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Genital herpes

Genital herpes is a sexually transmitted infection (STI). It is caused by the herpes simplex virus (HSV).

This article focuses on HSV type 2 (HSV-2) infection.

Alternative Names

Herpes - genital; Herpes simplex - genital; Herpesvirus 2; HSV-2

Causes

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 two kinds of HSV:

  • HSV-1 usually 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-2 most often causes genital herpes. HSV-2 can be spread through secretions (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

Many people with genital herpes never have sores. Or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.

If signs and symptoms do occur during the first outbreak, they can be severe. This first outbreak usually happens within 2 days to 2 weeks of being infected.

General symptoms may include:

  • Decreased appetite
  • Fever
  • General sick feeling (malaise )
  • Muscle aches in the lower back, buttocks, thighs, or knees
  • Swollen and tender lymph nodes in the groin during an outbreak

Genital symptoms include small, painful blisters filled with clear or straw-colored fluid. They are usually found:

  • In women, blisters may be on the outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks.
  • In men, blisters may be on the penis, scrotum, around the anus, on the thighs or buttocks.
  • In both genders, blisters may be on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body.
  • Before the blisters appear, there may be tingling, burning, itching, or pain at the site where the blisters will appear.
  • When the blisters break, they leave shallow ulcers that are very painful. These ulcers crust over and heal in 7 to 14 days or more.

Other symptoms may include:

A second outbreak can appear weeks or months later. It is usually less severe and goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.

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 women develops genital herpes symptoms. Tests include:

  • Culture of fluid from a blister or open sore may be positive for herpes simplex virus. It is most useful during the first outbreak.
  • Polymerase chain reaction (PCR) done on fluid from a blister 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 can identify whether a person has been infected with the herpes virus, even between outbreaks. Tests may be positive even if the person never had an outbreak.

Treatment

Genital herpes cannot be cured. Antiviral medicines may be prescribed:

  • They help relieve pain and discomfort during an outbreak by healing the sores more quickly. They seem to work better during a first attack than in later outbreaks.
  • For repeat outbreaks, the medicine should be taken as soon as tingling, burning, or itching begins, or as soon as blisters appear.
  • Persons who have many outbreaks may take these medicines daily over a period of time. This helps prevent outbreaks or shorten their length. It can also reduce the chance of giving herpes to someone else.

Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended to reduce the chance of infecting the baby.

Possible side effects from herpes medicines include:

  • Fatigue
  • Headache
  • Nausea and vomiting
  • Rash
  • Seizures
  • Tremor

Follow your health care provider's advice on how to care for your herpes symptoms at home .

Support Groups

You can ease the stress of illness by joining a herpes support group . Sharing with others who have common experiences and problems can help you not feel alone. 

Outlook (Prognosis)

Once you are infected, the virus stays in your body for the rest of your life. Some people never have another episode. Others have frequent outbreaks that can be triggered by fatigue, illness, menstruation, or stress.

Possible Complications

Pregnant women who have an active genital herpes infection when they give birth may pass the infection to their baby.

The virus may spread to other parts of the body, including the brain, eyes, esophagus, liver, spinal cord, or lungs. These complications often develop in people who have a weakened immune system due to HIV or certain medicines.

When to Contact a Medical Professional

Call your health care provider if you have any symptoms of genital herpes or if you develop fever, headache, vomiting, or other symptoms during or after an outbreak of herpes.

Prevention

The best way not to get genital herpes is to avoid all sexual contact, including oral sex.

Being in a long-term, mutually monogamous relationship with someone who has been tested and has never been infected with the virus can also help reduce your chance of becoming infected. If you have genital herpes, you should tell your partner that you have the disease, even if you do not have symptoms.

Condoms are the best way to protect against catching genital herpes during sexual activity:

  • Using a condom correctly and consistently helps prevent spread of the disease.
  • Only latex condoms prevent infection. Animal membrane (sheepskin) condoms do not work because the virus can go right through them.
  • Using the female condom also reduces the risk of spreading genital herpes.
  • A latex condom should be used during all sexual contact, even if the infected person does not have any sores or blisters at that time. Be aware you can still get genital herpes when using a condom.

References

Habif TP. Sexually transmitted viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 11.

Schiffer JT, Corey L. Herpes simplex virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 136.

Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1-110.

Updated: 8/5/2013

Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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