Genital Herpes

HSV-2 or genital herpes is a communicable viral infection that affects about 45 million Americans. Annually, as many as 1 million new cases are thought to occur. The infection is caused by the herpes simplex virus (HSV). There are two types of HSV and both can cause the symptoms of genital herpes. HSV-1 most commonly causes fever blisters or cold sores, but it can also cause genital infections. HSV-2 most often causes genital sores, but it also can infect the mouth. The virus stays in the body for life, causing periodic outbreaks. Many HSV-infected individuals never experience symptoms.

Typically, HSV-2 causes genital herpes and research has found that in some countries, up to one in five people have the virus. HSV-1, the virus more commonly responsible for facial herpes, can also cause genital herpes.

In most individuals, genital herpes is a recurrent, possibly painful condition that can be treated (not cured). It is not life-threatening and has no permanent side effects to other aspects of one’s health.

Anyone, regardless of gender, race or class, who is sexually active may contract genital herpes.

TRANSMISSION

Herpes is usually transmitted by sexual contact with a person who has an infection. People with cold sores can pass herpes to the genital area of a partner during oral-genital sex. Herpes also can be passed by a person who has HSV but is not experiencing visible signs. Such asymptomatic shedding (link to glossary) may be common, taking place 5% -20% of the time people have the virus.

SIGNS AND SYMPTOMS

Signs of a primary episode vary from person to person. They usually arise within two to 10 days of exposure and generally involve small red bumps that may turn into blisters and open lesions. These “bumps” may be in or around the vaginal area, the cervix, the penis, urinary tract of both men and women, and around the anal opening, buttocks or thighs. Sores also arise on other body parts where broken skin has touched the virus. Over a period of days, the sores erupt, scab over and then disappear.

Other symptoms of a primary episode may include fever, headache, muscle soreness, inflamed glands in the genital area, and pain when urinating or vaginal secretions.

Following its entry to the skin or mucous membranes, the virus travels to the sensory nerves at the end of the spinal cord. Even after the skin lesions have vanished, the virus remains dormant inside the nerve cells. In most cases, the virus reactivates on a regular basis. When this happens, the virus passes along the nerves to the skin, where it reproduces on the outside at or near the original herpes site, causing new lesions to appear. It also can reactivate without any visible sores. At these times, small amounts of the virus may be shed around the original infection site, in genital or oral discharge, or from unapparent lesions. This shedding is sporadic, but it is enough to transmit the virus.

Recurrent outbreaks are generally milder than the first outbreak and typically have a shorter duration. A recurrent episode may be identified by a tingling sensation or itching in the genital region or soreness in the buttocks or down the leg. These are called prodromal symptoms (link to glossary) and, for some individuals, they can be the most painful and annoying part of a recurrent outbreak. Sometimes no visible sores are present. At other times, blisters appear that may be tiny and barely noticeable or may break into open sores that crust over and then disappear. The frequency and severity of the recurrent episodes vary greatly. While some people experience only one or two recurrences in a lifetime, others may experience multiple recurrences a year. The number and pattern of recurrences often change over time for a person. Researchers are unsure what triggers the virus’ reactivation. Although some individuals attribute outbreaks to physical/emotional stress, exposure to sunlight or menstruation, outbreaks often have no verifiable triggers.

It is possible to have genital herpes without knowing it. A lot of individuals have no visible symptoms and are not aware that they have been exposed to the HSV virus. As many as 80% of individuals who have HSV-2 don’t know that they have it. These individuals can still pass HSV to others, however. The only way to be sure is to discuss the possibility of a herpes test (link to herpes testing page) with a physician. Cultures and blood tests (link to herpes testing page) can determine whether you have been exposed to the virus, and sometimes, can establish whether you have been infected with HSV-1 or HSV-2.

Some people with genital herpes experience general symptoms: fever, muscle pain/tiredness and swollen lymph nodes in the groin area.

For males and females, the sores will typically erupt at or near the area of original contraction.

In females, look for lesions on the vaginal lips (the vulva), urethra, cervix, upper thigh and around the anus. In males, lesions can appear on the penis, urethra, scrotum, upper thigh and around the anus. In an initial episode, lesions are often painful for about 9 days and heal in about 2–3 weeks.

In some cases, the lesions in an initial outbreak may not appear as tiny blisters, but as be single, large bumps.

Identifying these symptoms as herpes is important and a doctor’s appointment should be made immediately. A physician will typically take a culture (link to glossary) to determine herpes infection.

When the first outbreak occurs, the virus passes up the nerves and deposits near the spine, and it is in a period of latency. Outbreaks (link to Outbreaks page) occur when the virus becomes active.

Tingling in the skin (prodrome) is often the first sign of herpes. A slight, sometimes painful, swelling may then develop and then the fluid-filled blisters surface on the skin.

OUTBREAKS

Genital herpes outbreaks often appear in the same area each time because the virus is transported from the nerve ganglia along the nerve paths to the skin, which limits where a recurrence can take place (generally below the waist if it affects the genital area). Symptoms, however, may not always appear in exactly the same place. It is not uncommon for a lesion to appear on the genitals in one recurrence and near the anus in another instance.

Once blisters have ruptured, small sores appear. And if these sores are irritated by water or urine, they may be painful.

