Genital Herpes

Although genital herpes is common there are a lot of misperceptions about this sexually transmitted infection. Genital herpes is caused by a virus, called Herpes Simplex Virus, or "HSV" for short. Viruses are different than bacteria. First, they are much smaller, and second, they are much harder to treat. For example, although antibiotics commonly kill bacteria they do not work on viruses. Because of this, there is no known cure for genital herpes. However, there are ways to prevent infection, and to treat infections once they develop.

Genital herpes is an extremely common infection. Some researchers estimate that 1 out of every 5 Americans have been infected with the virus that causes genital herpes! This represents 20% of the population, making genital herpes one of the most common sexually-transmitted infections.

There are 2 main types of herpes viruses, HSV-1 and HSV-2. HSV-1 usually causes "cold sores" or "fever blisters" around the mouth, and is not necessarily sexually transmitted. HSV-2 usually cause sores on the genitals and is sexually transmitted. However, it is quite possible to contract HSV-1 on the genitals, or HSV-2 on the mouth (through oral sex). In fact, any type of sexual contact, whether it's vaginal intercourse, anal sex, touching the genitals, or oral sex, can transmit the herpes virus.

Once HSV enters the skin and begins to reproduce. A very important point is that HSV in many cases never causes symptoms. It may simply invade the skin, reproduce, then lie dormant for many months, years, or sometimes even forever. Some very fortunate individuals may never even know they have contracted HSV, because they never get any symptoms. In other cases the virus reproduces and causes symptoms such as extremely painful blisters on the penis or the lips of the vagina (labia). The first time this infection develops the patient may have such severe pain and inflammation that he or she needs to be admitted to the hospital. Other conditions can cause small bumps on the genitals, but HSV almost always causes extremely painful sores that burn when touched. After a few days, these blisters become small, shallow ulcers with some redness around them. Finally, after a few more days, they crust over and are less painful. The entire first-ever infection usually lasts 1-2 weeks.

After a primary infection, the virus again lies dormant and may or may not ever recur. Some people have a recurrent infection as often as every month, while others get them only once every few years. (Some never get a recurrent infection again). The recurrent infections can be brought on by stress, other infections, irritation to the tissues, or exposure to the sun. Some patients notice a tingling or burning sensation around their penis or labia right before an outbreak of genital herpes. This is called a "prodrome" and is helpful since it can alert you that you need to abstain from sex, or to begin taking medication, if necessary. Recurrent infections are usually less painful and often go away more quickly than primary infections.

The diagnosis of genital herpes is made by a health care provider who has experience in genital infections. He or she will examine the genital organs and may take a swab of the blister or ulcer and send it for culture. You should make an appointment immediately after the blisters develop, since they may disappear after a few days which makes the diagnosis difficult.

Treatment depends on how painful the sores are and if you have other medical problems. Sometimes there is minimal pain and the patient is advised to abstain from sexual relations and other activity that may irritate the affected area until the sores go away. In other cases one may receive anti-viral medications such as valacyclovir, acyclovir, or famciclovir. These may help reduce the duration of the sores. If you are prescribed these medications for recurrent infections, please remember to begin taking them as soon as you notice the "prodrome" or blisters forming! (The medicine works best if it is taken as early as possible). People who have many recurrent infections, say 6 or more a year, might want to ask about taking an anti-viral pill once or twice a day to help prevent these recurrent infections. This can become expensive, but in some cases it is worth it to help prevent having genital herpes infections all the time. These treatments can help treat outbreaks, but unfortunately there is no way to completely rid the body of the virus once infection occurs.

A common question when a patient is diagnosed with their first-ever herpes outbreak is "does this mean my partner is having an affair?" Remember that this virus can "hang out" in your body for a long period of time, and may never produce symptoms. In other cases the first-ever outbreak may occur weeks, months or even many years after one was exposed. Thus, you or your partner may have been exposed many years prior but the virus only now has surfaced to create problems. Obviously, this makes it almost impossible for you or your health care provider to determine when you were exposed.

The only known way to prevent genital herpes is to not have sexual relations. Since herpes can be spread by vaginal, anal, or oral sexual activity, and sometimes even by touching the genitals, all of these activities can lead to an infection. It is easiest to contract HSV when there are sores present, but even without sores the virus can be passed to someone else during sex. This is called "asymptomatic shedding" of the virus, and for this reason one should strongly consider the use of latex condoms. Their use should be considered by anyone in a non-monogamous relationship and certainly anyone who has genital herpes. Married couples where one partner has HSV are also encouraged to use condoms. Even though condom use may not always prevent the other partner from becoming infected, it should help decrease the chances of this happening. Because genital herpes can affect each person differently and because in some cases the virus can cause severe symptoms, you should always tell your sexual partner that you have this condition and should encourage condom use in your relationship. Many couples have fulfilling sex lives when one partner has genital herpes. As with all aspects of a relationship, honest communication is important.

Many people have heard that HSV can cause problems in pregnant patients. Babies born to women who have blisters or sores on their genitals from HSV may become infected and may become extremely ill from this infection. When women are in labor but there are no sores present it is usually quite safe to deliver naturally, through the vagina. In women who are in labor and have sores present a cesarean section will often (but not always) prevent infection. Always tell your doctor or midwife if you have been diagnosed with genital herpes so that he or she can examine you during the pregnancy and especially when you go in to labor.

Genital herpes is a common and troublesome condition that can result in a number of other problems, such as depression, low self-esteem, and relationship problems. Although there is no known cure, there are effective medications to help reduce the symptoms and sometimes even prevent new outbreaks. Many couples make adjustments when one (or both) partners have HSV and continue in a loving relationship. Many cities have support groups, and one can obtain information from national organizations, medical libraries, the internet, and of course your doctor or health care provider.

Roberta replies:

Great article. Question:
Can HSV be detected in asymptomatic individuals by a blood test?

Roberta-

Dr. Hill responds:

Yep. There is a fairly sensitive antibody test that will detect past exposure to HSV I or II. It is really only clinically useful in a research setting. For example, if you went the the local mall, set up a testing area, and tested the first 100 people that walked by, in some areas of the country you might find 20-40% with documented exposure to HSV II!! (Of course, almost all of us have been exposed to HSV I). As I said in the article, a number of people have been exposed, but never get herpes. They must either have a super immune system against HSV, or perhaps they only got a "small" viral load when first exposed. In any event, they're lucky, as it can be a very painful and chronic disease for women.

References:

Dr. Hill's Recommended HSV Links:
Herpes Simplex Virus: AAD Derminfo NetHerpes Simplex Virus - University of Cape Town
Herpes Simplex Virus (HSV) Infection (Images)
Herpes Simplex - (Labialis) 1Herpes Simplex 2Herpes Simplex 3Herpes Simplex 4

D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
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