What is genital herpes

Genital herpes is a common sexually transmitted disease (STD) that is caused by the herpes simplex virus (HSV) – the same type of virus that causes cold sores.

Most people with the herpes simplex virus (HSV) don’t have symptoms. Even without signs of the disease, herpes can still be spread to sex partners.

Genital herpes is common in the United States. At least 50 million people in the United States—about one in six adults—are infected with HSV. More than one out of every six people aged 14 to 49 years have genital herpes. Genital herpes is more common in women than in men.

Genital herpes can cause outbreaks of blisters or sores on the genitals and anus. Once infected, you can continue to have recurrent episodes of symptoms throughout your life.

There are 2 types of herpes simplex virus (HSV), both viruses can affect either the lips, mouth, genital or anal areas, however:

  • Herpes simplex virus type 1 (HSV1) commonly causes cold sores on the lips, mouth or face. However, most people do not have any symptoms. Most people with oral herpes were infected during childhood or young adulthood from non-sexual contact with saliva. Oral herpes caused by HSV-1 can be spread from the mouth to the genitals through oral sex. This is why some cases of genital herpes are caused by HSV-1.
  • Herpes simplex virus type 2 (HSV2) causes most genital herpes.

It is most easily spread when there are blisters or sores, but can still be passed even if a person has no current blisters or sores or other symptoms. HSV also can be present on the skin even if there are no sores. If a person comes into contact with the virus on an infected person’s skin, he or she can become infected.

If you have Genital Herpes
  • If you think you have genital herpes, it is important to see a doctor as soon as possible. Your doctor can confirm the diagnosis with testing and start treatment. Anti-viral medication may help to prevent transmission. Talk to your doctor about this in more detail.
  • If you have genital herpes, it is important to always use condoms and dental dams when having sex, even when you have no symptoms. A dental dam is a square of thin latex that can be placed over the vulva or anal area during oral sex. It is safest to avoid sex when you have blisters, sores or symptoms.
  • It is also important to tell your sexual partners that you have genital herpes. Your doctor can help you decide who to tell and how to tell them.
  • If you’re pregnant: It’s important to tell your obstetrician that you or a partner have had genital herpes, so that they can monitor you for symptoms and manage your pregnancy safely. There is a risk you can pass the virus on to your baby if you have a vaginal delivery during a first attack of genital herpes. If this happens you may be recommended to have a caesarean delivery.

Vaccine development is an area of active research, and several different approaches are being tested in animal models, including “therapeutic” vaccines that might help those already infected. In May 2015, a promising vaccine design was announced 1).

I’m pregnant. How could genital herpes affect my baby?

If you are pregnant and have genital herpes, it is very important for you to go to prenatal care visits. Tell your doctor if you have ever had symptoms of, or have been diagnosed with, genital herpes. Also tell your doctor if you have ever been exposed to genital herpes. There is some research that suggests that genital herpes infection may lead to miscarriage, or could make it more likely for you to deliver your baby too early.

Herpes infection can be passed from you to your unborn child before birth but is more commonly passed to your infant during delivery. This can lead to a potentially deadly infection in your baby (called neonatal herpes). It is important that you avoid getting herpes during pregnancy. If you are pregnant and have genital herpes, you may be offered anti-herpes medicine towards the end of your pregnancy. This medicine may reduce your risk of having signs or symptoms of genital herpes at the time of delivery. At the time of delivery, your doctor should carefully examine you for herpes sores. If you have herpes symptoms at delivery, a ‘C-section’ is usually performed.

How is genital herpes spread?

You can get genital herpes by having vaginal, anal, or oral sex with someone who has the disease.

If you do not have herpes, you can get infected if you come into contact with the herpes virus in:

  • A herpes sore;
  • Saliva (if your partner has an oral herpes infection) or genital secretions (if your partner has a genital herpes infection);
  • Skin in the oral area if your partner has an oral herpes infection, or skin in the genital area if your partner has a genital herpes infection.

