Genital Herpes (Overview)
Herpes is an infection caused by the herpes simplex virus (HSV) and can appear in various parts of the body. Most commonly herpes occurs in the mouth and on the genitals (sex organs).
There are two types of this virus – HSV-1 is known as oral herpes (cold sores and fever blisters around the mouth or face) and HSV-2 (genital herpes).
Genital herpes is a common sexually transmitted infection that occurs in both men and women. HSV-2 typically causes pain, itching and sores in the genital area and is contagious. A person may not even have visible sores, but is still capable of passing on the infection if sexual contact is made with another person.
Sexual contact is the main way this infection is transmitted (and spreads). A virus can be dormant in the body, but reactivate several times in a year. HSV-2 is treatable, but currently is not a curable condition.
Medications can alleviate symptoms and reduce the risk of infecting others. An additional preventative measure, which is highly recommended, is the correct use of condoms during sexual contact to reduce the risk of virus transmission.
Genital herpes symptoms
Signs and symptoms of genital herpes may be so mild a person may not even notice the infection or regard it as something to be concerned about. For most symptoms first appear within a few days to several weeks after the initial contact.
Symptoms common for both men and women include:
- Itching or pain: Exposure to an infected sex partner can cause itching, severe discomfort or pain within 2 to ten days. The areas around the genitals may become inflamed, raw and cracked, but without any itching, tingling or pain sensations.
- Small red bumps or white blisters: These can appear within a matter of days following contact with an infected person. Raw and painful sores will generally appear where the infection entered the body (buttocks or anus, mouth, vaginal area, cervix, penis, scrotum, thighs, urethra). An infection can be spread by touching the sore and then rubbing or scratching another area of the body (for instance, the eyes).
- Ulcers: Blisters may rupture and begin to ooze or bleed. The presence of an ulcer will cause pain and tenderness in the genital area until the infection clears up.
- Scabs: Once ulcers begin to heal, scabs will form.
- Flu-like symptoms: During the initial stages of infection you may experience flu-like symptoms such as swollen lymph nodes, headaches, muscle aches, fatigue and fever.
Signs and symptoms may recur on and off, for years. Many experience numerous episodes each year. In some cases, HSV-2 outbreaks are less frequent as time passes.
Shortly before a recurrence, you may notice burning, tingling and itching sensations (where the infection first entered the body) before actual sores appear. You may also experience some degree of pain in your lower back, buttocks and legs.
Recurrences are typically less painful than the original outbreak, and sores can heal more quickly. The number of recurrences a person may have during their lifetime may vary.
Women need to take care not to confuse herpes with a vaginal yeast infection. Likewise, both men and women, can sometimes mistake herpes symptoms for other bacterial or bladder infections. If any herpes symptoms are noted it is recommended that you consult your medical doctor as soon as possible for proper diagnosis and treatment.
What causes genital herpes?
The cause of herpes directly relates to its type (HSV-1 or HSV-2). HSV-1 herpes is transmitted through oral secretions or sores that develop on the skin. Typically, this type is transmitted through kissing (exchanging of saliva) or sharing objects such as eating utensils or toothbrushes.
Genital herpes (HSV-2) is transmitted from person to person during sexual contact (oral, anal, vaginal) with an infected individual. Both types can be spread, even without the presence of any physical symptoms (sores).
A pregnant woman with genital herpes can pass on her infection to the unborn baby during childbirth. A herpes infection may come and go, and can also be brought on by the following conditions:
- General illness (mild or serious), such as a cold or flu
- Stress (physical or emotional)
- Immunosuppression (due to AIDS or treatment methods such as chemotherapy or steroid medications)
- Trauma to the affected area (including sexual activity)
Once the virus enters the body through the skin, it travels along the nerve paths. The virus may then be either inactive (become dormant in the nerves but remain there indefinitely) or active (causing an outbreak of symptoms).
When active, the virus travels back along the nerve path to the surface of the skin. This results in physical symptoms where the virus begins to shed.
An active virus is easily passed from person to person through sexual contact.
Risk factors and complications
High risk factors include:
- Females (women): Genital herpes is more commonly noted in women than it is men. The virus is sexually transmitted more easily from men to women than it is the other way around.
- Multiple sex partners: More than one sex partner increases your risk of exposure to the virus that causes genital herpes.
Common complications associated with HSV-2 are:
- Other sexually transmitted infections: Genital sores increases a person’s risk of contracting or transmitting other sexually transmitted infections such as AIDS.
- Newborn infections: When a baby passes through the birth canal during delivery, an infant can be exposed to the virus from an infected mother. Complications that can affect the baby include brain damage, blindness or even death.
- Bladder problems: Sores can cause inflammation around the urethra (the tube that delivers urine from the bladder and out of the body). Swelling can in turn cause blockage (closing or narrowing of the urethra) for several days. If this happens a person’s natural ability to urinate is compromised and may need the insertion of a catheter to assist with draining the bladder.
- Meningitis: It is rare, but inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord can occur, causing meningitis.
- Proctitis (rectal inflammation): The lining of the rectum can become inflamed.
Treatment Procedures – Remedies and Relief
When should you see a doctor?
Any genital herpes symptoms experienced should be examined, diagnosed and treated by a medical health professional (general practitioner or gynaecologist) as soon as possible.
Diagnosis and tests
To make a diagnosis, your doctor will likely ask you a series of questions. These can include:
- What are your symptoms?
