Genital herpes is a sexually transmitted disease (STD) that can cause blisters and skin ulcers in the genital and anal area. It can be caused by either of two types of herpes simplex virus, HSV-1 or HSV-2. HSV-2 is the more common cause. HSV-1 more commonly causes sores on the face and mouth.

HSV spreads from person to person through kissing and skin-to-skin contact, as well as through vaginal, oral or anal intercourse. An infected person often transmits the virus when skin blisters or ulcers are visible, but the virus also can be spread when there are no symptoms or skin sores at all. Herpes virus can be transmitted by people who don't know they are infected.

In a pregnant woman with HSV infection (usually HSV-2), the virus can pass to the baby during delivery, causing infections of the newborn's skin, mouth, lungs or eyes. If the herpes virus spreads through the baby's bloodstream, it can cause serious infections of the brain and other vital organs.

Approximately 45 million people in the United States older than age 12 have genital herpes. Among Americans between the ages of 15 and 45, genital herpes affects approximately 1 in every 4 women and 1 in every 5 men. In the past decade, the number of genital herpes infections has increased significantly among Americans and as many as 1 million people are newly infected with herpes each year. The most dramatic increase has been seen in adolescents and young adults.

Many people with genital herpes infection have no symptoms. When symptoms appear, they can include:

• Itching, burning, soreness and small blisters in the genital or anal area
• Small ulcers (skin sores) when the blisters break
• Local pain if urine touches the genital ulcers
• Discharge from the vagina or urethra
• Enlarged or painful lymph nodes (swollen glands) in the groin
• Headache, fever, muscle aches and a generally sick feeling

In some people with genital herpes, cold sores or fever blisters also can erupt around the mouth. In a smaller number of people, genital herpes can cause problems with urination when the virus affects the nerves to the bladder; can cause meningitis (inflammation around the brain) that can be recurrent (known as Mollaret’s meningitis); or can cause proctitis (inflammation of the rectum or anus that can involve pain, bleeding, fever and chills), particularly in men who have sex with men.

The first episode of herpes symptoms usually has the worst symptoms. When symptoms develop, they can occur from a few days to a few weeks after contact with an infected person, but sometimes an infected person might not have any symptoms for years. Almost everyone with symptomatic genital herpes will have at least one recurrence. In people who have repeated herpes episodes, symptoms can be triggered by physical or emotional stress, sunlight, and in women by birth control pills or menstrual periods.

Newborns infected with herpes around the time of delivery usually develop symptoms 5 to 9 days after birth. Symptoms can include blisters on the skin, eyes and mouth. If the virus spreads through the baby's bloodstream to the brain, there can be sleepiness or irritability, and seizures. The virus can also spread to the baby's liver, lungs and other organs, causing disseminated (wide-spread) disease. Some babies may need to be placed on a ventilator to help with breathing. Herpes in a newborn can be from either HSV-1 or HSV-2, but HSV-2 causes severe disease.

Your doctor may suspect that you have genital herpes based on your sexual history, your symptoms and the results of your physical examination. Your doctor may want to confirm the diagnosis by scraping the affected skin area for laboratory testing. He or she may also want to do a blood test to confirm the diagnosis. Because people who have one type of STD are at risk of others, your doctor may wish to test you for other STDs, such as syphilis, gonorrhea, chlamydia, trichomoniasis and human immunodeficiency virus (HIV).

The diagnosis of herpes infection in the newborn can be difficult because other things can cause similar symptoms in babies, including other types of infections. The diagnosis is made in a similar way to adults.

There is no cure for genital herpes. Herpes infection is a lifelong illness whose symptoms tend to return periodically. The pattern of recurrence (how frequently it happens, how long it lasts and what the symptoms are) is different for every person.

To avoid getting herpes, you should always follow safer sexual practices. Limit your number of sexual partners, and always use condoms unless you are in a monogamous relationship with an uninfected person.

People with genital herpes should abstain from sexual activity when they have symptoms. They also should tell all sex partners about their herpes infection and use condoms during sexual activity. Even without symptoms, a person can shed the herpes virus and infect others.

There is some evidence that people who are infected with genital herpes can reduce the frequency and severity of recurrences and reduce the risk of transmitting the infection to sexual partners by taking antiviral medication every day (see Treatment, below).

People with genital herpes are more likely to become infected with HIV if they are exposed through sexual intercourse. If you have HIV and you are infected with HSV-2, you may be more likely to spread HIV to others.

Pregnant women who have visible ulcers from genital herpes at the time of delivery usually are encouraged to have a Caesarean section to prevent HSV from spreading to the newborn. Because the decision to have a Caesarean section is based on many factors, a pregnant woman with HSV infection should discuss the subject with her physician as early as possible in her pregnancy. Women with their first outbreak at the time of delivery have the highest risk of transmitting the virus to the baby. Women known to have herpes before delivery may be counseled to take antivirals for the last few weeks of their pregnancy, but this decision should be made on a case-by-case basis.

Episodes of genital herpes can be treated with oral antiviral medications, including valacyclovir (Valtrex), famciclovir (Famvir) and acyclovir (Zovirax). Acyclovir also comes in a cream for application to the skin and in a form that is given in a vein (intravenously). Studies suggest acyclovir by mouth is more effective in treating genital herpes than the cream. The intravenous form is reserved for very severe infection or for people who can’t swallow or keep down pills. Although these medications cannot cure the herpes infection, they can reduce the severity and shorten the duration of symptoms. Genital herpes should be treated as soon as possible; ideally antivirals should begin within three days of when symptoms start.

For recurrences, these antiviral medications can be started at soon as symptoms are noticed to make the outbreak less severe. People with severe or frequent recurrences might discuss with their doctor if they should take antiviral medications daily. Daily use of antiviral medications can reduce the severity and frequency of recurrences. Daily antivirals might also help prevent transmission of herpes virus to sexual partners.

The decision about whether to treat a pregnant woman known to have herpes with antivirals during the weeks before delivery should be made on a case-by-case basis together with an obstetrician. If a newborn baby is infected with herpes, the infection is treated with an antiviral medication given intravenously.

Call your doctor if you have any blisters or sores in your genital area, especially if you are pregnant, have frequent bouts of symptoms or want to know how to best protect your sexual partner from getting infected.

Although there is no cure for genital herpes, the frequency and severity of recurrences often decreases with time. Daily oral antiviral medication also can decrease the number and severity of recurrences.

For babies with disseminated herpes infection (the most severe type), early treatment with antivirals improves the chance of survival. Babies with this type of infection who do not get the right treatment at the right time can die of disseminated herpes.

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Toll-Free: 1-800-232-4636
TTY: 1-888-232-6348
Email: cdcinfo@cdc.gov
http://www.cdc.gov/std/

American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
Phone: 919-361-8400
Fax: 919-361-8425
Email: std-hivnet@ashastd.org
http://www.ashastd.org/