You can get herpes from a sex partner who does not have a visible sore or who may not know he or she is infected. It is also possible to get genital herpes if you receive oral sex from a sex partner who has oral herpes.

  • You will not get herpes from toilet seats, bedding, or swimming pools, or from touching objects around you such as silverware, soap, or towels. If you have additional questions about how herpes is spread, consider discussing your concerns with a healthcare provider.

Risk factors for genital herpes

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 of genital herpes

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.

How can you reduce your risk of getting genital herpes?

The only way to avoid sexually transmitted diseases (STDs) is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting genital herpes:

  • Be in a long-term mutually monogamous relationship with a partner who is not infected with an STD (e.g., a partner who has been tested and has negative STD test results);
  • Using latex condoms the right way every time you have sex.

Be aware that not all herpes sores occur in areas that are covered by a latex condom. Also, herpes virus can be released (shed) from areas of the skin that do not have a visible herpes sore. For these reasons, condoms may not fully protect you from getting herpes.

If you are in a relationship with a person known to have genital herpes, you can lower your risk of getting genital herpes if:

  • Your partner takes an anti-herpes medication every day. This is something your partner should discuss with his or her doctor.
  • You avoid having vaginal, anal, or oral sex when your partner has herpes symptoms (i.e., when your partner is having an outbreak).

Sexually Transmitted Disease (STD) Risk and Oral Sex

Oral sex involves using the mouth, lips, or tongue to stimulate the penis (fellatio), vagina (cunnilingus), or anus (anilingus) of a sex partner. The penis and testicles and the vagina and area around the vagina are also called the genitals or genital area.

Facts:

  • The only way to avoid STDs is to not have vaginal, anal, or oral sex.
  • Many sexually transmitted diseases (STDs) can be spread through oral sex.
  • Using a condom, dental dam or other barrier method each and every time you have oral sex can reduce the risk of giving or getting an STD.
  • Although oral sex may carry a lower risk for spreading HIV than other forms of sex, repeated unprotected exposures may increase risk of transmission.

Many STDs, as well as other infections, can be spread through oral sex. Anyone exposed to an infected partner can get an STD in the mouth, throat, genitals, or rectum. The risk of getting an STD from oral sex, or spreading an STD to others through oral sex, depends on a number of things, including:

  • The particular STD.
  • The sex acts practiced.
  • How common the STD is in the population to which the sex partners belong.
  • The number of specific sex acts performed.

Oral sex is commonly practiced by sexually active adults. Oral sex can happen between heterosexual (straight) and same-sex (gay or lesbian) couples. More than 85% of sexually active adults aged 18-44 years reported having had oral sex at least once with a partner of the opposite sex. A separate survey conducted during 2007-2010 found that 33% of teenage girls and boys aged 15-17 years reported having had oral sex with a partner of the opposite sex.

In general:

  • It may be possible to get some STDs in the mouth or throat from giving oral sex to a partner with a genital or anal/rectal infection, particularly from giving oral sex to a partner with an infected penis.
  • It also may be possible to get certain STDs on the penis (and possibly the vagina, anus or rectum) from getting oral sex from a partner with a mouth or throat infection.
  • It’s possible to have an STD in more than one area at the same time, for example in the throat and the genitals.
  • Several STDs that may be transmitted by oral sex can then spread throughout the body of an infected person.
  • STDs can be spread to a sex partner even when the infected partner has no signs or symptoms. If you are infected with an STD, you might not know it because many STDs may have no symptoms.

Which Sexually Transmitted Diseases (STDs) Can Be Passed On from Oral Sex?

  • Herpes (herpes simplex virus types 1 and 2)
  • Syphilis (Treponema pallidum)
  • Human papillomavirus (HPV)
  • Human immunodeficiency virus (HIV)
  • Trichomoniasis (Trichomonas vaginalis)
  • Chlamydia (Chlamydia trachomatis)
  • Gonorrhea (Neisseria gonorrhoeae)
  • Hepatitis A virus, Shigella and intestinal parasites (amebiasis) can be spread through giving oral sex on the anus.

