" of symptoms before the actual outbreak, with itching, tingling, numbness, or painful feelings in the area where the lesions
will develop. Some have pain where lesions will not appear, such as the buttocks, back of legs or even lower back. The Prodromeoften
usually starts a day or two before the actual an outbreak begins.
· Some people experience red bumps that become blisters then
open sores as for the first episode of genital herpes. However, in recurrent outbreaks, there usually are fewer lesions and they don’t
last as long as the first outbreak; pain usually lasts for 3 – 5 days and healing usually occurs in 10 – 14 days.
· Recurrent
lesions can occur anywhere on or near the genitals, but the most common sites are the penis in men; near the vaginal opening or on
the labia in women; or near the anus or on the buttocks of either men or women. Recurrent outbreaks usually appear at the same location
every time.
· Many recurrences are very mild; they may cause only a minor itch, irritation or a small painless sore.
Subclinical
shedding:
Genital Herpes can reactivate without causing noticeable bumps, blisters, or sores, or other symptoms. Sometimes symptoms
are there, but are so mild that they aren’t noticed. This is called subclinical shedding. During these times, Herpes can be transmitted
to an uninfected sex partner even though there are no symptoms. Subclinical shedding is most frequent in the first year after the
initial infection, but it continues on and off for several years. Most new cases of genital herpes are caught from a person with subclinical
shedding. This is because persons with genital sores often avoid sex, but those with subclinical shedding don't know it. As for recurrent
outbreaks, subclinical shedding is more common due to HSV-2 than HSV-1.
What happens to me if I have GH?
Herpes symptoms can be severe,
but most outbreaks are mild. But whether mild or severe, Herpes can be very stressful and can be challenging for personal relationships.
But herpes can be managed very effectively. Genital Herpes infections almost never cause permanent disability or long-term damage
in healthy adults. In people who have suppressed immune systems (such as people with HIV) herpes episodes can be long-lasting and
unusually severe, but even these usually can be effectively prevented or treated.
The psychological impact of the disease can be severe.
Some persons become depressed or anxious because they fear recurrent outbreaks, transmission to sex partners, or difficulties in developing
new relationships. Fortunately, proper treatment and knowledge about the true risks which usually are less than infected persons first
fear can greatly lessen all these effects. Many persons with Genital Herpes eventually come to view it only as a minor nuisance. With
proper treatment and open communication, Herpes almost never prevents a healthy, rewarding sex life. Contrary to what many people
have heard, Genital Herpes does not cause cervical cancer or of any other kind of cancer.
How is GH transmitted?
Herpes is spread by
direct skin-to-skin contact. Genital Herpes is acquired sexually. Most cases are acquired through vaginal or anal intercourse with
a person who has genital HSV-2 infection. Some cases are acquired through oral sex; this probably is the main is the main way persons
get genital herpes due to HSV-1.
Oral Herpes (cold sores) probably are acquired mostly by kissing or other kinds of by nonsexual personal
contact. Oral Herpes is due almost entirely to HSV-1, almost never HSV-2.
If you have Genital Herpes, you are very infectious whenever
you are having an outbreak (either initial or recurrent). However, you can also transmit herpes during periods of subclinical shedding
of the virus, when you don't have any symptoms.
As described above, many cases are passed during an episode of subclinical shedding.
Therefore, it is very important for infected persons to recognize even very mild symptoms and avoid sex when they are present.
Sexual
intercourse and oral sex are the only ways Genital Herpes is transmitted; it is not transmitted by sitting on contaminated toilet
seats, by hot tubs or swimming pools, or through other kinds of non-intimate contact.
How do I avoid infection with GH?
· Abstinence
from sex is the surest way to avoid getting genital herpes--not having any anal, oral or vaginal sex.
· The next surest way is
to limit sex to one uninfected partner who only has sex with you—mutual-monogamy.
· If you have a partner with genital herpes,
do not have sex—even with a condom— when he or she is having a Herpes outbreak (from Prodrome until the blisters are completely healed).
· Similarly,
if your partner has oral herpes, he or she should not perform oral sex on you during outbreaks.
· Between outbreaks, condoms used
correctly and consistently (every time you have sex) can reduce the risk of transmission.
Please Note: Condoms are not as effective
at preventing Herpes transmission as they are at preventing the transmission of some other STDs. This is because the male condom does
not prevent all skin-to-skin contact. The female condom provides wider coverage and might offer greater protection.
? Ask your
partner if she/he has herpes (or other STDs) and work out a risk reduction plan.
How do I avoid transmitting GH to others?
· Abstinence
from sexual activity is the surest way to avoid transmitting genital herpes--not having any anal, oral or vaginal sex--not having
any anal, oral or vaginal sex.
· You should tell your partners that you have herpes before you have sex with them—even if you
aren't having an outbreak and intend to use a condom. Discuss the possibility of transmission and work out a risk reduction plan with
your partner.
· Do not have sex with an uninfected sex partner—even with condoms— during the entire duration of a Herpes outbreak
(from Prodrome until the blisters are completely healed.)
· Be aware of very mild symptoms that might be due to herpes and avoid
sex during those times.
· Between outbreaks, condoms used correctly and consistently to minimize transmission.
Please Note: Condoms
are not as effective at preventing Herpes transmission as they are at preventing the transmission of some other STDs. This is because
the male condom does not prevent all skin-to-skin contact. The female condom provides wider coverage and might offer greater protection.
At
least one of the antiviral drugs used to treat Herpes can help prevent transmission to sex partners. But this protection is not complete;
even persons on treatment need to use condoms and avoid sex if herpes sores appear.
