Genital Herpes

Genital herpes is a viral condition which causes blisters on the genitals. It is a common condition that can affect both men and women, usually caused by herpes simplex virus 2 and sometimes by herpes simplex virus 1. This condition is contagious and is transmitted through direct physical contact, usually sexual contact.

The blisters associated with genital herpes are often stinging or painful, and people with this condition may also have a fever or swelling of the lymph nodes in the groin. Treatment involves antivirals, such as aciclovir, in cream or tablet form. The symptoms of this condition tend to be recurring, especially when a person feels stressed or unwell.

Genital herpes is caused by the human herpes simplex virus (HSV), specifically HSV-2 and HSV-1. This virus is spread through skin contact, genital contact or oral contact with people who have the virus. 1

Good to know: HSV-1 and HSV-2 infect the cells of the top layer of the skin, the epithelium, and the mucus membranes. After an episode of symptoms, the virus lies dormant in the nerve cells; when reactivated by factors such as stress or illness, it travels along the nerves to the skin or mucous membranes. 1

Genital herpes is mostly transmitted during sexual contact. People are usually infected during adolescence or in young adulthood, though infection at any age is possible. People who have other sexually transmitted infections (STIs) are more likely to have genital herpes. It is estimated that one in five women and one in nine men between the ages of 14 and 49 have a genital HSV-2 infection. 2 More women than men have genital herpes as it is easier for men to transmit HSV-2 to women than it is for women to transmit the virus to men. 3

Good to know: While most cases of HSV-1 and HSV-2 infection cause either oral or genital ulcers, it is also possible to develop herpetic ulcers on the fingers and thumb. This is known as a herpetic whitlow and is often found among healthcare workers. Herpetic whitlow is more often caused by HSV-1 than HSV-2. 4

Read more about Human Herpesvirus (HHV) »

Factors that make passing on the virus more likely include: 2 5

• Multiple sex partners, both current and across the lifetime
• Unprotected vaginal or oral sex
• Sharing sex toys without using a new condom for each partner or proper cleaning between uses
• Skin-to-skin contact with ulcers during sex or other intimate contact
• Receiving oral sex from a partner with an active cold sore
• Not recognizing the presence of ulcers
• Sex with a partner with an uncircumcised penis
• Touching the genital or anal area with a herpetic whitlow on the hand.

Like all herpes viruses, HSV-1 and HSV-2 can lie dormant in the body between active episodes. Certain factors can cause the virus to reactivate, including: 6

• Stress
• Illness, which can weaken the immune system
• Surgery or injury
• Extreme heat or cold weather
• Menstruation
• Fever.

If you are experiencing these or other symptoms about which you are concerned, you can do a free symptom assessment using the Ada app at any time.

The typical symptoms of genital herpes are: 2 3 4 5

1. Itching or pain in or on the genital areas
2. Followed by small, fluid-filled blisters.
3. These blisters developing into crusted sores.

The symptoms may last for up to two weeks. The first time a person has an outbreak of genital herpes, the blisters may be very painful. Other symptoms include:

• Fever
• Feeling unwell
• Pain when passing urine
• Muscle aches
• Swelling of the lymph nodes in the groin.

These symptoms may occur from time to time, especially when unwell or at times of stress.

Men and women experience the same symptoms when affected by genital herpes.

Symptoms of genital herpes in adults and sexually active teenagers usually have a prodromal phase, in which the affected person may feel generally unwell and also experience: 5

• Tiredness
• Headache
• Fever
• Swollen lymph glands
• Aches and pain in the lower back, groin and legs.

The affected person may also experience a tingling, itching or stinging sensation in the genital or anal area for between two hours and five days before the skin lesions appear. 2 6 The prodromal phase is followed by the development of lesions of the skin and mucous membranes, and can be located on the: 2 5

• Penis
• Labia
• Vagina
• Buttocks
• Thighs

These lesions begin as blisters, progress to red spots, then to fluid-filled blisters, which burst within a few days and become ulcers. 2 6 The first episode of genital herpes is usually the longest and most painful one the affected person will experience, with later episodes being generally shorter and less uncomfortable. People with genital herpes caused by HSV-1 are thought to experience fewer recurrences of the symptoms.

Good to know: About 66 percent of people with genital herpes do not show symptoms, but can still pass on the virus to their partners. 6

If you are concerned that you or someone you care for may be experiencing the symptoms of genital herpes, you can check the symptoms at any time using the free Ada app.

