What is genital herpes?
Herpes is a sexually transmitted infection (STI), which has existed for thousands of years. Herpes is often misunderstood, so it is important to have accurate information. Herpes is caused by the Herpes Simplex Virus (HSV). There are two types of the Herpes Simplex Virus: Herpes Simplex Type 1 (HSV-1) and Herpes Simplex Type 2 (HSV-2). HSV-1 or oral herpes most commonly causes cold sores or fever blisters in and near the mouth. HSV-1 also accounts for one-third of new cases of genital herpes and is transmitted during oral-genital sex. HSV-2 causes lesions in the genital area and is responsible for two-thirds of new genital infections. HSV-2 is only very rarely the cause of oral infections.
All herpes viruses to set up a lifelong presence in the body by traveling up the nerve pathways after an initial infection. The herpes virus remains in a dormant state in the nerve roots for long periods of time. A variety of triggers, such as prolonged exposure to bright sunlight, fever, menstruation, stress and localized skin trauma, can cause the Herpes Simplex Virus to reawaken. This process can lead to a recurrence of symptoms or a more actively contagious state without recognizable symptoms (known as asymptomatic or silent shedding).
Is it common?
Genital herpes (HSV-2) is common in the United States, and is found in about 1 out of every 6 people aged 14 to 49 years.
Oral Herpes (HSV-1) is extremely common in the United States. The CDC estimates that between 50% and 80% of adults are infected. It is estimated that as much as 90% of the US population will carry the HSV-1 virus by the time they reach age 50.
How is it transmitted?
Herpes is spread through micro abrasions during vaginal, oral or anal sex with an infected partner. It is also possible to spread oral herpes through kissing. The herpes virus is most easily spread when a blister is present, but it is often spread at other times, too. Some people notice itching, tingling or other sensations before they see blisters or sores on their skin. These are called prodromal symptoms and they are a warning that the virus may be present on the skin. Herpes is most likely to be spread from the time these first symptoms are noticed until the area is completely healed and the skin looks normal again. Sexual contact, including any oral, vaginal or anal contact, poses a very clear risk of transmitting the virus to a partner during this time.
In addition, it is possible to spread the infection from one part of the body to another by touching the blisters, so be sure to wash your hands thoroughly or wear gloves if applying lotions or creams during an outbreak. Avoid touching your eyes after touching lesions.
Although herpes is most contagious when symptoms are present, it can also be transmitted during asymptomatic periods. Recurrences may go unrecognized by the infected person because they may be mild, atypical or in areas that are difficult to see (such as the cervix or the anus). Current research shows that the virus can also be shed without causing any symptoms. Many people are totally unaware that they have the herpes virus.
Abstaining from sex if you or your partner(s) are having an outbreak and using condoms or dental dams during every sexual encounter can reduce the risk of transmission. Even with condoms and dental dams and abstinence during outbreaks, there is still a risk of transmission since herpes can spread from areas not covered by the condom or dam and can spread even when there are no symptoms.
What are the symptoms?
Initial primary infection: usually occurs 2 to 10 days after the virus enters the body. Symptoms may include:
Painful blisters on the genitals (including the anus), thighs or buttocks that eventually crust over and are completely healed in 2 to 4 weeks.
Discharge from the urethra
General discomfort, muscle aches, and headaches
Painful urination or difficulty urinating
Pain with intercourse
Tender, enlarged lymph nodes near the groin
Recurrent infection: HSV-2 is more likely to recur than HSV-1 on the genitals. Symptoms are usually milder and of shorter duration than the initial outbreak. Symptoms may include:
Localized tingling and irritation (known as prodrome) 12 to 24 hours prior to the appearance of blisters. This symptom occurs in 50% of all cases.
Painful genital lesions lasting 4 to 6 days.
Vaginal discharge is a rare symptom in a recurrent infection.
How is it diagnosed?
Your medical provider may be able to diagnose herpes based on a physical exam if you have typical symptoms such as painful blisters, swollen glands or fever. This diagnosis can often be confirmed by a viral culture, which is most accurate early in the course of the disease (when lesions look like fluid-filled blisters). There are blood tests that may be useful in certain circumstances. Most blood tests screen for antibodies to HSV so they cannot be used to diagnose a very recent infection. Your medical provider will decide which tests are appropriate in your case. Click here to learn about Providence area testing options.
