Women’s Health

Genital Herpes

Herpes is not—in the vast majority of cases—a serious medical condition yet it almost always produces much more hysteria than the diagnosis of hepatitis, chlamydia or gonorrhea. I suspect the hysteria that surrounds this diagnosis is based on the following three issues:

  1. images-Herpes-Virus-631x465Some words, by their very sound are powerful and “loaded”. Words like “herpes”, ovarian “cysts” and “breast” cancer are more powerful words than “chlamydia”, “hypertension” and “colorectal” cancer. The facts, however, tell another story–herpes causes few problem for most women, chlamydia may cause permanent sterility; ovarian cysts are “normal” in 99% of cases while hypertension is a major risk factor for heart disease and strokes. Breast cancer is more common than colorectal cancer but not nearly as lethal.
  2. Herpes is a “chronic” condition—you don’t fully eliminate it from your body. The same is true, by the way of chickenpox (also in the family of herpes viruses) which rarely causes us to feel “dirty” and has no “stigma”. There was once a time when herpes was thought to be the cause of cervical cancer. That theory has long since been dispelled, but the “fear factor” has persisted.
  3. The media continues to hype “herpes”. There are many reasons for this not least of which is that media advertising is often paid for by pharmaceutical companies who stand to profit from evoking fear from a disease for which they can sell the “cure”.

In summary, the word “herpes” evokes shame, fear and self-loathing out of all proportion to the reality of the diagnosis. The combination of this diagnosis with underlying guilt and anxiety often results in consequences far greater than the disease itself. That said, it’s important to learn about the specifics of this sexually transmitted disease.

What are the different types of herpes viruses?

We generally hear of two types of herpes virus infection—HSV-1 (oral) and HSV-2 (genital). The majority of genital herpes is caused by HSV-2. However, an increasing number of genital lesions are also caused by HSV-1—likely from oral-genital sex

How common is genital herpes?

Up to 80% of Americans have oral herpes (HSV-1) at some time in their lives. Between 45 and 60 million Americans have HSV-2—the virus that causes genital herpes. It is estimated that up to a million people become infected each year with genital herpes. Women are more susceptible to genital herpes than men.

What are the risk factors for genital herpes?

The major risk factors for genital herpes include:

  • History of a prior STD
  • African American race
  • Three to five years of sexual experience
  • Female gender
  • History of a partner with oral (‘cold”) sores

What are the symptoms of genital herpes?

In all likelihood the majority of individuals with genital herpes have no symptoms whatsoever. However, blood tests can reveal a history of a past subclinical infection. In other cases the symptoms are so mild that they are easily overlooked.

At the other end of the spectrum individuals whose symptoms can be so severe and disabling that they require prompt medical care. Symptomatic cases generally begin with one or more blisters around the genital or rectum. The blisters become increasingly sore and filled with pus (pustules). After these pustules break they leave a tender sore (ulcer) that may take 7-21 days to heal.

The first episode of symptoms of a genital herpes infection is called the “primary” infection. The localized symptoms of the primary infection include:

  • A “tingling” sensation
  • Blisters (vesicles or pustules)
  • Open sores (ulcers)
  • Pain in the infected area
  • Itching
  • Burning when urine comes into contact with a sore
  • Inability to urinate if sores are in the area of the urethra

In addition to these symptoms, primary herpes is often accompanied by systemic symptoms that include:

  • Fever
  • Swelling of lymph nodes in the groin
  • Headaches
  • Achy flu-like symptoms

The “average” primary infection takes about 2-3 weeks to clear up.

Can genital herpes recur?

Yes. Symptoms of genital herpes can come and go but the virus stays in the nerve cells of your body even after all signs of the infection have disappeared. In many people, the virus becomes “active” from time to time creating a “recurrent” outbreak. Some women have an outbreak only once or twice in their lifetimes. Others have many outbreaks each year. In general, recurrent outbreaks tend to be less severe than the initial one. Over time women generally experience fewer and fewer recurrences. In some cases outbreaks appear to be precipitated by stress, other illness, excessive sun exposure or even the onset of menstrual flow.

About half of women with recurrent infections have prodromal symptoms before an eruption of visible lesions. These symptoms include mild tingling or shooting pains in the buttocks, legs and hips. The average recurrence lasts for about 10 days.

How do I know for sure if I have genital herpes?

Health care providers can often diagnose genital herpes by the classic appearance of visible sores. In other cases, especially when the appearance is atypical, viral cultures can offer conclusive evidence of an infection. Blood tests, which detect antibodies to HSV-1 or HSV-2, can help to detect herpes in people without symptoms.

Can genital herpes be treated?

While there is no cure for genital herpes it can certainly be treated. The virus will remain in the nerve cells of your body. However, certain drugs such as acyclovir, Valacyclovir (Valtrex) and famciclovir (Famvir) can shorten the duration of recurrent outbreak, decrease the frequency of outbreaks and often prevent them from occurring entirely. When used in conjunction with safe sex practices Valacyclovir can help to prevent you from passing the infection to someone else.

During outbreaks, you should:

  • Keep the infected area clean and dry
  • Try not to touch the sores
  • Wash your hands after contact with the sores
  • Avoid sexual contact from the time that symptoms are first notice (often “tingling” is the first symptom) until the sores have completely healed.
  • In addition to these anti-viral medications the use of painkillers and even local anesthetic ointments can be very helpful during an outbreak.

What about genital herpes and pregnancy? Is there a problem?

If the mother is having her first outbreak while she is pregnant she is more likely to pass the virus to her baby. In general, transmission to the baby happens only if the baby passes through the birth canal and is exposed to the virus. Women who have herpetic lesions or who experience a prodrome (the symptoms one experiences just prior to the appearance of lesions) generally undergo Cesarean section in order to avoid the possibility of transmitting the virus to the fetus. The overwhelming majority of women with a history of herpes infection do not transmit the virus to their babies.

What can be done to protect myself from contracting genital herpes?

Aside from abstinence there is no way to completely avoid the risks of a herpes infection. However, these risks can be minimized. Here are some suggestions:

  • Have sex in the framework of a long term mutually monogamous relationship.
  • When in doubt, use condoms.
  • Understand that most methods of contraception (birth control pills, Depo-Provera, Implanon, Diaphragms,
  • Intrauterine Devices and sterilization procedures do not protect against most STDs.
  • If you have any questions about symptoms you are experiencing contact your health care provider.
  • Talk frankly with your prospective partner before you establish sexual contact.

Is it possible to spread genital herpes to someone else if I don’t have an active infection?

Yes. Even after resolution of the primary genital herpes infection, intermittent viral shedding can occur in the absence of any visible lesion. This has been documented in both men and women and is called subclinical herpes virus shedding.

Where can I get additional information?

CDC Info, HHS
Phone: (800) CDC-INFO or (800) 232-4636

CDC National Prevention Information Network (NPIN), CDC, HHS
Phone: (800) 458-5231
Internet Address: http://www.cdcnpin.org

National Center for HIV, STD and TB Prevention, CDC, HHS
Internet Address: http://www.cdc.gov/std

National Institute of Allergy and Infectious Diseases
Phone: (301) 496-5717

American Social Health Association’s National Herpes Resource Center and Hotline
Phone: (919) 361-8488