Genital herpes

• ANATOMY OR SYSTEM AFFECTED: Genitalia, genitourinary tract, mouth, penis, peripheral nervous system, skin, vagina
• ALSO KNOWN AS: Genital herpes simplex, herpes genitalis, herpes simplex 2, herpes simplex virus types 1 and 2

Definition

Genital herpes is a highly contagious infection that is caused by a virus. Genital herpes causes fluid-filled blisters or sores on the skin of the genitals (areas on or around the vagina or penis). The infection can also cause blisters at the anal opening, on the buttocks or thighs, inside the vagina on the cervix, or in the urinary tract of women and men.

Causes

The infection is caused by the herpes simplex virus (HSV), of which there are two kinds: herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). HSV-2 is usually the cause of genital herpes, but the disease can also be caused by HSV-1, the virus that is associated with oral herpes (cold sores on the mouth).

Genital herpes is a common virus and is more common among women than men. Johns Hopkins University estimates that between 50 and 80 percent of Americans have HSV-1 oral herpes, and one in every six Americans aged fourteen to forty-nine have HSV-2 genital herpes. The prevalence of genital herpes overall is most likely even higher, as more cases of genital herpes are being caused by HSV-1.

HSV is transmitted from skin-to-skin contact, especially in places that are warm and moist. The virus enters the body through a cut or opening in the skin or through mucous membranes, the moist inner lining of the urinary tract (in the vaginal area), or the digestive system that includes the mouth, esophagus, stomach, intestines, and anus. The virus stays in the nerve cells of the body, even if a person does not have symptoms or signs of genital herpes. Genital herpes is a chronic, life-long infection with symptoms that will come and go (be active and inactive) throughout a person’s life.

Risk Factors

Genital herpes is considered a sexually transmitted disease. One can spread the virus by touching, kissing, or having sexual contact, including vaginal, anal, and oral sex. Several factors lead to the spread of HSV, including having sexual contact with someone who does not have any obvious sores and with someone who has a clear outbreak of the virus. An outbreak means that the sexual partner has visible sores or blisters in the genital area. These sores give off (or shed) some of the virus that can infect the other partner. The virus is most contagious when the sores are visible and open and are producing a discharge.

It is possible to develop genital herpes with or without the risk factors discussed here; however, the more risk factors one has, the greater the likelihood of becoming infected with genital herpes. From the 1970s to the 1990s, the incidence of HSV-2, the virus that causes genital herpes, increased by 30 percent. However, according to the CDC, there was a decrease in the percentage of people infected with HSV-2 from the number reported between 1988 and 1994 and the estimate recorded between 2007 and 2010.

Anyone who is sexually active (has vaginal, oral, or anal contact with others) can get genital herpes. If a person has oral herpes and performs oral sex, it is possible for that person’s partner to develop genital herpes from that contact.

The following factors can increase the risk of becoming infected with genital herpes:

• Behaviors. Having unprotected sex, becoming sexually active at a young age, having been sexually active for many years, having had several sexual partners, having a partner who is infected with genital herpes, and anal sex.
• Gender. Women (20.3 percent of people between the ages of fourteen and forty-nine) are more likely than men (10.6 percent of people between the ages of fourteen and forty-nine) to become infected with genital herpes.
• Socioeconomics. The majority of new infections occur in adolescents and young adults (ages twenty to forty years). In young adults, HSV-1 infection is becoming a more common cause of genital herpes.
• Health. Persons with a higher risk of genital herpes are those with human immunodeficiency virus infection, a history of other sexually transmitted infections, and a weak immune system.
• Outside factors. Studies suggest there are several things that can trigger the virus and make it active, including stress, excessive sunlight, menstruation, and vigorous sexual activity.

Symptoms

Not all persons are aware they have genital herpes, mostly because they may not have symptoms. They may also not recognize the symptoms if they have them. According to the CDC, 60 to 90 percent of people do not realize that they are infected. When first infected, a person has the following symptoms, which appear within two to twelve days:

Early symptoms that can last two to three weeks include itching, burning, and pain in the genital or anal area; discharge from the vagina; flu-like symptoms, such as fever and swollen glands; and pressure in the abdomen (the area below the stomach).

As the infection progresses, symptoms of an outbreak include sores that start to form on the part of the body where the virus was contracted; sores that begin as small red bumps, develop into blisters, and then become painful open sores; sores or blisters that appear and occur in clusters or small groupings; vaginal discharge; pain when urinating; and flu-like symptoms, including fever, muscle aches, swollen glands, and headache.

The outbreak is coming to an end when, after a few days, the sores form a scablike outer layer and then fall off. The virus will recur and become active and inactive over time. The frequency of these recurrences varies from person to person. One may experience symptoms a number of times throughout a given year or may experience an outbreak only once or twice in a lifetime. Doctors and researchers do not yet know why these recurrences happen.

Every case of genital herpes is unique. The average number of outbreaks that a person experiences each year is about four or five. The first year of the virus is usually the worst. The first outbreak is usually the most severe and painful, with the second occurrence often happening only a few weeks later. As time goes on, the frequency of outbreaks lessens, and the outbreaks become much less severe. Recurrences tend to become milder and usually last only a week.

