SEXUALLY TRANSMITTED INFECTIONS
Genital herpes is one of the most common sexually transmitted diseases (STDs) and is caused by the herpes simplex virus (HSV). There are two types of HSV.
- Herpes simplex virus type 1 (HSV-1)
HSV-1 usually causes fever blisters and cold sores on the mouth, but can also cause sores on the genitals, usually from oral-genital contact (i.e., oral sex) from someone who is infected with oral herpes.
- Herpes simplex virus type 2 (HSV-2)
HSV-2 usually causes blisters and sores on the genitals (vagina, penis, anus) and the skin around those areas.
Genital herpes is transmitted via direct skin-to-skin contact during oral, anal, and vaginal sex. It is possible for genital herpes to be transmitted even when blisters or sores are not present. Once HSV gets into the body, it lives there forever, either with periodic symptoms or without any symptoms at all. Genital herpes is not usually a severe or dangerous infection by itself. The sores can be painful and it can cause emotional distress because the infection is not curable.
About 50-80% of the adult population in the United States has oral herpes and about 15% of adults in the United States has genital herpes; however, as many as 90% of these infected people don't know they have the virus.
Many people have genital herpes but don't know it because they have no symptoms. Others have very mild symptoms and may not even know they are caused by herpes. The typical symptoms of herpes are blisters or open sores that occur around the genital area. These sores can be painful and last up to 2-3 weeks, first "weeping", then scabbing over, and then healing. This is sometimes referred to as “having an outbreak”.
1. Initial episode
The first outbreak is usually the worst; it lasts the longest, is most severe, and can be very uncomfortable. In addition to blisters or open sores, you may have swollen glands, fever, and body aches.
2. Repeat episodes
Usually recurrences are more frequent in the first year after the initial outbreak. These episodes tend to be milder and shorter in length than the initial episode of herpes. Recurrences tend to become less severe, last a shorter time, and occur less often over time. Repeat outbreaks are more common in HSV-2 than in HSV-1.
You may have tingling or itching at the site of the sores before they appear which can help you prepare for an upcoming outbreak. For some people, the recurrences are so mild that they have been mistaken for jock itch, razor burn, insect bites, or ingrown hairs. Genital recurrences after the first outbreak seem to be linked to stress, tiredness, lack of sleep, menstruation, and genital friction (new sexual partner after a time of no sex).
In many cases, experienced clinicians can diagnose an initial herpes outbreak by its appearance. There are swab tests that can tell if an ulcer or sore is caused by herpes and, if so, which type (HSV-1 or HSV-2). The swab tests are most accurate when sores are present.
There are also blood tests available to determine if you have herpes. The blood test looks for the antibodies your body makes to fight the virus and not the actual virus. These tests can’t tell you when you were infected.
Herpes testing is not routinely offered at San Francisco City Clinic. We offer tests for herpes to patients based on symptoms, the clinical history and evaluation by our medical staff.
There is no cure for herpes, but there are medications to help with the symptoms, prevent outbreaks, and to help reduce the chance of spreading it to others. There are currently three FDA-approved antiviral medications that are available to treat herpes: acyclovir (Zovirax, Sitavig), famciclovir (Famvir) and valacyclovir (Valtrex).
There are two different ways to take these medications:
- Episodic therapy is taking medications several times a day only when an outbreak occurs. This can help reduce the symptoms of herpes and speed the healing process.
- Suppressive therapy is taking medications every day on an ongoing basis, even when no sores are present. This helps prevent outbreaks and also decreases the chances that you can spread herpes to a sex partner.
Learn to recognize the symptoms that occur during the period just before the sores appear. People often describe a tingling or burning feeling during this time. Taking medications in this time period before an outbreak can prevent the sores from starting or reduce how long an outbreak lasts.
We recommend discussing your herpes diagnosis with your partner before you have sex. It’s possible to transmit herpes even if you're using condoms since not all affected areas can be covered by a condom. If you're in a long-term relationship, your partner might want to test for herpes as they might already be infected.
Having genital herpes increases your risk of becoming infected with HIV if you are exposed to HIV, and increases the risk of transmitting HIV to a sex partner if you have HIV. Taking PrEP for HIV prevention reduces the risk of HIV infection even if you or your partner has genital herpes.
Pregnant women who have a first episode of genital herpes near the time they give birth may transmit herpes to their infant. This can cause a serious and sometimes deadly condition. Women who get herpes before they become pregnant have a much lower risk of transmitting the virus to their babies. Pregnant women with herpes, or who have a partner with herpes infection, should talk to their healthcare provider about how to prevent passing herpes to their baby during childbirth.
Herpes is transmitted most easily when sores are present but it can also be spread when there are no symptoms. If your partner has herpes, avoid sex when blisters or sores are present. Your partner can also take daily, suppressive therapy, which will decrease their chances of spreading it. Condoms provide some, but not complete, protection.
Communication is a wonderful tool to help you and your partners make decisions about what's right for each of you at any given time.