Genital Herpes

  • What Is Genital Herpes?

    Genital herpes is a viral infection characterized by outbreaks of painful sores on the genitals. Most often it spreads through sexual contact. Once infected, a person carries the virus permanently in a latent form in the nerve cells; there is no cure. An initial attack and any recurrences generally last from one to three weeks, after which the infection may go into remission for months or years. Subsequent attacks tend to be less severe, and in about one-third of cases, permanent remission follows the initial outbreak.

    Most people with genital herpes have no symptoms. In about one third of those who develop clinical symptoms, permanent remission occurs after the initial attack, most likely due to the ability of the body’s immune system to contain the virus. The remaining two thirds of people with symptoms will suffer additional outbreaks at unpredictable intervals. The first outbreak is usually the most severe.

    Genital herpes is highly contagious, and one partner may transmit it to another even when no visible sores or lesions are present. It is more easily transferred from men to women than vice versa; it may also be transferred to babies of infected mothers during childbirth, possibly causing blindness, retardation, or even death. Genital herpes is also a risk factor for HIV infection.


    Who Gets Genital Herpes?

    According to the Centers for Disease Control and Prevention (CDC), about 45 million people in the United States over the age of 12 are infected with HSV-2. Genital herpes is more common in women (approx. 1 out of 4) than men (approx. 1 out of 5) and more common in African Americans (46%) than Caucasians (18%). Men who have sex with men have a higher incidence of HSV-2 infection than heterosexual men.

    Incidence of genital herpes in the United States has increased 30% over the past 20 years. The largest increase has occurred in Caucasians between the ages of 12 and 19 (5 times more common) and ages 20–29 (twice as common). About 1 million new cases occur each year. Tests for antibodies against the HSV-2 virus show that 22% of the adult population of the United States has been exposed to HSV-2.



    • Often no symptoms.
    • Pain or itching in the genital area.
    • Watery blisters in the genital area that break to form painful, shallow ulcers. The ulcers scab over and disappear spontaneously within three weeks. Occasionally, blisters and ulcers around the mouth may accompany genital sores.
    • Painful urination in women.
    • Fever, fatigue, loss of appetite, and enlarged lymph nodes in the groin (typically occurring only with the initial attack).
    • Possibly headache (in those who develop viral meningitis).


    Causes/Risk Factors

    • Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes.
    • Herpes simplex virus type 1 (HSV-1), the virus that commonly causes cold sores around the mouth, may also cause genital herpes.
    • Genital herpes is transmitted when an active herpes lesion or its secretion comes into direct contact with a break in the skin or the moist membranes of the mouth, penis, vagina, urethra, anus, or cervix.
    • Recurrence in both sexes may be triggered by sexual intercourse, fatigue, injury, heat, cold, and stress. In women, recurrence may also be triggered by menstrual periods.
    • People with weakened immune systems, such as those undergoing cancer treatment or those with AIDS, are more likely to have a severe case.


    What If You Do Nothing?

    Genital herpes in incurable; once you are infected, the virus remains dormant in your body and symptoms may reappear. The level of discomfort will vary from person to person, but symptoms can be lessened with treatment. If you have recurrent herpes, refrain from sexual contact when you have sores, since you are certainly contagious during this period. The risk of transmitting HSV-2 is greatest during the first 96 hours after the rash appears.



    • Patient history and physical examination.
    • Culture of fluid from blisters or sores.
    • Microscopic examination of lesion samples.



    • Treatment is aimed at relieving symptoms. The prescription antiviral drugs acyclovir, valacyclovir, and famciclovir may be prescribed to lessen the duration and severity of outbreaks. In people who have frequent recurrences (more than six a year), these drugs may be used long-term as suppressive therapy. (Valacyclovir and famciclovir have been approved specifically for treating recurrences.)
    • Take aspirin, acetaminophen, or ibuprofen to relieve pain.
    • Frequent warm baths may lessen discomfort during an outbreak.
    • A cesarean section may be necessary for pregnant women who have active genital herpes at time of delivery, in order to avoid transferring the infection to the infant during childbirth. The mother and infant may both be treated with acyclovir.



    • Avoid sexual contact if symptoms are present in either partner.
    • Latex condoms during sexual intercourse reduce the risk of transmission, but they are not foolproof.
    • If you are infected and pregnant, tell your physician, so precautions can be taken to prevent passing the virus to your baby.


    When To Call Your Doctor

    • Call a doctor if you develop symptoms of genital herpes.


    Robert Hurd, M.D., American Board of Internal Medicine and Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.