Genital herpes also can result in no symptoms. One can still spread genital herpes even if they do not experience symptoms or if the symptoms are inactive.

Many people fail to recognize the symptoms of genital herpes. Women often confuse the discomfort with their menstrual period or an itchy yeast infection. Men often confuse the symptoms with jock itch or friction burn. Symptoms of genital herpes have also been mistaken for insect bites or hemorrhoids.

Screening and Diagnosis

Sometimes genital herpes is easy to diagnose because the blisters or open sores around the genital area are easily visible, but oftentimes, for an adequate diagnosis, one will need more than an examination. Also, one can have genital herpes yet display no visible sores.

During an examination, laboratory tests will be done to determine if HSV is in the body. These tests will also determine whether the infection is caused by HSV-1 or by HSV-2.

The following tests are used to check for genital herpes:

Viral culture. If the infection is visible, the doctor will rub a swab over an open sore or blister to collect some cells. The cells are then tested to see if the virus is present in those cells. It is recommended that this culture test be taken within the first forty-eight hours after symptoms appear. The problem with this test is that if the body’s immune system already killed the herpesvirus from that sore, the test may come back negative for genital herpes, leading to a false-negative diagnosis.

Blood tests. These blood tests are also called antibody tests because they measure HSV antibodies, the disease-fighting substances in the blood. If the blood tests show HSV antibodies, the affected person is most likely infected with HSV. Modern tests can distinguish between HSV-1 and HSV-2. It is recommended that one wait a minimum of twelve to sixteen weeks from possible exposure to herpes so that the body has enough time to develop antibodies. This will ensure a more accurate blood test.

Specific blood tests include a point-of-care test, in which the physician gets a small blood sample from the patient (by pricking the skin). Results are available in less than ten minutes. This blood test checks for the presence of HSV-2 antibodies. The HerpeSelect ELISA (enzyme-linked immunoabsorbent assay), the HerpeSelect Immunoblot, and Captiva HSV IgG Type Specific ELISA all involve the patient going to a lab, where blood will be drawn from a vein for testing for HSV-1 or HSV-2 antibodies. Results are available in approximately one to two weeks. None of these tests, however, can pinpoint the site of the infection.

Treatment and Therapy

There is no cure for genital herpes and no surgical option for treatment. There are, however, medications that treat the symptoms and help prevent future outbreaks. Antivirals commonly prescribed to help treat the symptoms of genital herpes include acyclovir (Sitavig, Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir).

Prevention and Outcomes

Because there is no cure, behavioral change is the best way to lower the risk of contracting the virus and spreading it to others. Abstaining or refraining from sex is the most certain way to avoid contracting genital herpes. Another preventive measure is to have a long-term mutually monogamous (only one exclusive sexual partner) with someone who does not have genital herpes. Persons should avoid sexual contact with others during a genital herpes outbreak, and one should always use a condom during sex. Persons with cold sores (a blister caused by HSV-1 infection) should avoid kissing other people and should avoid oral sex.

One should recognize when the disease is most contagious and know that the virus can be spread even if the person does not have visible sores or is not experiencing an outbreak. One should not touch any visible sores or blisters and should wash hands thoroughly with soap and warm water if a sore or blister is touched. One can ensure against spreading the virus to other parts of the body, such as the mouth or eyes, by not touching sores and then touching these uninfected areas.

One can also take medications, such as valacyclovir, that are approved by the US Food and Drug Administration for use in preventing the spread of genital herpes. Taking valacyclovir only reduces the risk of transmission by 50 percent. A better way to protect oneself and one’s partner is to take valacyclovir and use a condom.

Bibliography

"About Genital Herpes." Centers for Disease Control and Prevention, 20 Feb. 2024, www.cdc.gov/herpes/about/index.html. Accessed 20 Oct. 2024.

Drake, S., et al. “Improving the Care of Patients with Genital Herpes.” British Medical Journal, vol. 321, 2000, pp. 619–23.

"Genital Herpes." Mayo Clinic, 22 Nov. 2022, www.mayoclinic.org/diseases-conditions/genital-herpes/symptoms-causes/syc-20356161. Accessed 20 Oct. 2024.

"Genital Herpes." Medline Plus, 31 May 2024, medlineplus.gov/genitalherpes.html. Accessed 20 Oct. 2024.

Groves, M. J. “Transmission of Herpes Simplex Virus via Oral Sex.” American Family Physician, vol. 73, 2006, p. 1153.

"Herpes: HSV-1 and HSV-2." Johns Hopkins University, www.hopkinsmedicine.org/health/conditions-and-diseases/herpes-hsv1-and-hsv2. Accessed 20 Oct. 2024.

“Herpes Simplex.” American Academy of Dermatology, www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex. Accessed 20 Oct. 2024.

“Herpes Simplex.” Ferri’s Clinical Advisor 2011: Instant Diagnosis and Treatment, edited by Fred F. Ferri, Elsevier, 2011.

Langlais, Robert P., and Craig S. Miller. Color Atlas of Common Oral Diseases. 5th ed., Lippincott Williams & Wilkins, 2020.