Diseases & Conditions

Genital Herpes

Genital herpes is a common sexually transmitted disease that affects both men and women. Features of genital herpes include pain, itching and sores in your genital area.

The cause of genital herpes is a type of herpes simplex virus (HSV), which enters your body through small breaks in your skin or mucous membranes. Sexual contact is the primary way that the virus spreads.

There's no cure for this recurrent infection, which may cause embarrassment and emotional distress. Having genital herpes is no reason to avoid sex or give up on relationships though. If you or your partner is infected, you can manage the spread of HSV by taking steps to protect yourself and your partner.

The majority of people who've been infected with HSV never know they have the disease because they have no signs or symptoms. The signs and symptoms of HSV can be so mild they go unnoticed. The first outbreak is generally the worst, and some people never experience a second outbreak. Other people, however, can experience outbreaks as long as 40 years after the initial outbreak.

When present, genital herpes symptoms may include:

• Small red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal or nearby areas
• Pain or itching around your genital area, buttocks or inner thighs

The initial symptom of genital herpes usually is pain or itching, beginning within a few weeks after exposure to an infected sexual partner. After several days, small red bumps may appear. They then rupture, becoming ulcers that ooze or bleed. Eventually, scabs form and the ulcers heal.

In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs or inside the urethra, the channel inside the penis leading to the bladder.

While you have ulcers, it may be painful to urinate. You may also experience pain and tenderness in your genital area until the infection clears. During an initial outbreak, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.

Recurrences
Genital herpes is different for each person. The signs and symptoms may recur for years. Some people experience numerous episodes each year. For many people, however, the outbreaks are less frequent as time passes. Various factors may trigger outbreaks, including:

• Stress
• Menstruation
• Immune system suppression, from medications such as steroids or chemotherapy, or due to infections, such as HIV/AIDS
• Illness
• Surgery
• Friction, such as that caused by vigorous sexual intercourse
• Fatigue

In some cases, the infection can be active and contagious even when lesions aren't present.

When to see a doctor
If you suspect you have genital herpes — or any other sexually transmitted disease — see your doctor.

Two types of herpes simplex virus infections can cause genital herpes:

• HSV type 1 (HSV-1). This is the type that usually causes cold sores or fever blisters around your mouth, though it can be spread to your genital area during oral sex.
• HSV type 2 (HSV-2). This is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious whether or not you have an open sore. However, in many people the infection causes no recognized signs or symptoms and can still be spread to a sexual partner.

Because the virus dies quickly outside of the body, it's nearly impossible to get the infection through contact with toilets, towels or other objects used by an infected person.

Your doctor usually can diagnose genital herpes based on a physical exam and the results of certain laboratory tests:

• Viral culture. This test involves taking a tissue sample or scraping of the sores for examination in the laboratory.
• Blood test. This test analyzes a sample of your blood for the presence of HSV antibodies to detect a past herpes infection.
• Polymerase chain reaction (PCR) test. From a blood, tissue or spinal fluid sample, this DNA test can establish the presence of HSV and determine which type of HSV you have.

Because people with herpes commonly have other sexually transmitted diseases (STDs), such as chlamydia, gonorrhea or HIV/AIDS, your doctor will likely examine you for these diseases as well. If you suspect that you previously had a herpes outbreak, a blood test can confirm past exposure to HSV-1 or HSV-2 infection.

Genital herpes treatment includes oral prescription antiviral medications, such as acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex).

There's no cure for genital herpes. But with treatment, you might:

• Help sores heal sooner during an initial outbreak
• Lessen the severity and duration of symptoms in recurrent outbreaks
• Reduce the frequency of recurrences
• Minimize the chance of transmitting the herpes virus to another

Your doctor may recommend that you take the medicine only when you're experiencing symptoms of an outbreak (episodic therapy). Or your doctor may recommend that you take a medicine daily, even when you're not experiencing any signs of an outbreak, to minimize your chances of recurrent outbreaks (suppressive therapy). Suppressive therapy usually is recommended if you experience five or more outbreaks per year. But because these medications have proven very safe and effective, people with even fewer outbreaks per year are opting for daily, suppressive therapy.