Is Oral Sex Safer than Vaginal or Anal Sex?

Many STDs can be spread through oral sex. However, it is difficult to compare the exact risks of getting specific STDs from specific types of sexual activity. This is partly because most people who have oral sex also have vaginal or anal sex. Also, few studies have looked at the risks of getting STDs other than HIV from giving oral sex on the vagina or anus, compared to giving oral sex on the penis.

Studies have shown that the risk of getting HIV from having oral sex with an infected partner (either giving or getting oral sex) is much lower than the risk of getting HIV from anal or vaginal sex with an infected partner. This may not be true for other STDs – in one study of gay men with syphilis, 1 out of 5 reported having only oral sex.

  • Getting HIV from oral sex may be less likely than vaginal or anal sex, but it still carries risk. If you are having oral sex you should still protect yourself. Repeated unprotected oral sex exposure to HIV may represent a considerable risk for spread of HIV, as well as other STDs for which the risk of spread through oral sex has not been as well studied.

It is possible that getting certain STDs, such as chlamydia or gonorrhea, in the throat may not pose as great a threat to an infected person’s health as getting an STD in the genital area or rectum. Having these infections in the throat might increase the risk of getting HIV. Having gonorrhea in the throat also may lead to spread of the disease throughout the body. In addition:

  • Having infections of chlamydia and gonorrhea in the throat may make it easier to spread these infections to others through oral sex. This is especially important for gonorrhea, since throat infections are harder to treat than urinary, genital or rectal infections.
  • Infections from certain STDs, such as syphilis and HIV, spread throughout the body. Therefore, infections that are acquired in the throat may lead to the same health problems as infections acquired in the genitals or rectum.
  • Mouth and throat infections by certain types of HPV may develop into oral or neck cancer.

What May Increase the Chances of Giving or Getting an STD through Oral Sex?

It is possible that certain factors may increase a person’s chances of getting HIV or other STDs during oral sex if exposed to an infected partner, such as:

  • Having poor oral health which can include tooth decay, gum disease or bleeding gums, and oral cancer.
  • Having sores in the mouth or on the genitals.
  • Being exposed to the “pre-cum” or “cum” (also known as pre-ejaculate or ejaculate) of an infected partner.

However, no scientific studies have been done to show whether or not these factors actually do increase the risk of getting HIV or STDs from oral sex.

What Can You Do to Prevent STD Transmission During Oral Sex?

You can lower your chances of giving or getting STDs during oral sex by using a condom, dental dam or other barrier method each and every time you have oral sex.

For oral sex on the penis:

  • Cover the penis with a non-lubricated latex condom.
  • Use plastic (polyurethane) condoms if you or your partner is allergic to latex.

For oral sex on the vagina or anus:

  • Use a dental dam.
  • Cut open a condom to make a square, and put it between the mouth and the partner’s vagina or anus.

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting an STD:

  • Being in a long-term mutually monogamous relationship with a partner who is not infected with an STD (e.g., a partner who has been tested and has negative STD test results).
  • Using latex condoms the right way every time you have sex.

It’s important to remember that many infected individuals may be unaware of their infection because STDs often have no symptoms and are unrecognized.

If you are sexually active, you should get tested regularly for STDs and HIV and talk to your partner(s) about STDs. If you think you might have an STD, stop having sex and visit your doctor or clinic to get tested. There are free and low-cost options for testing in your area. It is important that you talk openly with your health care provider about any activities that might put you at risk for an STD, including oral sex.

What does genital herpes look like

Most people who have genital herpes have no symptoms, or have very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it.

Herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take a week or more to heal. These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

People who experience an initial outbreak of herpes can have repeated outbreaks, especially if they are infected with HSV-2. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection stays in the body for the rest of your life, the number of outbreaks may decrease over time.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD. STD symptoms can include an unusual sore, a smelly genital discharge, burning when urinating, or (for women) bleeding between periods.

