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  • Michael Frey, MD

Herpes

Genital herpes affects the skin or mucous membranes of the genitals.

The Herpes virus is spread from one person to another during sexual contact.



There are 2 types of HSV:

  • HSV-1 most often affects the mouth and lips and causes cold sores or fever blisters. But it can spread from the mouth to the genitals during oral sex.

  • HSV-2 most often causes genital herpes. It can be spread through skin contact or through fluids from the mouth or genitals.

You may become infected with herpes if your skin, vagina, or mouth comes into contact with someone who already has herpes.


You are most likely to get herpes if you touch the skin of someone who has herpes sores, blisters, or a rash. But the virus can still be spread, even when no sores or other symptoms are present. In some cases, you do not know you are infected.

Symptoms Many people with genital herpes never have sores. Or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.

If signs and symptoms do occur during the first outbreak, they can be severe. This first outbreak most often happens within 2 days to 2 weeks of being infected.

General symptoms may include:

  • Decreased appetite

  • Fever

  • General sick feeling (malaise)

  • Muscle aches in the lower back, buttocks, thighs, or knees

  • Swollen and tender lymph nodes in the groin


Genital symptoms include small, painful blisters filled with clear or straw-colored fluid. Areas, where the sores may be found, include:

  • Outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks (in women)

  • Tongue, mouth, eyes, gums, lips, fingers, and other parts of the body


Before the blisters appear, there may be tingling, burning, itching, or pain at the site where the blisters will appear. When the blisters break, they leave shallow ulcers that are very painful. These ulcers crust over and heal in 7 to 14 days or more.

Other symptoms may include:

  • Pain when passing urine

  • Vaginal discharge

  • Problems emptying the bladder that may require a urinary catheter

A second outbreak can appear weeks or months later. It is most often less severe and it goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.

Exams and Tests Tests can be done on skin sores or blisters to diagnose herpes. These tests are most often done when someone has a first outbreak and when a pregnant woman develops genital herpes symptoms. Tests include:

  • Culture of fluid from a blister or open sore. This test may be positive for HSV. It is most useful during the first outbreak.

  • Polymerase chain reaction (PCR) done on fluid from a blister. This is the most accurate test to tell whether the herpes virus is present in the blister.

  • Blood tests that check for antibody level to the herpes virus. These tests can identify whether a person has been infected with the herpes virus, even between outbreaks. A positive test result when a person has never had an outbreak would indicate exposure to the virus at some time in the past.

Treatment Genital herpes cannot be cured. Medicines that fight viruses will be prescribed.

  • These medicines help relieve pain and discomfort during an outbreak by healing the sores more quickly.

  • For repeat outbreaks, the medicine should be taken as soon as tingling, burning, or itching begins, or as soon as blisters appear.

  • People who have many outbreaks may take these medicines daily over a period of time. This helps prevent outbreaks or shorten their length. It can also reduce the chance of giving herpes to someone else.

  • Side effects are rare with acyclovir and valacyclovir.

Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended. This reduces the chance of infecting the baby.

Support Groups You can ease the stress of illness by joining a herpes support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis) Once you are infected, the virus stays in your body for the rest of your life. Some people never have another episode. Others have frequent outbreaks that can be triggered by fatigue, illness, menstruation, or stress.

Possible Complications Pregnant women who have an active genital herpes infection when they give birth may pass the infection to their baby. Herpes can cause a brain infection in newborn babies. It is important that your provider know if you have herpes sores or have had an outbreak in the past. This will allow steps to be taken to prevent passing the infection to the baby.

The virus may spread to other parts of the body, including the brain, eyes, esophagus, liver, spinal cord, or lungs. These complications can develop in people who have a weakened immune system due to HIV or certain medicines.

Prevention If you have genital herpes, you should tell your partner that you have the disease, even if you do not have symptoms.

Condoms are the best way to protect against catching genital herpes during sexual activity.

  • Use a condom correctly and consistently to help prevent the spread of the disease.

  • Only latex condoms prevent infection. Animal membrane (sheepskin). condoms do not work because the virus can pass through them.

  • Using a female condom also reduces the risk of spreading genital herpes.

  • Although it is much less likely, you can still get genital herpes if you use a condom.


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