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Genital herpes is a
sexually transmitted disease (STD) caused by the herpes simplex viruses
type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by
HSV-2. Most individuals have no or only minimal signs or symptoms from
HSV-1 or HSV-2 infection. When signs do occur, they typically appear as
one or more blisters on or around the genitals or rectum. The blisters
break, leaving tender ulcers (sores) that may take two to four weeks to
heal the first time they occur. Typically, another outbreak can appear
weeks or months after the first, but it almost always is less severe and
shorter than the first outbreak. Although the infection can stay in the
body indefinitely, the number of outbreaks tends to decrease over a
period of years.
Results of a nationally
representative study show that genital herpes infection is common in the
United States. Nationwide, at least 45 million people ages 12 and older,
or one out of five adolescents and adults, have had genital HSV
infection. Between the late 1970s and the early 1990s, the number of
Americans with genital herpes infection increased 30 percent.
Genital HSV-2 infection
is more common in women (approximately one out of four women) than in
men (almost one out of five). This may be due to male-to-female
transmissions being more likely than female-to-male transmission.
HSV-1 and HSV-2 can be
found in and released from the sores that the viruses cause, but they
also are released between outbreaks from skin that does not appear to be
broken or to have a sore. Generally, a person can only get HSV-2
infection during sexual contact with someone who has a genital HSV-2
infection. Transmission can occur from an infected partner who does not
have a visible sore and may not know that he or she is infected.
HSV-1 can cause genital
herpes, but it more commonly causes infections of the mouth and lips,
so-called “fever blisters.” HSV-1 infection of the genitals can be
caused by oral-genital or genital-genital contact with a person who has
HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than
genital HSV-2 outbreaks.
Most people infected
with HSV-2 are not aware of their infection. However, if signs and
symptoms occur during the first outbreak, they can be quite pronounced.
The first outbreak usually occurs within two weeks after the virus is
transmitted, and the sores typically heal within two to four weeks.
Other signs and symptoms during the primary episode may include a second
crop of sores, and flu-like symptoms, including fever and swollen
glands. However, most individuals with HSV-2 infection may never have
sores, or they may have very mild signs that they do not even notice or
that they mistake for insect bites or another skin condition.
Most people diagnosed
with a first episode of genital herpes can expect to have several
(typically four or five) outbreaks (symptomatic recurrences) within a
year. Over time these recurrences usually decrease in frequency.
Genital herpes can
cause recurrent painful genital sores in many adults, and herpes
infection can be severe in people with suppressed immune systems.
Regardless of severity of symptoms, genital herpes frequently causes
psychological distress in people who know they are infected.
In addition, genital
HSV can cause potentially fatal infections in babies. It is important
that women avoid contracting herpes during pregnancy because a first
episode during pregnancy causes a greater risk of transmission to the
baby. If a woman has active genital herpes at delivery, a cesarean
delivery is usually performed. Fortunately, infection of a baby from a
woman with herpes infection is rare.
Herpes may play a role
in the spread of HIV, the virus that causes AIDS. Herpes can make people
more susceptible to HIV infection, and it can make HIV-infected
individuals more infectious.
The signs and symptoms
associated with HSV-2 can vary greatly. Health care providers can
diagnose genital herpes by visual inspection if the outbreak is typical,
and by taking a sample from the sore(s) and testing it in a laboratory.
HSV infections can be difficult to diagnose between outbreaks. Blood
tests, which detect HSV-1 or HSV-2 infection, may be helpful, although
the results are not always clear-cut.
There is no treatment
that can cure herpes, but antiviral medications can shorten and prevent
outbreaks during the period of time the person takes the medication. In
addition, daily suppressive therapy for symptomatic herpes can reduce
transmission to partners.
The surest way to avoid
transmission of sexually transmitted diseases, including genital herpes,
is to abstain from sexual contact, or to be in a long-term mutually
monogamous relationship with a partner who has been tested and is known
to be uninfected.
Genital ulcer diseases
can occur in both male and female genital areas that are covered or
protected by a latex condom, as well as in areas that are not covered.
Correct and consistent use of latex condoms can reduce the risk of
genital herpes only when the infected area or site of potential exposure
is protected. Since a condom may not cover all infected areas, even
correct and consistent use of latex condoms cannot guarantee protection
from genital herpes.
Persons with herpes
should abstain from sexual activity with uninfected partners when
lesions or other symptoms of herpes are present. It is important to know
that even if a person does not have any symptoms he or she can still
infect sex partners. Sex partners of infected persons should be advised
that they may become infected. Sex partners can seek testing to
determine if they are infected with HSV. A positive HSV-2 blood test
most likely indicates a genital herpes infection.
Division of STD
Prevention (DSTDP)
Centers for Disease Control and Prevention
http://www.cdc.gov/std/
Personal health
inquiries and information about STDs:
CDC National STD and
AIDS Hotlines
(800) 227-8922 or (800) 342-2437
En Espanol (800)
344-7432
TTY for the Deaf and Hard of Hearing (800) 243-7889
National Herpes
Hotline
(919) 361-8488
National Herpes
Resource Center
http://www.ashastd.org/hrc
herpesnet@ashastd.org
Resources:
CDC National
Prevention Information Network (NPIN)
P.O. Box 6003
Rockville,
MD 20849-6003
1-800-458-5231
1-888-282-7681 Fax
1-800-243-7012 TTY
http://www.cdcnpin.org/scripts/index.asp
E-mail: info@cdcnpin.org
American Social
Health Association (ASHA)
P. O. Box 13827
Research Triangle
Park, NC 27709-3827
1-800-783-9877
http://www.ashastd.org/
STD
questions: std-hivnet@ashastd.org
Sources
Centers for Disease Control and
Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002.
MMWR 2002;51(no. RR-6)
Centers for Disease
Control and Prevention. Sexually Transmitted Disease Surveillance,
2002. Atlanta, GA: U.S. Department of Health and Human Service,
October 2003.
Corey L, Wald
A. Genital herpes. In: Holmes KK, Sparling PF, Mardh P et al (eds).
Sexually Transmitted Disease, 3rd Edition. New York: McGraw-Hill, 1999, p.
285-312.
Corey L, Wald
A, Patel R et al. Once-daily valacyclovir to reduce the risk of
transmission of genital herpes. New England Journal of Medicine 2004;
350:11-20.
Fleming DT,
McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, St. Louis ME.
Herpes Simplex Virus Type 2 in the United States, 1976 to 1994. NEJM 1997;
16:1105-1111.
Wald A,
Langenberg AGM, Link K, et al. Effect of condoms on reducing the
transmission of herpes simplex virus type 2 from men to women. JAMA
2001;285: 3100-3106.
Wald A, Link
K. Risk of human immunodeficiency virus infection in herpes simplex virus
infection in herpes simplex virus type 2 – seropositive persons: A
meta-analysis. J Infect Dis 2002; 185: 45-52.
Weinstock H,
Berman S, Cates W. Sexually transmitted diseases among American youth:
Incidence and prevalence estimates, 2000. Perspectives on Sexual and
Reproductive Health 2004; 36:6-10.
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