Figure 1. Male genital herpes

male genital herpes

male genital herpes

Figure 2. Female genital herpes

female genital herpes
female genital herpes

Genital herpes signs and symptoms

The symptoms of genital herpes can vary widely, depending upon whether you are having an initial or recurrent episode. However, many people infected with genital herpes never experience symptoms.

The first time a person has noticeable signs or symptoms of herpes may not be the initial episode. For example, it is possible to be infected for the first time, have few or no symptoms, and then have a recurrent outbreak with noticeable symptoms several years later. For this reason, it is often difficult to determine when the initial infection occurred, especially if a person has had more than one sexual partner. Thus, a current sexual partner may not be the source of the infection.

  • 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

Genital Herpes Stages

Initial episode

For most people, the first herpes outbreak is the most severe, and symptoms tend to be more severe in women than men. The first outbreak usually occurs within a few weeks after infection with the virus. When a person is first infected with HSV, symptoms appear about 2–10 days after the virus enters the body. Symptoms tend to resolve within two to three weeks.

The signs of an initial (or primary) episode of genital herpes include multiple blisters in the genital area. For women, the sites most frequently involved include the vagina, vulva, buttocks, anus, and thighs; for men, the penis, scrotum, anus, buttocks and thighs may be affected. Signs and symptoms typically include blisters that become painful ulcers. Blisters on the penis or outer labia may crust over and heal. New lesions may develop for up to five to seven days after the first group appears.

The first outbreak of genital herpes may last 2–4 weeks. During this time, the sores break open and release fluid. Over a period of days, the sores become crusted and then heal without leaving scars.

There may also be tender, swollen lymph nodes in the groin, flu-like symptoms, such as joint pain, fever, and headache, and it may be painful to urinate.

A small percentage of people can develop headache, nausea and vomiting, or difficulty urinating. These symptoms occur when the herpes infection affects the nervous system.

People who have pain when they try to defecate may have proctitis (inflammation of the rectum or anus). Men who have sex with men are more prone to this complication than other patients.

Latent stage

After the initial outbreak, the virus travels to a bundle of nerves at the base of the spine, where it remains inactive for a period of time. This is called the latent stage. There are no symptoms during this stage.

Recurrent episodes

After a person is first infected, HSV stays in the body. It travels to nerve cells near the spine and stays there until something triggers it to become active again. When this happens, the virus then travels along the nerves, back to where it first entered the body, and causes a new outbreak of sores and blisters. This is called a recurrence. The virus can be passed to others during a recurrence.

Many people experience recurrent episodes of genital herpes, which occur when the virus travels through nerves to the skin’s surface, causing an outbreak of ulcers. These recurrent episodes tend to be milder than the initial outbreak. The signs and symptoms of genital herpes 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.

Ulcers may develop in the same area as those of the first outbreak, or may appear in other areas. It is possible to develop lesions in areas where there was no direct contact; for example, it is possible to have lesions around the anus without having had anal sex.

Genital herpes recurs frequently in many patients, especially in those with HSV type 2. Over time, recurrences generally become less frequent and less severe. However, it is also possible to have a recurrence a few years after the initial HSV infection was acquired. This type of delayed herpes outbreak can be especially distressing if you never had symptoms during the initial infection, leading you to worry about the sexual activities of your past or present sexual partner(s).

Prodrome — As many as 50 percent of people with a recurrent outbreak experience mild symptoms before ulcers develop. These are called prodromal symptoms, and may include burning, itching, tingling, or pain in the buttocks, lower back, legs, or hips. Recurrences tend to become less frequent and less severe after the first year.

Triggers for recurrence — Illness, stress, sunlight, and fatigue can trigger recurrent herpes outbreaks. In women, menstrual periods may trigger an outbreak.

Genital herpes 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.

