What is genital herpes?
Genital herpes is an infection caused by the herpes simplex virus or HSV.
There are two types of HSV, and both can cause genital herpes. HSV type
1 most commonly infects the lips, causing sores known as fever blisters
or cold sores, but it also can infect the genital area and produce sores.
HSV type 2 is the usual cause of genital herpes, but it also can infect
the mouth. A person who has genital herpes infection can easily pass or
transmit the virus to an uninfected person during sex.
Both HSV 1 and 2 can produce sores (also called lesions) in and around
the vaginal area, on the penis, around the anal opening, and on the
buttocks or thighs. Occasionally, sores also appear on other parts of
the body where the virus has entered through broken skin.
HSV remains in certain nerve cells of the body for life, and can produce
symptoms off and on in some infected people.
According to the U.S. Centers for Disease Control and Prevention, 45
million people in the United States ages 12 and older, or 1 out of 5
of the total adolescent and adult population, are infected with HSV-2.
Nationwide, since the late 1970s, the number of people with genital
herpes infection has increased 30 percent. The largest increase is occurring
in young teens. HSV-2 infection is more common in three of the youngest
age groups which include people aged 12 to 39 years.
How does someone get genital herpes?
Most people get genital herpes by having sex with someone who is having
a herpes ďoutbreak.Ē This outbreak means that HSV is active. When active,
the virus usually causes visible lesions in the genital area. The lesions
shed (cast off) viruses that can infect another person. Sometimes, however,
a person can have an outbreak and have no visible sores at all. People
often get genital herpes by having sexual contact with others who donít
know they are infected or who are having outbreaks of herpes without any
A person with genital herpes also can infect a sexual partner during
oral sex. The virus is spread only rarely, if at all, by touching objects
such as a toilet seat or hot tub.
What are the symptoms?
Unfortunately, most people who have genital herpes donít know it because
they never have any symptoms, or they do not recognize any symptoms they
might have. When there are symptoms, they can be different in each person.
Most often, when a person becomes infected with herpes for the first time,
the symptoms will appear within 2 to 10 days. These first episodes of
symptoms usually last 2 to 3 weeks.
Early symptoms of a genital herpes outbreak include
- Itching or burning feeling in the genital or anal area
- Pain in the legs, buttocks, or genital area
- Discharge of fluid from the vagina
- Feeling of pressure in the abdomen
Within a few days, sores appear near where the virus has entered the
body, such as on the mouth, penis, or vagina. They also can occur inside
the vagina and on the cervix in women, or in the urinary passage of
women and men. Small red bumps appear first, develop into blisters,
and then become painful open sores. Over several days, the sores become
crusty and then heal without leaving a scar.
Other symptoms that may go with the first episode of genital herpes
are fever, headache, muscle aches, painful or difficult urination, vaginal
discharge, and swollen glands in the groin area.
Can outbreaks recur?
If you have been infected by HSV 1 and/or 2, you will probably have symptoms
or outbreaks from time to time. After the virus has finished being active,
it then travels to the nerves at the end of the spine where it stays for
a while. Even after the lesions are gone, the virus stays inside the nerve
cells in a still and hidden state, which means that itís inactive.
In most people, the virus can become active several times a year. This
is called a recurrence. But scientists do not yet know why this happens.
When it becomes active again, it travels along the nerves to the skin,
where it makes more viruses near the site of the very first infection.
That is where new sores usually will appear.
Sometimes, the virus can become active but not cause any sores that
can be seen. At these times, small amounts of the virus may be shed
at or near places of the first infection, in fluids from the mouth,
penis, or vagina, or from barely noticeable sores. You may not notice
this shedding because it often does not cause any pain or feel uncomfortable.
Even though you might not be aware of the shedding, you still can infect
a sex partner during this time.
After the first outbreak, any future outbreaks are usually mild and
last only about a week. An infected person may know that an outbreak
is about to happen by a tingling feeling or itching in the genital area,
or pain in the buttocks or down the leg. For some people, these early
symptoms can be the most painful and annoying part of an episode. Sometimes,
only the tingling and itching are present and no visible sores develop.
At other times, blisters appear that may be very small and barely noticeable,
or they may break into open sores that crust over and then disappear.
The frequency and severity of recurrent episodes vary greatly. While
some people have only one or two outbreaks in a lifetime, others may
have several outbreaks a year. The number and pattern of repeat outbreaks
often change over time for a person. Scientists do not know what causes
the virus to become active again. Although some people with herpes report
that their outbreaks are brought on by another illness, stress, or having
a menstrual period, outbreaks often are not predictable. In some cases,
outbreaks may be connected to exposure to sunlight.
How is genital herpes diagnosed?
Because the genital herpes sores may not be visible to the naked eye,
a doctor or other health care worker may have to do several laboratory
tests to try to prove that symptoms are caused by the herpes virus. A
person may still have genital herpes, however, even if the laboratory
tests do not show the virus in the body.
A blood test cannot show whether a person can infect another with the
herpes virus. A blood test, however, can show if a person has been infected
at any time with HSV. There are also newer blood tests that can tell
whether a person has been infected with HSV 1 and/or 2.
How is genital herpes treated?
