5 min read Genital Herpes

Genital Herpes: The Basics

Genital Herpes: The Basics
Valacyclovir 500 mg

What is Genital Herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).

How Common is Genital Herpes

Infection is common.  The Centers for Disease Control and Prevention (CDC) estimates that there are over a half million new genital herpes infections annually.(1) And data from 2015-2016 estimates that 12% of the population is infected with HSV-2.(2)  However, the percentage of the population with genital herpes is actually higher than 12%, since an increasing number of genital herpes infections are caused by HSV-1.

Risk of Infection

Anyone having vaginal, oral, or anal sex with someone infected with HSV can become infected. Infection is spread through contact with HSV from visible herpes lesions, genital secretions (vaginal discharge, semen), or oral secretions.  HSV-1 and HSV-2 can also be spread through invisible viral shedding from normal appearing mucosa surfaces (think mouth) and genitals, although the risk if spreading the virus to another is much greater when signs of symptoms of infection are present.  Genital herpes can spread:

  • During genital contact with someone with a genital HSV-2 infection
  • By receiving oral sex from someone with an oral HSV-1 infection

The spread of genital herpes often occurs from contact with an infected partner who does not have symptoms and does not know they are infected.(3)

Genital Herpes Symptoms

Most genital herpes infections do not cause of symptoms or cause only mild symptoms that can easily be mistaken for another condition. When symptoms do occur, they appear as small blisters in the genital area, rectum or mouth.  The blisters eventually break, leaving painful ulcers that may take several weeks to fully heal.  This is referred to as having a first herpes “outbreak.”  The average time (incubation period) between being infected and developing a first outbreak is 4 days, and ranges from 2 to 12 days.

There are differences between the first herpes outbreak and subsequent outbreaks.  The first outbreak is typically the most severe, the herpetic lesions tend to last longer and are often accompanied by systemic symptoms like fever, headache, and body aches.  Recurrent genital herpes outbreaks can occur frequently; individuals sometimes experience prodromal symptoms  - genital pain or tingling - before an outbreak occurs.  Recurrent genital herpes outbreaks are shorter in duration and less sever than the first outbreak.  Over time, outbreaks tend to become less frequent and severe.

Genital Herpes Complications

In persons with suppressed immune systems, people living with HIV, undergoing cancer treatment, or on chronic steroid therapy, genital herpes can causes painful genital ulcers that can be more long lasting and severe.  HSV-1 and -2 can also cause rare complications like inflammation of the lining of the brain, and infection can develop in areas outside of the groin including buttocks, finger, groin, or eye.

Genital ulcers caused by genital herpes outbreaks make it easier to transmit or acquire HIV.

Because the infection is life-long, most people infected genital herpes have concerns about how it will impact their sex life, relationships, and overall health.   They are sometimes embarrassed, feel shame and even stigma because of the diagnosis.  While there is no cure, there are concrete measures individuals can take to prevent currencies and protect their partners.  The risk of genital herpes transmission can be reduced by talking to present and future partners about genital herpes, avoiding sex during an outbreak, using suppressive antiviral therapy, and wearing condoms.

Genital Herpes Diagnosis

Diagnosis is generally based on an individual’s medical history, signs and symptoms, and lab work.  For patient’s presenting with active ulcers, samples can be from the ulcer and either cultured or used in a polymerase chain reaction (PCR) test to identify the herpes virus.  If no visible ulcers are present, but an individual has a history of genital ulcers or believes they’ve been exposed or infected, a blood test can be performed.  The CDC does not recommend screening for HSV-1 or-2 in young people without symptoms.  The blood test detects antibodies to HSV type 1 and 2; antibodies are not detectable the first few weeks after infection.  The blood test can be helpful in several ways: in serodiscordant couples - ie where one partner has antibodies to HSV-1 or -2 and the other does not - then the couple can discuss ways to prevent transmission. Also, knowing whether genital herpes is caused by HSV-2 or HSV-1 can help individuals predict the likelihood of future outbreaks, since HSV-2 causes more frequent genital herpes outbreaks.

Is there a Cure or Treatment for Genital Herpes?

There is no cure for genital herpes.  However, the infection can be managed with antiviral medication and self-care.

Antiviral medication valacyclovir (Valtrex) is taken by mouth in a pill form.  The dose and length of treatment depends upon whether an outbreak is a first occurrence or recurrent outbreak, as well as on medical history.

For recurrent outbreaks, there are two strategic ways individuals can use valacyclovir: episodic therapy and suppressive therapy.

Episodic therapy is taking antiviral medication only when outbreaks occur.  It can decrease the duration and severity of outbreaks if started within 72 hours of the onset of symptoms, including prodromal symptoms of tingling or pain before a blister occurs.  Episodic therapy does not reduce the frequency of outbreaks.

Suppressive therapy is taking antiviral medication every day to prevent outbreaks.  It decreases the frequency and duration of recurrences, and can reduce the risk of spreading genital herpes to someone else.  Suppressive therapy is recommended for individuals with frequent outbreaks, and or are in a relationship with a partner who does not have antibodies to HSV-1 or 2.

Key Points:

  • Genital Herpes is caused the herpes simplex virus type 1 or 2.
  • Symptoms of infection range from no symptoms to blisters on in the genital area, mouth, and rectum that evolved into painful shallow ulcers.
  • The first outbreak is usually the worst, and may include systemic symptoms like fevers or muscle aches; subsequent recurrent outbreaks tend to resolve sooner, be less severe, and diminish in frequency overtime.
  • Genital herpes is spread most easily when signs or symptoms of infection are present; HSV can also be spread when no symptoms are present due to invisible viral shedding.
  • Although it can’t be cured, genital herpes can be managed with antiviral medication taken either episodically or every day to decrease outbreak severity and speed up healing; suppressive therapy also has been shown to decrease spread to uninfected partners.


References

1.Kreisel KM, Spicknall IH, Gargano JW, Lewis FM, Lewis RM, Markowitz LE, Roberts H, Satcher Johnson A, Song R, St. Cyr SB, Weston EJ, Torrone EA, Weinstock HS. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2018. Sex Transm Dis 2021; in press

2.McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016. NCHS Data Brief, no 304. Hyattsville, MD: National Center for Health Statistics. 2018

3. Mertz GJ. Asymptomatic shedding of herpes simplex virus 1 and 2: implications for prevention of transmission. J Infect Dis, 2008. 198(8): 1098–1100.