The diagnosis is usually based on symptoms and the appearance of herpes blisters. Testing fluid from the blister for the herpes simplex virus can confirm the diagnosis.

Four main types of test are used to diagnose genital herpes: 3 5 7

• Polymerase chain reaction (PCR), which is accurate and fast
• Direct fluorescent antibody, which is relatively quick and can identify specific strains of the virus
• Type-specific serological tests, which tests for type-specific antibodies that develop in the first weeks after infection
• Human herpesvirus culture, which requires a sample of fluid taken from an active lesion

Doctors decide which test to use based on the presentation of the condition. Culture and PCR testing are generally chosen for cases where there are active lesions. 7

The Tzanck smear method, while previously widely used, is now considered to be relatively insensitive and nonspecific compared to PCR and viral HSV culture.

Good to know: Genital herpes cannot be diagnosed by pap smear or routine blood tests.

Testing for genital herpes is generally widely available through general practitioners, gynecologists, and specialized sexual health clinics. People who should consider being tested for genital herpes include: 2 3

• People with a partner who reports genital herpes or shows symptoms of it
• People with multiple sexual partners
• People who have recently had unprotected sex with a new partner
• People who are HIV-positive
• Men who have sex with men
• People who have another sexually transmitted infection, such as chlamydia
• People who are pregnant or planning a pregnancy.

It is important to note that the best time to be tested is while symptoms are present.

In mild cases, where there are few blisters and the affected person is otherwise well, treatment may consist of antiviral creams. Tablets are also available to help prevent or reduce the symptoms of an outbreak of blisters. Severe or complicated cases need antiviral medication intravenously, i.e. through a drip. Pregnant women with genital herpes should be checked regularly; babies born vaginally can catch the herpes virus from their mother, and this may put the baby at risk for serious complications.

Treatment for genital herpes is intended to manage the infection rather than cure it. Genital herpes cannot be cured. 1 Antiviral treatment does, however, reduce the duration of the outbreak and decrease the likelihood of the virus being passed on to others. To be maximally effective, antiviral treatment has to be started as early as possible, while the lesions are still forming or even before, when the prodromal symptoms are felt.

Antiviral drugs used in the treatment of genital herpes include: 1 2

• Aciclovir
• Famciclovir
• Valaciclovir

Good to know: Because genital herpes is the result of a viral infection, antibiotics are not effective. Antibiotics are only effective against bacterial infections. Furthermore, topical creams intended for the treatment of cold sores are not effective against genital herpes.

In some cases, where the affected person experiences frequent or prolonged outbreaks, a longer-term course of oral antivirals may be prescribed to reduce the severity of episodes. 1

Because herpes cannot be totally eliminated from the body, episodes can recur throughout life. Some remedies that people affected by an active episode of genital herpes can use to relieve the discomfort are: 1 5

• Using acetaminophen, also known as paracetamol, or ibuprofen to manage the pain
• Applying ice packs to the affected area of skin
• Wearing loose-fitting clothes and underwear made from breathable, natural fibers such as cotton

Good to know: Never apply ice directly to the skin; always wrap it in a clean cloth or plastic bag. Petroleum jelly can damage condoms, contraceptive caps and diaphragms. 5

Many people who are affected by genital herpes deal with feelings of embarrassment, anxiety and low self-esteem. For this reason, many people living with this condition may find counseling helpful. 1

Using condoms and lubricants during sexual intercourse helps to prevent catching the herpes virus. Avoiding sex while blisters are present may also help.

If you are concerned that you or someone you care for may have genital herpes, you can do a free symptom assessment using the Ada app at any time.

• Herpes genitalis
• Herpes simplex genitalis

Q: Is genital herpes the only cause of genital ulcers?
A: No, but it is one of the most common. Other infectious conditions which can cause ulcers on the genitals include: 2

• Syphilis
• Chancroid, a bacterial infection spread by sexual contact, causing open sores on the genitals
• Lymphogranuloma venereum, a chronic lymphatic infection caused by the sexually-transmitted bacteria Chlamydia trachomatis.
• Granuloma inguinale, a bacterial condition caused by Klebsiella granulomatis bacteria, causing genital ulcers

Non-infectious conditions include: 2

• Trauma
• Psoriasis, a common skin condition that causes inflammation and a rash
• Behcet Syndrome, a rare disorder that causes blood vessel inflammation, which can cause mouth ulcers, mucus membrane and skin ulcers.

