GENITAL HERPES (HSV-2)

Genital herpes is a sexually transmitted infection that can cause blisters and open sores (lesions) in the genital area, but it can also be asymptomatic, meaning a person does not show symptoms.

Genital Herpes Overview

In the United States, about 1 in every 6 people ages 14 to 49 have genital herpes.

While there is no cure for herpes, the severity of the virus varies over the course of an infected person’s lifetime. In fact, some people with the disease do not experience any symptoms for extended periods. They may still shed the virus, though, even when no symptoms are present.

What are the different types of herpes?

There are two types of herpes simplex virus: HSV I and HSV II. HSV I commonly causes oral herpes, or cold sores. This virus can show up as an upper respiratory tract infection during early childhood. HSV II is the cause of most cases of genital herpes. However, it is possible for HSV I to cause genital herpes and HSV II to cause oral herpes.

Clinicians cannot tell the difference between the two types by physical examination alone, but there are differences between the two viruses. For example, genital herpes caused by HSV II is much more likely to recur. This diagnosis can be helpful in establishing a health care plan.

What causes genital herpes?

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

Where does the herpes virus live in the body?

The herpes simplex viruses are latent, meaning they can live in the body without causing symptoms. After the initial infection, the virus gets into the nerve roots and spreads to the sensory nerve ganglia, the junctions where nerves from different parts of the body come together. For the genital area, the ganglia are adjacent to the spinal cord in the lower back. For orofacial herpes (cold sores), the ganglia are located behind the cheek bone.

How common is genital herpes?

According to the Centers for Disease Control and Prevention, approximately 40 million to 50 million adults in the United States have genital herpes. HSV II infection is more common in women and in people who have had more than five sexual partners. Most people with HSV II do not know they have it, because it does not always cause symptoms.

What does genital herpes look like?

While some people with genital herpes will never have any symptoms, other people can develop symptoms within a few weeks of being infected.

Most people notice a group or cluster of blisters or ulcers (lesions). These lesions burn and can be painful. They can appear on the buttocks, anus or thighs, on the vulva or vagina in women, and on the penis or scrotum in men.

Often, before the lesions appear, patients describe a prodrome, characterized by a tingling or burning sensation in the area where the lesions will develop that can be noticed during urination, along with itching or discomfort in the genital area.

You can also have the following symptoms:

• ♦ Blisters on the mouth or lips
• ♦ Fever, headache or pain in the joints
• ♦ Trouble urinating

The symptoms of genital herpes often go away and come back as recurring outbreaks. For most people, the first outbreak is the worst, and can last from two to three weeks. Future flare-ups are often less severe and do not last as long. Still, some people shed the virus regularly. The following triggers can make outbreaks more likely to occur:

• ♦ Viral or bacterial infections
• ♦ Menstrual periods
• ♦ Stress

Recurrent genital herpes is most common in the first year after the initial infection and decreases as time goes on.

In many cases, anti-herpes medicine can help patients. When a person experiences a prodrome and suspects a recurrence is going to happen, they begin taking anti-herpes medications that lessen symptoms and shorten the time of the outbreak.

What if I don’t have lesions?

Most people with genital herpes don’t have lesions. Many people don’t realize they have genital herpes until a blood test reveals they have antibodies to the virus.

How does genital herpes spread?

Herpes can be spread when an infected person has lesions — blisters and open sores — on their body or when you do not have any symptoms. Taking antiviral medicine can help you reduce the risk of spreading genital herpes to your sexual partners. You can also:

• ♦ Inform your sexual partner that you have genital herpes.
• ♦ Use a condom every time you have sex.
• ♦ Refrain from having sex when you have symptoms.
• ♦ Abstain from performing oral sex if you have blisters or open sores around your mouth.

Do condoms help prevent the spread of genital herpes?

Yes. To prevent transmission of herpes, we recommend that condoms be used 100% of the time. Many patients will shed the virus and be contagious when they don’t have symptoms. Studies have shown that asymptomatic shedding occurs between 1% and 3% of the time in patients with HSV II genital infections. Many new herpes infections occur from partners who are shedding the virus asymptomatically, so condoms are highly recommended.

Condoms may not be an attractive option for monogamous couples or for couples who desire to become pregnant. Couples may opt to have serological tests to determine if either partner has an asymptomatic infection. In close monogamous relationships, the risks of transmission can be weighed against other relationship issues, such as intimacy and pregnancy.

If you have genital herpes already, can it be spread to other parts of the body, such as the arms or legs?

