Genital herpes

Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). Sexual contact is the primary way that the virus spreads. After the initial infection, the virus lies dormant in your body and can reactivate several times a year.

Genital herpes can cause pain, itching and sores in your genital area. But you may have no signs or symptoms of genital herpes. If infected, you can be contagious even if you have no visible sores.

There's no cure for genital herpes, but medications can ease symptoms and reduce the risk of infecting others. Condoms also can help prevent the spread of a genital herpes infection.

Symptoms

Most people infected with HSV don't know they have it because they don't have any signs or symptoms or because their signs and symptoms are so mild.

When present, symptoms may begin about two to 12 days after exposure to the virus. If you experience symptoms of genital herpes, they may include:

• Pain or itching. You may experience pain and tenderness in your genital area until the infection clears.
• Small red bumps or tiny white blisters. These may appear a few days to a few weeks after infection.
• Ulcers. These may form when blisters rupture and ooze or bleed. Ulcers may make it painful to urinate.
• Scabs. Skin will crust over and form scabs as ulcers heal.

During an initial outbreak, you may have flu-like signs and symptoms such as swollen lymph nodes in your groin, headache, muscle aches and fever.

Differences in symptom location

Sores appear where the infection entered your body. You can spread the infection by touching a sore and then rubbing or scratching another area of your body, including your eyes.

Men and women can develop sores on the:

• Buttocks and thighs
• Anus
• Mouth
• Urethra (the tube that allows urine to drain from the bladder to the outside)

Women can also develop sores in or on the:

• Vaginal area
• External genitals
• Cervix

Men can also develop sores in or on the:

• Penis
• Scrotum

Recurrences are common

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

During a recurrence, shortly before sores appear, you may feel:

• Burning, tingling and itching where the infection first entered your body
• Pain in your lower back, buttocks and legs

However, recurrences are generally less painful than the original outbreak, and sores generally heal more quickly.

When to see a doctor

If you suspect you have genital herpes — or any other sexually transmitted infection — see your doctor.

Causes

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

• HSV-1. This is the type that usually causes cold sores or fever blisters around your mouth. HSV-1 is often spread through skin-to-skin contact, though it can be spread to your genital area during oral sex. Recurrences are much less frequent than they are with HSV-2 infection.
• 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.

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.

Risk factors

Your risk of becoming infected with genital herpes may increase if you:

• Are a woman. Women are more likely to have genital herpes than are men. The virus is sexually transmitted more easily from men to women than it is from women to men.
• Have multiple sexual partners. Each additional sexual partner raises your risk of being exposed to the virus that causes genital herpes.

Complications

Complications associated with genital herpes may include:

• Other sexually transmitted infections. Having genital sores increases your risk of transmitting or contracting other sexually transmitted infections, including AIDS.
• Newborn infection. Babies born to infected mothers can be exposed to the virus during the birthing process. This may result in brain damage, blindness or death for the newborn.
• Bladder problems. In some cases, the sores associated with genital herpes can cause inflammation around the tube that delivers urine from your bladder to the outside world (urethra). The swelling can close the urethra for several days, requiring the insertion of a catheter to drain your bladder.
• Meningitis. In rare instances, HSV infection leads to inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord.
• Rectal inflammation (proctitis). Genital herpes can lead to inflammation of the lining of the rectum, particularly in men who have sex with men.

Prevention

The suggestions for preventing genital herpes are the same as those for preventing other sexually transmitted infections: Abstain from sexual activity or limit sexual contact to only one person who is infection-free. Short of that, you can:

• Use, or have your partner use, a latex condom during every sexual contact
• Avoid intercourse if either partner has an outbreak of herpes in the genital area or anywhere else

Pregnancy precautions

If you're pregnant and know you have genital herpes, tell your doctor. If you think you might have genital herpes, ask to be tested for it.

Your doctor may recommend that you start taking herpes antiviral medications late in pregnancy to try to prevent an outbreak around the time of delivery. If you're having an outbreak when you go into labor, your doctor will probably suggest a cesarean section to reduce the risk of passing the virus to your baby.

Diagnosis

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.
• Polymerase chain reaction (PCR) test. PCR is used to copy your DNA from a sample of your blood, tissue from a sore or spinal fluid. The DNA can then be tested to establish the presence of HSV and determine which type of HSV you have.
• Blood test. This test analyzes a sample of your blood for the presence of HSV antibodies to detect a past herpes infection.

Treatment

There's no cure for genital herpes. Treatment with prescription antiviral medications may:

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

Antiviral medications used for genital herpes include:

• Acyclovir (Zovirax)
• Valacyclovir (Valtrex)

Your doctor may recommend that you take the medicine only when you have symptoms of an outbreak or that you take a certain medication daily, even when you have no signs of an outbreak. These medications are usually well-tolerated, with few side effects.

Coping and support

Finding out that you have genital herpes can cause embarrassment, shame and anger, among other emotions. You may be suspicious or resentful of your partner if you think he or she "gave" you the infection. Or you might fear rejection by your current partner or future partners.

What you're feeling is normal. Here are healthy ways to cope with having genital herpes:

• Communicate with your partner. Be open and honest about your feelings. Trust your partner and believe what he or she tells you. Don't assign blame. Genital herpes can lie dormant in your body for years, so it's often difficult to determine when you became infected.
• Educate yourself. Talk with your doctor or a counselor to learn how to live with the condition and minimize your chances of infecting others. Learn about your treatment options and how to manage outbreaks.
• Join a support group. Look for a group in your area or online so that you can talk about your feelings and learn from others' experiences.

Preparing for an appointment

If you think you have genital herpes or other sexually transmitted infection, make an appointment to see your primary care doctor or gynecologist.

What you can do

Before your appointment, you might want to list answers to the following questions:

• What are your symptoms? When did they start?
• Do you have a new sexual partner or multiple partners?
• Have you ever been diagnosed with a sexually transmitted infection?
• Do you regularly use condoms?
• What medications or supplements do you take regularly?

Some basic questions to ask your doctor include:

• What tests do I need?
• Should I be tested for other sexually transmitted infections?
• Should my partner be tested?
• Do I need to abstain from sexual activity during treatment?
• How can I avoid infecting my partner?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• Do you have pelvic pain?
• Do you have pain while urinating?
• Do you have sores or unusual discharge?

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