Genital herpes treatments

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

Genital herpes anti-viral medications include:

  • Acyclovir (Zovirax)
  • Valacyclovir (Valtrex)
  • Famciclovir

These antiviral drugs will stop the herpes simplex virus multiplying once it reaches the skin or mucous membranes but cannot eradicate the virus from its resting stage within the nerve cells. They can therefore shorten and prevent episodes while the drug is being taken, but a single course cannot prevent future episodes.

Your doctor may prescribe anti-viral medication to help reduce the severity of genital herpes symptoms. This is most effective when started within 72 hours of the first symptoms.

If you have frequent or severe recurrent episodes there are medications available to help control them.

Other treatments being studied include:

  • Imiquimod cream, an immune enhancer
  • Human leukocyte interferon alpha cream.

Both appear less beneficial than conventional antiviral drugs.

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.

  • Different formulations of topical antiviral creams are available. They are not generally recommended for genital herpes.

Treatment regimen

The dose and length of treatment depends upon whether the outbreak is the first episode or is a recurrence.

Initial episode — The first episode of genital herpes is generally treated with 7 to 10 days of one antiviral medication, taken by mouth.

Episodic therapy — Episodic therapy is a treatment strategy of taking antiviral medicines only when outbreaks occur. Episodic therapy may be recommended if you have fewer than six outbreaks each year. Unfortunately, episodic treatment does not reduce the frequency of outbreaks.

The advantage of episodic therapy is that it can decrease the duration and severity of the illness by hours to a few days.

Treatment is most likely to be effective if it is started within 72 hours of the first symptoms. People with a history of recurrent genital herpes are often advised to keep a supply of antiviral medication in their home, which they can initiate at the first signs of a recurrence (eg, pain or tingling symptoms or at the sign of their first blister).

Suppressive therapy — Suppressive therapy is low dose antiviral treatment that is taken every day to prevent outbreaks.

The advantage of suppressive therapy is that it decreases the frequency and duration of recurrences, and can reduce the risk of transmitting HSV to an uninfected sex partner.

Suppressive therapy may be recommended if you have six or more recurrences each year or have a weakened immune system due to the human immunodeficiency virus (HIV), use of immune-suppressing drugs, or other factors.

Suppressive therapy may also be an option if you are in a sexual relationship with a partner who does not have a history of genital herpes or antibodies to HSV-1 or 2 (as determined by blood testing). One study of valacyclovir showed that taking suppressive therapy can reduce the chances of transmitting the virus by approximately one-half.

It is not clear how long suppressive therapy should continue. Some experts recommend taking a break from treatment periodically (every few years) to determine if suppressive therapy is still needed. If recurrent outbreaks develop, suppressive therapy may be restarted.

No treatment — It is not necessary to treat a recurrent episode of genital herpes. No treatment may be appropriate for some patients, particularly those with infrequent outbreaks or minimal symptoms. It also may be appropriate if the patient is not currently sexually active, so transmission of HSV is not a consideration.

Which treatment regimen is right for me?

Many people with recurrent herpes are unsure which treatment regimen (episodic or daily suppression) is right for them. The factors you should consider include how often you have outbreaks, how severe your symptoms are, and the risk of passing the infection to a sexual partner.

  • If you have frequent outbreaks, severe symptoms, or want to avoid infecting a sexual partner, suppressive treatment might be recommended.
  • If you do not have frequent outbreaks, are not bothered by symptoms (pain) during an outbreak, and are not concerned about infecting a sexual partner (because you are not sexually active), episodic therapy or no therapy are reasonable options.

 

Home remedies for genital herpes

The symptoms can also be helped by:

  • gently bathing the area with a warm salt solution (also called a sitz bath) (1 teaspoon to 2 cups water, or 1 cup of salt in a bath)
  • pain medication, such as paracetamol or ibuprofen may also help relieve the pain of genital ulcers.
  • local anesthetic ointment
  • urinating while sitting in a warm bath, if urination is painful
  • soaps and bubble baths should be avoided. It is important to keep the genital area clean and dry, and to avoid tight or irritating underwear and clothing.
  • over-the-counter creams and ointments are generally not recommended.

References   [ + ]

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