Article updated and reviewed by David Aronoff, M.D., Assistant Professor, Division of Infectious Diseases, University of Michigan Medical School on May 9, 2005.
herpes simplex virus (HSV) and is one of the most common sexually transmitted diseases (STDs).
There are two types of HSV, HSV-1 and HSV-2.
HSV-1 is usually responsible for cold sores (fever blisters) of the lips and mouth.
HSV-2 is the one that most commonly causes genital herpes. The infection causes painful, ulcerative sores on the genitals in both men and women.
However, HSV-1 can cause genital herpes, and HSV-2 can cause cold sores.
Genital herpes is common. In the United States, one out of five of the total adolescent and adult population is infected with HSV.
Herpes is spread by direct contact with an infected person. For example, if you have genital herpes and have sexual intercourse, you can give your partner genital herpes. If you have oral herpes, you can give your partner oral herpes while kissing, and you can also give it to your partner during oral sex.
Symptoms of genital herpes can vary. Many individuals infected have few, if any, noticeable symptoms.
In people who do have symptoms, the symptoms start 2 to 20 days after exposure to someone with HSV infection. Symptoms may last for several weeks.
The first episode of genital herpes is usually worse than subsequent outbreaks. The following symptoms may occur during the first episode of herpes:
- Painful bumps or blisters that break open and form ulcers in the genital area
- Itching, tingling, or burning sensation of the skin
- Swollen, tender glands (lymph nodes) around the genital area
- General flu-like symptoms, including muscle aches
- Vaginal discharge
- Painful urination
Following the primary infection, HSV-2 infects nerve cells, which allows the virus to remain indefinitely in a dormant state within the body. Sporadic reactivation of the virus can occur resulting in a recurrence of lesions on the genitalia. In fact, most infected persons with genital herpes have five to eight outbreaks per year, but not everyone has recurrent symptoms. As time goes on, the number of outbreaks usually decreases.
Sores typically come back near the site of the first infection. Usually, as the outbreaks recur, there are fewer sores and they heal faster and are less painful.
Diagnosis can be based on the medical history, including symptoms and a physical examination. However, lesions may have an atypical appearance and other diseases may mimic typical HSV. Therefore, infection by HSV is best confirmed in the laboratory either by demonstration of HSV DNA in scrapings or tissue from lesions or by isolation of virus in tissue culture. HSV DNA detection has been shown to be more sensitive than viral isolation and is less affected by problems in specimen transport.
Currently, there is no cure or vaccine for herpes infections. Once HSV enters the body, it is a lifelong resident that is capable of causing recurrent attacks. Emotional stress, fatigue, excessive exposure to sun or wind, skin friction, menstruation, and physical trauma have all been implicated as possible triggers of recurrent episodes. But, it is still unclear how the dormant virus is reactivated and just what triggers this process.
For years no effective drug therapy for herpes infections was available, and patients simply had to wait for episodes to resolve naturally. At least three medications are now available for treatment of herpes infections. They are acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). All three agents are very effective. Typically, these drugs are prescribed during active outbreaks, and may not be needed for mild cases.
Long-term drug therapy (suppressive treatment) may be helpful for individuals who suffer frequent recurrent outbreaks. Suppressive treatment will reduce outbreaks by 85 percent and reduces viral shedding by more than 90 percent.
Topical antibiotic ointments also may be applied to prevent secondary bacterial infections.
During an outbreak of genital herpes, a number of measures should be taken to make the patient more comfortable:
- Wear loose clothing
- Avoid excessive heat or sunlight
- Keep the sore area clean and dry
- Place cool or lukewarm cloths on the sore area for short periods of time
- Do not use perfumed soaps, sprays, feminine deodorants, or douches
- Take aspirin, acetaminophen or ibuprofen for the pain
- Avoid touching sores
- Wash hands if you do touch the sores<//li>
What treatment do you prescribe?
What are the side effects?
Do I need 'suppressive treatment'?
What else can be done to reduce the pain and discomfort?
What preventive measures should be taken to avoid spreading HSV infection?
Editorial review provided by VeriMed Healthcare Network.
To reduce the risk of spreading HSV to others, it is important to avoid intimate contact when sores are on the body. Itching, burning or tingling may occur just before the sores develop. Sexual intercourse should be avoided during this time.
Herpes can even be spread when there are no sores or symptoms. To minimize the risk of spreading herpes, latex condoms should be used during all sexual contact. Spermicidal foams and jellies may offer added protection.
HSV can also be spread by touching the sores and then touching another part of the body. If you touch the sores, wash your hands with soap and water as soon as possible. Also, do not share towels or clothing with anyone.
Babies can be infected with the herpes virus, which can have devastating consequences for the newborn. If you are pregnant or considering having children, you should tell your health care provider if you have ever been exposed to anyone with herpes, even if you have never had any symptoms. Your health care provider can take special precautions at the time of delivery to protect the baby from getting infected with herpes.