Genital herpes is a viral infection of the genitals. It is transmitted by sexual activity such as intercourse or oral sex and can affect both sexes (man and woman). Genital herpes is often associated with other sexually transmitted infections. It is an infection caused by the herpes simplex virus or HSV. There are two types of HSV and both can cause genital herpes. HSV type 1 most commonly infects the lips, causing sores, but it also can infect the genital area. HSV type 2 is the usual cause of genital herpes but can also infect the mouth during oral sex. The lesions can occur in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin.
How Does Someone Get Genital Herpes?
Most people get genital herpes through sexual activity with someone who is having active lesions. When active, visible sores will be present in the genital area. The sores will shed viruses that can infect another person. However, a person can still have an outbreak with no visible sores. A person with genital herpes also can infect a sexual partner during oral sex.
It is very unlikely to get herpes infection by touching objects such as a toilet seat or hot tub.
What Are the Symptoms?
Some people who have genital herpes may not realize it because they may not have any symptoms, or the symptoms may be mild. When there are symptoms, they can be different in each person. Once infections occur, the symptoms will appear within two to 10 days. The first episode of symptoms may last for two to three weeks and includes:
- itching or burning feeling in the genital or anal area.
- pain in the legs, buttocks, or genital area.
- presence of small blisters which later breaks and are seen as sores.
- fluid discharge from the vagina and the sores.
- painful or difficult urination
Other sites of the sores are the mouth, or inside the vagina, and on the cervix. Over the next few days, the sores will become crusty, weepy, and then heal well without leaving a scar. Symptoms are more severe during the first episode and may include fever, headache, muscle aches, and swollen glands in the groin area.
In an acute episode, the diagnosis is made from the history and the presence of the typical lesions in the genital area. Confirmation may be made by laboratory identification of the virus particles in the fluid taken from one of the lesions. However, a negative laboratory test does not mean that there is no infection. Recurrent episodes are more difficult to diagnose due to the milder or even absent lesions. Viral shedding may also be intermittent, giving a negative result. HSV-specific antibody detection test (type-specific glycoprotein G-based test) can be done to assist in the diagnosis. The older antibody lab test is not accurate and not recommended.
- Develop severe infection in those with lowered immunity such as patients on anti-cancer or immunosuppressive drugs.
- Transmission of life-threatening systemic herpes to a newborn infant from an infected mother during vaginal delivery.
- Secondary bacterial infection.
- Associated with other sexually transmitted infections.
- Antiviral medications (e.g. acyclovir, valacyclovir]) are prescribed to treat herpes. They can help speed up the healing of outbreaks and to help reduce the frequency of outbreaks. A topical form of acyclovir is available but is usually not as effective.
- A painkiller medication is necessary to relieve the pain. A local anesthetics gel can be applied to the sores for relief.
- Keep the infected area clean and dry to prevent other infections from developing.
- Try to avoid touching the sores.
- Wash your hands after contact with the sores.
- Laundry your clothes separately until all lesions are healed.
- Avoid sexual contact from the time you first feel any symptoms until the sores are completely healed.
- Women should have a cervical cancer screening test done and discuss with the doctor regarding screening for other sexually transmitted infections.
- There is no dietary restriction during the acute episode.
- Genital herpes infection can be chronic, but symptoms and recurrence can be relieved with treatment.
- The discomfort varies from person to person and from time to time in the same person. In most people, the first herpes infection is much more painful and severe compared to the subsequent attack.
- It is possible that the recurrent episodes will be less frequent over time and may not even recur at all.
- Genital herpes infections do not cause other major problems in healthy adults.
- Avoid sexual activity if either partner has blisters or sores.
- Avoid oral sex with a partner who has cold sores on the mouth.
- Practice safe sex: reduce the number of sexual partners, use condoms (when used correctly, can reduce the risk of getting genital herpes but it is not 100%). The male partner should use a condom even if either sex partner has no active genital herpes. This is important if the infected partner has frequent recurrences.
- If you are pregnant, tell your obstetric provider if you have had genital herpes in the past. Precautions will be taken to prevent infection to the baby.
Will it recur?
Following the infection, the HSV can remain in certain nerve cells of the body for a long time and can produce symptoms intermittently in some infected individuals. In some people, the virus can become active several times a year. In others, it may be infrequent like once in a few years. This is called a recurrence. It is still not known why this happens. An infected person can suspect that an outbreak may start by feeling a tingling sensation or itching in the genital area or burning discomfort or pain in the buttocks or down the leg. Recurrent episodes are usually milder and in some cases, the sores may not be obvious. However, the virus is still active and you can still infect a sex partner during this time.
Recurrence episodes are often not predictable and it is uncertain whether it can be triggered by life events such as another illness, stress, reduced immunity, or having a menstrual period,
You should consult your doctor immediately if you:
- Did not improve in 1 week, despite treatment.
- Symptoms worsen, despite treatment.
- Unusual vaginal bleeding or swelling occurs.
- Fever returns during treatment or you become generally ill.