Overview
Genital herpes is a sexually transmitted infection (STI). It is caused by a virus called herpes simplex virus (HSV). Infection with HSV can cause painful sores and blisters around the lips, genitals, or anus. Sometimes, infection with HSV causes no sores. It is possible to have HSV and not know it. There is no cure, but the infection can be managed.
Two types of HSV can cause genital herpes: 1) HSV-1 and 2) HSV-2. The most common cause of genital herpes is HSV-2. HSV-1 usually causes cold sores that appear on the mouth, lips, and eyes, but it is becoming more common as a cause of genital herpes, especially in young women.
How does infection with the herpes virus occur?
HSV is spread through direct contact with herpes sores, usually during vaginal, oral, or anal sex. HSV also can be present on the skin even if there are no sores. If a person comes into contact with the virus on an infected person’s skin, he or she can become infected.
After a person is first infected, HSV stays in the body. It travels to nerve cells near the spine and stays there until something triggers it to become active again. When this happens, the virus then travels along the nerves, back to where it first entered the body, and causes a new outbreak of sores and blisters. This is called a recurrence. The virus can be passed to others during a recurrence.
How does infection with the herpes virus occur?
HSV is spread through direct contact with herpes sores, usually during vaginal, oral, or anal sex. HSV also can be present on the skin even if there are no sores. If a person comes into contact with the virus on an infected person’s skin, he or she can become infected.
After a person is first infected, HSV stays in the body. It travels to nerve cells near the spine and stays there until something triggers it to become active again. When this happens, the virus then travels along the nerves, back to where it first entered the body, and causes a new outbreak of sores and blisters. This is called a recurrence. The virus can be passed to others during a recurrence.
When a person is first infected with HSV, symptoms appear about 2–10 days after the virus enters the body.
Cause
Genital herpes affects the skin or mucous membranes of the genitals. The virus is spread from one person to another during sexual contact.
There are 2 types of HSV:
• HSV-1 most often affects the mouth and lips and causes cold sores or fever blisters. But it can spread from the mouth to the genitals during oral sex.
• HSV type 2 (HSV-2) most often causes genital herpes. It can be spread through skin contact or through fluids from the mouth or genitals.
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. But the virus can still be spread, even when no sores or other symptoms are present. In some cases, you do not know you are infected.
Genital HSV-2 infections are more common in women than men.
Symptoms
Symptoms of herpes
Many people who get herpes never have symptoms. Sometimes the symptoms are mild and are mistaken for another skin condition.
If you experience symptoms, they may include:
● Painful sores in the genital area, anus, buttocks, or thighs.
● Itching.
● Painful urination.
● Tender lumps in the groin.
During the first outbreak (called primary herpes), you may experience flu-like symptoms. These include body aches, fever, and headache. Many people who have a herpes infection will have outbreaks of sores and symptoms from time to time. Symptoms are usually less severe than the primary outbreak. The frequency of outbreaks also tends to decrease over time.
Stages of infection
Once you have been infected with the virus, you’ll go through different stages of infection.
Primary stage
This stage starts 2 to 8 days after you’re infected. Usually, the infection causes groups of small, painful blisters. The fluid in the blisters may be clear or cloudy. The area under the blisters will be red. The blisters break open and become open sores. You may not notice the blisters, or they may be painful. It may hurt to urinate during this stage.
While most people have a painful primary stage of infection, some don’t have any symptoms. They may not even know they’re infected.
Latent stage
During this stage, there are no blisters, sores, or other symptoms. The virus is traveling from the skin into the nerves near the spine.
Shedding stage
In the shedding stage, the virus starts multiplying in the nerve endings. If these nerve endings are in areas of the body that make or are in contact with body fluids, the virus can get into those body fluids. This could include saliva, semen, or vaginal fluids. There are no symptoms during this stage, but the virus can be spread during this time. This means that herpes is very contagious during this stage.
Recurrences
Many people have blisters and sores that come back after the first herpes attack goes away. This is called a recurrence. Usually, the symptoms aren’t as bad as they were during the first attack.
Stress, being sick, or being tired may start a recurrence. Being in the sun or having a menstrual period may also cause a recurrence. You may know a recurrence is about to happen if you feel itching, tingling, or pain in the places where you were first infected.
Treatment
Laboratory tests are needed to diagnose genital herpes. If sores are present, a sample of fluid is taken from a sore. The sample is tested to see if it contains the virus and, if so, what type of HSV it is.
A blood test also can help diagnose HSV. The test looks for antibodies that the body creates to fight the virus. The blood test can show the type of HSV, but it cannot tell how you got the infection or how long you have been infected.
Treatment can reduce the outbreaks, but it can’t cure you of the herpes simplex viruses.
Medications
Antiviral drugs may help speed up the healing time of the sores and reduce pain. Medications may be taken at the first signs of an outbreak (tingling, itching, and other symptoms) to reduce the symptoms. People who get outbreaks may also be prescribed medicines to make it less likely that they’ll get outbreaks in the future.
Home care
Use mild cleansers when bathing or showering in warm water. Keep the infected site clean and dry. Wear loose cotton clothing to keep the area comfortable.
Other
Exams and Tests
Tests can be done on skin sores or blisters to diagnose herpes. These tests are most often done when someone has a first outbreak and when a pregnant woman develops genital herpes symptoms.
Tests include:
• Culture of fluid from a blister or open sore. This test may be positive for HSV. It is most useful during the first outbreak.
• Polymerase chain reaction (PCR) done on fluid from a blister. This is the most accurate test to tell whether the herpes virus is present in the blister.
• Blood tests that check for antibody level to the herpes virus. These tests can identify whether a person has been infected with the herpes virus, even between outbreaks. A positive test result when a person has never had an outbreak would indicate exposure to the virus at some time in the past.
At this time, experts do not recommend screening for HSV-1 or HSV-2 in adolescents or adults who have no symptoms, including pregnant women.
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