Genital Herpes

The Type 2 herpes simplex virus (HSV) commonly causes genital sores. HSV Type 2 is most commonly (but not exclusively) sexually transmitted.  It is much more common than most people think, affecting up to one in five sexually active adults in the United States.

A primary infection with HSV Type 2 usually causes sores in the genital area (buttocks, penis, vagina or cervix), two to twenty days after contact with an infected person.  Symptoms can range from none at all to a minor rash or itching, painful sores, fever, aching muscles, and burning during urination. HSV Type 2 may also occur in locations other than the genital area, but is usually found below the waist. 

As with Type 1 HSV infection, lesions may or may not recur.  The sites and frequency of recurrences may vary.  Even though it is primarily sexually transmitted, the initial episode can be so mild, or asymptomatic, that a person may not realize that they are infected. Years later, a recurrence may be mistaken for an initial infection, leading to unfair accusations about who infected whom. 

As with Type 1 HSV, infection is forever:  After the initial infection, HSV remains in the nerve cells, lying dormant until it recurs.

The clinical appearance of HSV is often easily recognized, so no further testing is necessary.  If the diagnosis is unclear, a swab from the infected area may be taken and sent to a laboratory for culture. Other laboratory tests include specially treated scrapings that are examined under the microscope, and blood tests for HSV antibodies.

The best treatment is prevention:  Safe sex practices are urged to prevent this and other sexually transmitted diseases (STD's) for those sexually active adults not in a mutually monogamous relationship.  For those infected, oral anti-viral medications are available to treat herpes infections or to reduce the rate of recurrences in those with frequent outbreaks.  These medications do not cure herpes however, or render someone non-contagious.  They can reduce the amount of viral shedding however, and decrease the number of days that an infected person could pass on herpes to a sexual partner. 

How does someone with HSV infection know if they will be contagious?  Many people with recurrences will have a prodromal set of symptoms such as tingling, burning, itching, or tenderness in an area where they were previously affected.  During this time, or during any outbreak, that area of the body should have no direct or indirect contact with other people. For those  with genital herpes, this means avoiding ALL sexual relations, including oral and genital contact during the period of symptoms or active lesions. Condoms can help prevent transmission of genital herpes to your sexual partner, but this is not a fail-safe method.

As if that wasn't bad enough, HSV can also be spread if the affected person has no sores or symptoms.  In fact, most of the time, HSV is transmitted in the absence of lesions. 

Pregnant women who have active genital herpes at the time of childbirth may transmit the virus to their babies if the baby passes through the vagina.  If this occurs during the mother's first episode of genital herpes, the baby may suffer severe damage. Women who know or even suspect that they have had genital herpes should tell their physicians so they can be tested and the baby can be protected. Often a cesarean section precludes maternal-child herpes infection.  Newborns are also susceptible to HSV from non-genital lesions. Those with any form of active HSV should not handle newborns.

Created: 8/11/2003  -  Donnica Moore, M.D.