Ultimately, these sores form a crusty overlay and scab over. If the region under the foreskin (prepuce) is affected, scabs may not develop, the sore will heal slowly without scarring.

Genital herpes indicators may differ from traditional blisters. Outbreaks may be so mild that the physician or the person who is infected does not visibly detect it. While the symptoms may not pose as a nuisance physically, they may pose as a nuisance with regards to sex.

The initial outbreak episode is commonly called the primary infection and during this period the virus may pass to the nerve ganglia. Later outbreaks, commonly called recurrences, take place when the virus reproduces in the ganglion, releasing particles that pass along the nerve back to the original location of infection. The first outbreak is typically the most intense because the body has not yet developed antibodies to fight the infection.

Frequency of Outbreaks

Some individuals may not have symptomatic recurrences but for individuals who do, they are generally shorter and less intense than the first outbreak. Subsequent outbreaks may decrease in both severity and frequency, although there is no clear-cut proof that this will occur. Warning signs (also called prodromal symptoms) like tingling, itching or burning often precede outbreaks.

Similar to the first outbreak, individual experiences can vary greatly. About 80% of individuals experiencing an HSV-2 initial outbreak will experience at least one recurrence, compared to only 50% of individuals who have HSV-1. Typically you can expect about 4 attacks a year. But, some individuals experience many more annual outbreaks.

The genital area is not the only place HSV-2 can occur. It is also common for blisters on the buttock to develop into ulcers after a day or two. It is also possible, but rare for lesions to appear on other body parts.

Warning symptoms will accompany most outbreaks in the form of a tingling sensation at the spot where the blister will appear, or a sciatica-like pain down the leg where the outbreak will appear.

Genital outbreaks usually clear up after a week or less. An exception to this is an outbreak that occurs on the buttock. These outbreaks may last longer because the skin on the buttock is thicker than skin in the genital area and perhaps as a result of the irritation that can occur from clothing.

Any area in the groin can be affected by genital herpes.

Severe sciatica-like pain usually accompanies outbreaks on the thigh and buttock. But, the pain generally subsides when blisters appear.

PREVENTION

The goal of this portion of the site is to inform you of what you can do to avoid genital herpes contraction and also, how to minimize the chance of spreading genital herpes if you have already been infected.

One useful method in preventing the spread of many STDs is the use of condoms. If used properly (and for the duration of sexual intercourse), condoms greatly decrease the chances of transmitting chlamydia and HIV.

Abstinence is the best way to ensure protection from herpes and other STDs. Engaging in sex with only one uninfected partner who has sex exclusively with you also decreases your chances for contracting herpes.

Proper, consistent use of latex condoms can decrease chances of genital herpes and other STDs, but only when the condom protects the infected areas. Herpes lesions may arise in regions that can be covered or protected by a condom, but also in areas not protected. In HSV-2 instances, studies support the notion that use of condoms protects women from contraction. There have not yet been enough studies to verify if this is also the case in men.

Using a condom is not a guarantee, however, because they cannot protect areas on the skin not covered by the condom where the virus may be present—i.e. areas around the genitals.

In some documented instances, lesions cover a large area of the groin in a pattern similar to the initial outbreak. When it occurs in individuals who also have other skin disorders like eczema, for example, the virus may spread across a wider area. Damaged skin allows the virus to more easily infect a person or spread. People with herpes should be mindful that shaving the genital area could cause the infection to spread over the entire genital region. Therefore, herpes-infected individuals (facial or genital) should practice good hygiene.

A person can pass herpes to the genitals from the mouth during oral sex. In the last decade, these cases have become more common and it occurs more in Europe than in the U.S. As many as half of the genital herpes cases are caused by HSV-1, and oral sex is typically the vehicle for contraction.

There are multiple things that a person can do to reduce chances of contracting herpes. It’s important for you to know that if you are in a long-term relationship with somebody who is infected with genital herpes, you may still become infected regardless of taking all suggested precautions.

If genital herpes occurs in one partner and not the other, suppressive antiviral therapy (daily preventive treatment to reduce chance of transmission and frequency of recurrences) may be a treatment to discuss with a physician.

Herpes is not the only infection that causes genital sores. Bacterial infections have also been known to cause sores that resemble herpes sores. Therefore, proper diagnosis is key.

This following information is not intended for use as an alternative to a physician.

TREATMENTS

Read below for non-specific treatments can reduce the symptoms associated with genital herpes.

* Wash the genital area in a SALT BATH. This can clean, soothe and dry the sores. Place one teaspoon of salt in 600 ml of water, or in a shallow bath, add about a handful of salt.

* Take PAIN RELIEVERS and simple analgesics (i.e. aspirin and paracetamol), apply ice directly on infection (which soothes sores) and use creams that have an anaesthetic component. Creams may slow down drying and should only be used sparingly and only for pain relief. Also, topical creams (especially when used by women) are not very useful on moist mucosal surfaces.

* Wear LOOSE UNDERCLOTHES, preferably cotton (avoid nylon), can help reduce pain and aid in clearing up outbreaks.

* For people who have painful urination, pain can be reduced if this is done in a cool bath. Also, drink lots of fluids, as this dilutes urine and also reduces pain during urination.