How do I find out if I have GH?
Your health care
provider can determine if you have Herpes in two ways:
· You can be examined while you are having symptoms. If sores are present,
your provider will swab the sores and perform a viral culture test for the virus. This method is not always reliable; if the sores
are starting to heal, the test might be negative even if you have herpes.
You can have a blood test for herpes antibodies (the body’s
response to the infection). A blood test can detect herpes antibodies 4 – 6 weeks after the first infection; testing before that time
will not give an accurate result. A positive antibody test means that you are infected with HSV and are contagious from time to time.
It does not indicate when you were infected with HSV nor does it indicate which body site is infected (e.g. vagina, penis, anus, mouth)
What
is the treatment for GH?
There is no cure for Genital Herpes infection, but certain antiviral medications Genital Herpes(Valacyclovir,Famciclovir, or Acyclovir) are very effective in speeding healing and in helping prevent recurrent outbreaks.
Initial Genital Herpes.
The
first episode of Genital Herpes is almost always treated with an antiviral drug, which markedly speeds healing. Treatment for first
episode herpes usually is taken for 7-10 days.
Episodic therapy for recurrent Genital Herpes.
Some people with recurrent genital herpes
take antiviral medication during each recurrent outbreak to speed healing. Treatment must be started at the very first sign of an
outbreak, preferably during the Prodrome (if one is present). The medicine is continued for 3-5 days. Although episodic treatment
speeds healing, for most persons outbreaks are shortened only by one or two days. If you and your health care provider choose episodic
therapy, fill your prescription ahead of time and have it ready before an outbreak so you can begin treatment immediately.
Suppressive
therapy for recurrent Genital Herpes.
Some people with recurrent herpes take antiviral medication daily to prevent outbreaks. Suppressive
therapy can lower the number of outbreaks and, for many persons, prevent them altogether. Suppressive therapy also reduces (but does
not eliminate) subclinical shedding, and recent research shows that one antiviral drug helps reduce sexual transmission of herpes.
However, prevention is not complete; even if you are taking suppressive therapy, you must inform your partner that you have herpes
and continue to take precautions to protect your uninfected sex partner(s).
Pain Relief
During an outbreak, there are different ways
to relieve pain. These are especially helpful in initial Genital Herpes.
· Take warm baths. After bathing, carefully dry affected
areas gently with a soft, clean towel, or use a hair dryer set on low.
· Wear loose cotton clothes to prevent chafing.
· Keep
the area dry by sprinkling cornstarch in underwear.
· Hold cool compresses to the sores a few minutes several times.
· Hold
ice packs to the sores a few minutes several times.
· Take aspirin, acetaminophen, or ibuprofen to relieve pain and fever.
How
does GH effect pregnancy?
Herpes infection of the newborn (Neonatal Herpes) is extremely serious; many babies die and those who survive
may have severe, lifelong disabilities. Neonatal Herpes usually results from exposure of the baby to the virus during delivery. A
few cases may result from being kissed by someone with oral herpes.
Fortunately, Neonatal Herpes is rare. The highest risk occurs when
the mother first catches genital herpes during the last 3 months of pregnancy. Therefore, the main way to prevent neonatal herpes
is for pregnant women without Genital Herpes to avoid exposure to HSV near the end of pregnancy. A pregnant woman without Herpes must
not have intercourse with anyone with Genital Herpes. Similarly, she should not permit oral sex by a partner with oral Herpes.
Women
with longstanding recurrent Genital Herpes are at low risk for transmitting the virus to their babies. To be safe however, a cesarean
section often is done if a woman with recurrent herpes has an outbreak when she goes into labor. (A cesarean section delivers the
baby by surgery, so the infant does not pass through the vagina.)
Any pregnant woman with Genital Herpes, or whose partner has either
genital or oral herpes, should inform the doctor or other clinician providing care for the pregnancy. In some cases, a type-specific
herpes blood test of the woman and her partner can help determine the risk and reduce the chance of neonatal herpes.
If you're pregnant
and you have Herpes:
· Tell your doctor or health care provider about your infection.
· Notify your provider if you think
you have herpes symptoms when you go into labor.
· Remind your provider to check for herpes lesions when you go into labor, even
if you haven't noticed symptoms.
· If you have active herpes during delivery, you may have a cesarean section.
· If you do
not have active symptoms during delivery, you will probably be able to give birth vaginally.
· Ask your provider about whether
you should take an antiviral medicine during the last month of pregnancy to prevent an outbreak.
If you're are pregnant and don't haveGenital Herpes but your partner does:
· Avoid contracting Herpes; specifically, avoid sex with your infected partner during the
last 3 months of pregnancy.
· If your partner has oral herpes, avoid receiving oral sex during the last 3 months of pregnancy.
· Don't
risk giving herpes to your baby. A first episode during late pregnancy and delivery may make your baby very sick.
Resources & Information
for GH.
HIV/STD Hotline: 209-572-2437
HIV/AIDS Program:HIVSTDInfo@SCAP4.org
CDC national STD/HIV hotline numbers:
800-227-8922 or 800-342-2437
Spanish
800-344-7432
TTY 800-243-7889
Websites:
University of Washington Virology Clinic
Free online Herpes Handbook from the Westover Clinic
in Portland, OR
Herpes from the American Social Health Association (ASHA)
Glaxo Wellcome's Herpes Help web page
Herpes Questions and
Answers from Planned Parenthood
Genital Herpes Fact Sheet from the National Institute of Allergy and Infectious Diseases