If symptoms are present, but the affected person is unsure what might be causing them, they should see their doctor.

Q: For how long is genital herpes contagious?
A: HSV-1 and HSV-2 can be shed by the body even when no symptoms are present, so it is possible to contract genital herpes from a partner even when they do not have any active blisters or lesions. 5

Q: What is the effect of genital herpes on pregnancy?
A: Genital herpes does not affect fertility in men or women. 8

If a pregnant person contracts genital herpes for the first time, particularly during the first six months of pregnancy, it is possible for the baby to become infected. Herpes infection in newborn babies can be fatal, so it is generally advised that pregnant women avoid close contact with anyone who has oral or genital herpes. 3 However, genital herpes can be treated during pregnancy, and the baby may develop immunity. 5

The risk of passing on an HSV infection during birth is low, but if the condition is contracted during the last three months of a pregnancy, the virus <em>can</em> be passed on to the baby, but there will not be time for the baby to develop immunity. In such situations, the baby can be delivered by a caesarian section. This is because the baby is exposed to the virus when it passes through the cervix and vagina during a vaginal birth, but not during a C-section.

Q: Does everyone who has genital herpes show symptoms the same way?
A: No. Not everyone with genital herpes experiences the same symptoms, or experiences symptoms in the same way. Many people who have the virus that causes genital herpes do not show any symptoms at all, while others may experience only very mild symptoms. Still others may have severe symptoms. 5

Q: Does genital herpes cause genital warts?
A: No. Genital warts are caused by human papillomavirus, HPV, not herpes simplex. Therefore, genital herpes cannot cause genital warts.

Read more about Genital Warts »

Q: Does genital herpes cause cancer?
A: It is not yet known for sure whether herpes simplex 1 or herpes simplex 2 are linked to cancer. However, some studies have shown that cervical and prostate cancer may be linked to HSV-2. 9 10 Medical research into this question is ongoing.

Q: What is the relationship between genital herpes and HIV?
A: In people with HIV who are not being treated for the condition, an episode of active genital herpes, especially if caused by HSV-2, may make them more likely to pass on HIV to their intimate partners, 11 because the HIV virus is present in the fluid shed by the blisters. By the same token, an HIV-negative person who has active genital herpes blisters may be more likely to contract HIV while the blisters are present, as they create small breaks in the skin through which the virus can easily enter. 3 ref11

People with HIV may experience more frequent episodes of active genital herpes, with more severe symptoms. However, the condition responds to antiviral treatment. 12

Q: Can oral sex pass on genital herpes?
A: Yes, but this is relatively rare. It is possible, though not common, to contract genital herpes by receiving oral sex from a partner who has a current episode of oral herpes. HSV-1 is usually the source of genital herpes in such cases. 13

Q: Can anal sex pass on genital herpes?
A: Yes, it is possible to pass on the HSV-2 and, more rarely, the HSV-1, virus during anal sex. 14

Q: Can blood contact pass on genital herpes?
A: No. Herpes can only be passed on by direct skin contact. 8

Q: Can herpes cause proctitis?
A: Yes. Proctitis is an inflammation of the rectum and can be caused by several bacterial and viral infections, including genital herpes. It is a particular risk of unprotected anal sex. It is more common among people with weakened immune systems. 15

Q: Can someone with HSV-1 contract HSV-2, or vice versa?
A: Yes. It is possible to have both HSV-1 and HSV-2. Having one virus does not prevent infection by the other.

Q: Are there any home remedies to help manage the discomfort caused by genital herpes?
A: Yes. Along with using over-the-counter pain medication, people who experience discomfort caused by genital herpes can:

• Take a warm bath with salt, baking soda or epsom salts added
• Spread a thin layer of petroleum jelly on the affected area

These do not cure the condition but may help with the discomfort.

Q: Can genital herpes be fatal?
A: In healthy people with strong immune systems, genital herpes is uncomfortable but not dangerous. However, in newborn babies or people with HIV/AIDS, herpes simplex can spread throughout the body, causing a severe infection that can sometimes be fatal if not promptly and adequately treated. Immunosuppressed or immunocompromised people with HSV may develop pneumonia, encephalitis, hepatitis or a disseminated herpes infection, which may be fatal. 16