No. Genital herpes cannot be transmitted to another part of your body such as your arm, leg or hand after the first infection occurs. If you have genital HSV II, you will not get HSV II at another site in your body. The immune system produces antibodies that protect other parts of your body from infection. However, there are cases where a person has multiple site infections from the same virus. This is usually acquired at the time of the first infection. For example, if someone has never had herpes but then has oral and genital sex with an infected partner, they can acquire the infection at both sites.

Can genital herpes be transmitted by oral sex?

Yes: Genital herpes (types I or II) can be transmitted by oral sex. A person with herpes who is shedding the virus can be contagious even if they don’t have lesions or symptoms, which is why the population of patients with genital herpes caused by HSV I is thought to be increasing.

I have cold sores in my mouth. Can I still get genital herpes?

Yes. Cold sores are usually caused by HSV I. People who have HSV I are susceptible to becoming infected with HSV II, the common cause of genital herpes.

How is genital herpes diagnosed?

If you have blisters in your genital region, your physician can order a test to determine if you have genital herpes. Your physician may take a sample of cells from the fluid inside the blister or order a blood test.

I had lesions when I was evaluated, but my culture was negative. Does this mean that I don’t have herpes?

Not necessarily. Although lesions can be caused by something other than herpes, false negative herpes tests can occur if the samples are not taken appropriately, if there is a long transport time between the clinic and the laboratory, or if cultures were taken late in the course of the lesions. Lesions that occur early in the course of a herpes outbreak are much more likely to have positive cultures than cultures taken after the lesions crust over.

Can genital herpes be treated?

Your physician can prescribe different medications to help reduce your symptoms and speed up the healing of an outbreak. These medicines work best when you start them soon after an outbreak occurs.

To reduce pain during an outbreak:

• ♦ Sit in warm water in a portable bath or bathtub for about 20 minutes. Avoid bubble baths.
• ♦ Keep your genital area clean and dry, and avoid tight clothes.
• ♦ Take over-the-counter medications, such as acetaminophen or ibuprofen. Avoid aspirin.

Let your physician know if you are worried about your genital herpes. He or she can recommend a support group to help you cope with the virus.

Can I be treated to prevent genital herpes transmission to my partner?

Yes. A large study showed that if one partner has herpes and the other partner is uninfected, treating the infected partner with suppressive therapy can prevent transmission of symptomatic herpes in over 90% of cases. This is an option for couples who are interested in having unprotected sex or who are planning to become pregnant.

If you are entering into a new relationship and are aware that you have herpes simplex infection, you owe it to your partner to notify them before having sex.

Can treatment help prevent multiple genital herpes outbreaks?

Suppressive therapy can address frequent outbreaks. Taking a small dose of anti-herpes medication every day can reduce the number of outbreaks by over 90%. You can take suppressive therapy for long periods of time, or gradually taper off.

Are there any side effects from genital herpes medications?

The medications used to treat herpes have extremely low side effects. There are no major complications associated with these medications.

Is there any resistance to genital herpes medication?

Resistance to drugs that treat genital herpes — even after 20 years of use — is very rare. Herpes medications may not work as well in patients who are very immunosuppressed and have been treated with these drugs for a long time. Each individual’s response to treatment may vary. In some cases, patients may need more drugs to suppress their viral outbreaks than others.

Genital Herpes and Pregnancy

It is important to avoid contracting herpes during pregnancy. A first episode during pregnancy can create a greater risk of transmission to a newborn.

Fortunately, it is rare for women with genital herpes to infect their babies. If you know that you have genital herpes before becoming pregnant, your physician will monitor your condition throughout your pregnancy. If you have an active outbreak at the time of delivery, a C-section may be recommended. Depending on individual diagnosis, though, the American Congress of Obstetricians and Gynecologists endorses suppressive therapy to reduce the frequency of C-section.

Is genital herpes related to shingles?

Shingles, also called herpes zoster, is caused by the varicella zoster virus (VZV), which causes chickenpox earlier in life. The natural history of varicella zoster infection is similar to genital herpes infection in that VZV also becomes latent in the sensory nerve roots. Later in life the virus may exit, causing shingles.

Recurrences in shingles cause blister lesions in a single area of skin called a dermatome. Shingles is not a sexually transmitted infection and is independent from genital herpes.

Is genital herpes infection related to HIV?

Herpes and HIV are caused by different viruses. But patients infected with these viruses are more likely to transmit either disease to their sexual partners. Patients with herpes are more vulnerable to HIV infection. People newly diagnosed with herpes should be tested for HIV infection and other sexually transmitted infections.

Patients who are infected with both herpes and HIV also may have a higher concentration of HIV viruses in their body because of the interaction between the herpes virus and the HIV virus. When HIV damages a person’s immune system, the person may be more likely to shed herpes simplex virus asymptomatically.