Although there is no cure for genital herpes, your health care worker
might prescribe one of three medicines to treat it as well as to help
prevent future episodes.
- Acyclovir (Zovirax)
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
Recently, the Food and Drug Administration approved Valtrex for use
in preventing transmission of genital herpes. (See section below: How
can I protect myself or my sexual partner?)
During an active herpes episode, whether the first episode or a repeat
one, you should follow a few simple steps to speed healing and avoid
spreading the infection to other places on the body or to other people.
- Keep the infected area clean and dry to prevent other infections
- Try to avoid touching the sores.
- Wash your hands after contact with the sores.
- Avoid sexual contact from the time you first feel any symptoms until
the sores are completely healed, that is, the scab has fallen off
and new skin has formed where the sore was.
Can genital herpes cause any other problems?
Usually, genital herpes infections do not cause major problems in healthy
adults. In some people whose immune systems do not work properly, genital
herpes episodes can last a long time and be unusually severe. (The bodyís
immune system fights off foreign invaders such as viruses.)
If a woman has her first episode of genital herpes while she is pregnant,
she can pass the virus to her unborn child and may deliver a premature
baby. Half of the babies infected with herpes either die or suffer from
damage to their nerves. A baby born with herpes can develop serious
problems that may affect the brain, the skin, or the eyes. If babies
born with herpes are treated immediately with acyclovir, their chances
of being healthy are increased.
If a pregnant woman has an outbreak, which is not the first episode,
her babyís risk of being infected during delivery is very low. In either
case, if you are pregnant and infected with genital herpes, you should
stay in close touch with your doctor before, during, and after your
baby is born.
If a woman is having an outbreak during labor and delivery and there
are herpes lesions in or near the birth canal, the doctor will do a
cesarean section to protect the baby. Most women with genital herpes,
however, do not have signs of active infection with the virus during
this time, and can have a normal delivery.
Is genital herpes worse in a person with HIV infection or AIDS?
Genital herpes, like other genital diseases that produce lesions, increases
a personís risk of getting HIV, the virus that causes AIDS. Also, prior
to better treatments for AIDS, persons infected with HIV had severe herpes
outbreaks, which may have helped them pass both genital herpes and HIV
infection to others.
How can I protect myself or my sexual partner?
If you have early signs of a herpes outbreak or visible sores, you should
not have sexual intercourse or oral sex until the signs are gone and/or
the sores have healed completely. Between outbreaks, using male latex
condoms during sexual intercourse may offer some protection from the virus.
When used with these precautions, Valtrex can also help prevent infecting
your partner during heterosexual sex.
Is any research going on?
The National Institute of Allergy and Infectious Diseases (NIAID) supports
research on genital herpes and on herpes simplex virus (HSV-1 and HSV-2).
Studies are currently underway to develop better treatments for the millions
of people who suffer from genital herpes.
While some scientists are carrying out clinical trials to determine
the best way to use existing drugs, others are studying the biology
of herpes simplex virus. NIAID scientists have identified certain genes
and enzymes that the virus needs to survive. They are hopeful that drugs
aimed at disrupting these viral targets might lead to the design of
more effective treatments.
Meanwhile, other researchers are devising methods to control the virus'
spread. Two important means of preventing HSV infection are vaccines
and topical microbicides. Several different vaccines are in various
stages of development. These include vaccines made from proteins on
the HSV cell surface, peptides or chains of amino acids, and the DNA
of the virus itself.
NIAID and GlaxoSmithKline Biologicals are supporting a large clinical
trial in women of an experimental vaccine that may help prevent transmission
of genital herpes. The trial is being conducted at more than 20 sites
in 15 states nationwide. For more information, click here Herpevac
Trial for Women.
Topical microbicides, preparations containing microbe-killing compounds,
are also in various stages of development and testing. These include
gels, creams, or lotions that a woman could insert into the vagina prior
to intercourse to prevent infection.
Where can I get help if Iím upset about having genital herpes or I
have an infected partner?
Genital herpes outbreaks can be distressing, inconvenient, and sometimes
painful. Concern about transmitting the disease to others and disruption
of sexual relations during outbreaks can affect personal relationships.
If you or your partner has genital herpes, you can learn to cope with
and treat the disease effectively by getting proper counseling and medicine,
and by using ways to prevent getting infected or infecting someone else,
as mentioned above.
Where can I get more information?
National Herpes Resource Center and Hotline
American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
919-361-8488 (9 a.m. to 7 p.m. Eastern Time, Monday through Friday)
National STD and AIDS Hotline
1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)
National Institute of Allergy and Infectious Diseases
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
National Library of Medicine MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
The American College of Obstetricians and Gynecologists
409 12th Street, S.W.
P.O. Box 96920
Washington, DC 20090-6920
NIAID is a component of the National Institutes of Health
(NIH), which is an agency of the Department of Health and Human Services.
NIAID supports basic and applied research to prevent, diagnose, and
treat infectious and immune-mediated illnesses, including HIV/AIDS
and other sexually transmitted diseases, illness from potential agents
of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma
News releases, fact sheets and other NIAID-related
materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
Last Updated November 21, 2003 (alt)