- When did your symptoms begin?
- Are you currently sexually active?
- Do you have a new sexual partner or multiple partners?
- Have you ever been diagnosed and treated for another sexually transmitted infection?
- Do you use condoms with your partners?
- Are you taking any medications or supplements?
- Are you experiencing any pelvic pain?
- Are you experiencing pain while urinating?
- Have you noticed any unusual discharge or sores in your genital area?
Your doctor will then conduct a physical exam and or / perform laboratory tests to make a genital herpes diagnosis. Tests he or she may perform include:
- Viral culture: A tissue sample (cells) or scraping of sores will be taken for examination under a microscope in the laboratory.
- Polymerase chain reaction (PCR) test: A sample of blood, tissue from a sore or spinal fluid will be taken. A PCR test will be used to test pieces of the virus’s DNA and establish both its presence, as well as which type of HSV it is. The PCR test is very accurate and is the most common test done to diagnose genital herpes.
- Blood test / Antibody test: A blood sample will be taken to assess the presence of HSV antibodies (detect a herpes infection). Antibodies are proteins produced by the immune system in response to an infection. A sample of cells (blood sample) will be taken for analysis under a microscope. A solution containing HSV antibodies and a fluorescent dye will be added to the sample. Antibodies will ‘stick to’ the cells if the virus is present and glow. This test will only determine if you have been exposed to or have ever had the herpes virus. An antibody test can tell the difference between HSV-1 and HSV-2 types.
It can happen that a viral culture or PCR test gives a false-negative result. This generally happens if an infected person’s sores have begun the healing process or if a person has very recently become infected (before HSV antibodies are present in the blood).
A false-negative will show that you do not have genital herpes, even when in fact you might. False-positive results are also possible, where a person may test positive for the virus, but the risk of getting it is low. In this case an individual may be re-tested.
A viral culture and PCR test will show that you have been exposed to the virus at some point. It will not determine when exposure may have occurred. It is possible, and your doctor may recommend testing for HSV in saliva, tears or urine.
Treatments and medications
Genital herpes is not a curable condition. Your doctor may prescribe antiviral medications to help heal sores (especially during an initial outbreak), reduce the severity and duration of symptoms, reduce the frequency of recurrence, as well as minimise the risk of transmitting the virus to another person.
Medications may only be recommended when you experience symptoms of an outbreak. Certain medications may also be prescribed to be taken daily, even when there are no visible physical signs of an infection outbreak (or recurrence).
Medications will help to make living with the condition easier. Antiviral medications help to reduce viral shedding (when a virus makes new copies of itself on the surface of the skin).
Most medications prescribed are in pill form for between 7 and 10 days. If your sores do not heal in that time, you doctor may extend your course of medications, keeping you on the prescription for a longer period (until sores begin to heal).
As genital herpes can flare-up at any stage, intermittent treatment may be recommended by your doctor. In this instance an antiviral medication will be prescribed to keep on hand when a recurrence happens. This is usually a shorter course of medication (2 to 5 days) when sores develop or you feel an outbreak coming on. The medication will alleviate the discomforts and pain of physical symptoms and clear them up faster.
There are instances where your doctor may suggest a suppressive treatment plan (antiviral medications taken daily). This may be recommended if you experience frequent outbreaks (more than 6 in a year). Suppressive therapy can reduce the number of outbreaks by between 70% and 80%. If you are being treated with a suppressive plan, it is highly recommended to see your doctor at least once a year (or as needed if taking pills daily is inconvenient, don’t appear to be working for you or begin to experience fewer recurrences with time).
As with any drug, there are some side effects experienced by some people, when taking prescribed medication. Side effects are generally mild and most medical professionals will agree that they are generally safe to be used in the long term.
Living with herpes
A diagnosis of genital herpes may cause you embarrassment, shame, anxiety and even anger. Emotions will be high and can often lead a person to become suspicious, fear rejection and even resentful of their sexual partner.
Healthy ways to cope with this condition include:
- Communicating with your partner, be honest about your feelings and refrain from assigning blame.
- Educating yourself about the condition, how it affects the body, how it is transmitted, how you can treat it and manage future outbreaks.
- Joining a support group. This can help you to cope with any negative feelings that arise when diagnosed. You can also gain some level of comfort by sharing your experiences and well as learning from those of others.
How do you get genital herpes?
An infected person cannot transmit an infection through contact with toilets, towels or other objects. The virus cannot survive outside of the body for very long. Genital herpes is most often transmitted through direct sexual contact (vaginal, anal or oral).
Is there a cure for genital herpes?
No, there is no known cure for genital herpes at this time. Symptoms are best managed and treated by a medical health professional.
Can genital herpes be prevented?
As with any other sexually transmitted infection, genital herpes is best prevented by abstaining from sexual contact. Limiting sexual contact to one person (who is infection-free) will significantly reduce your risk of contracting such infections.
Correctly using a condom during sexual contact and avoiding intercourse if you or a partner has an active outbreak will also significantly reduce risk.
What can you do if you are pregnant and have genital herpes?
Consult your doctor as soon as you suspect such an infection and get tested for it. Antiviral medications may be prescribed late in the pregnancy to try and minimise risk of an outbreak around the time of delivery. A caesarean section may be recommended if you do experience an active outbreak when you go into labour. This will reduce the risk of passing the virus to the baby during childbirth.