How is it treated?
Although there is no cure, herpes is a very manageable infection. Your provider may prescribe antiviral medication. Early treatment with antivirals may shorten the course of the painful skin lesions and reduce viral shedding. This may lessen the chance of transmitting the virus to a sexual partner. The same medication may be used to reduce the duration and intensity of future outbreaks.
If you have an active infection:
Follow the full treatment prescribed by your provider.
When you have blisters, use disposable gloves to apply medication.
Wear loose clothing and cotton underwear to allow circulation of air and avoid pressure on the skin which may cause more blisters.
Your provider may prescribe a pain reliever if necessary or you can take Tylenol or Ibuprofen. (Avoid aspirin if you are under 20 years old due to its connection with Reyes Syndrome, a rare neurological syndrome associated with aspirin use to treat illness with high fever.)
Avoid sharing towels or clothing.
Do not use douches, perfumed soaps, feminine hygiene deodorants or other chemicals in the genital area.
Avoid a lot of sunlight or heat since this may cause more blisters.
A warm bath may be soothing.
If urination is painful, it may help to squirt tepid water over the genitals while urinating.
Avoid sexual contact with others when you have an active infection.
Are there possible complications associated with genital herpes?
Complications are rare, but you should be aware of the following:
The eyes are vulnerable to herpes and can become infected when someone touches an active infection and then transfers the virus to their eye by touching or rubbing. Herpes Keratitis can eventually lead to blindness if not treated. Warning signs include:
A prolonged feeling that something is in the eye
Irritation, redness, swelling or eye discharge
Unusual sensitivity to light
If you experience any of these symptoms in association with an active herpes infection, you need to see a medical provider immediately.
Neonatal herpes is the transmission of herpes from birthing parent to newborn during birth. A newborn is very susceptible to herpes since the immune system is not developed to ward off all infection. The danger is greatest when the birthing parent experiences their first herpes outbreak during labor. To be safe, many obstetricians will advise cesarean sections if active herpes sores are present during labor to prevent the baby from coming into contact with the virus. Any pregnant person who has ever had herpes should inform their obstetrician so that appropriate precautions can be taken to ensure a healthy newborn.
Is there any relationship between cervical cancer and genital herpes?
Research does not show a connection between herpes and cervical cancer. Cervical cancer seems to be almost always linked to the HPV virus. Regular Pap smear tests are important health care screenings for cervical cancer and are recommended for all people with cervixes beginning at age 21, regardless of whether they have herpes.
How do I deal with the emotional stress of having herpes?
The emotional stress of dealing with herpes can be more difficult to cope with than any physical discomforts caused by the virus. It is normal to feel frustrated, angry, guilty or isolated. Remember that herpes is a common infection. You are not alone. Some find it helpful to seek support from friends, family or partners, while others rely on a counselor or support group. Sorting out fact from misinformation and finding the support resources you need are the first steps in managing herpes infection. Besides your medical provider, counselor, and family and friends, there are many resources to help you through this experience:
The National Herpes Hotline
This hotline provides accurate information and appropriate referrals to anyone concerned about herpes. Health specialists can address questions related to transmission, prevention and treatment of herpes. The hotline also provides support for emotional issues surrounding herpes such as self-esteem and partner communication. The hotline is open from 9:00am to 7:00pm Monday through Friday.
Providence HELP (affiliated with Family Services, Inc.)
This local support group is for people concerned about herpes. The group provides a safe, confidential environment where participants can get accurate information and share experiences, fears, and feelings with others who are concerned about herpes.
Brown students can also access on campus resources for support, including:
Health Promotion 401.863-1330
Brown students can make an appointment with Naomi Ninneman, Health Educator, for confidential discussions of sexual health topics including STIs and STI testing, safer sex, and partner communication. Call 401-863-2794 or e-mail Naomi_Ninneman@brown.edu to schedule an appointment. If e-mailing, please include days and times when you would like to try to schedule your appointment. To protect your privacy, since e-mail is not a secure form of communication, avoid including any personal medical information in your e-mail.