Both types of HSV produce 2 kinds of infections: primary and recurrent. Because it is so contagious, HSV causes a primary infection in most people who are exposed to the virus. However, only about 20% of people who are infected with HSV actually develop visible blisters or sores. Appearing 5–6 days after a person's first exposure to HSV, the sores of a primary infection last about 2–6 weeks. These sores heal completely, rarely leaving a scar. Nevertheless, the virus remains in the body, hibernating in nerve cells.
Certain triggers can cause the hibernating virus to wake up, become active, and travel back to the skin, causing a recurrent infection. These outbreaks tend to be milder than primary infections and generally occur in the same location as the primary infection. The frequency of recurrence is unpredictable and tends to become less over time.
Herpes is spread from person to person by direct skin-to-skin contact. The virus is most contagious when there are visible sores in the genital region. HSV can also be spread when there are no sores present, however, which is called asymptomatic shedding. Remember that only 20% of people who are infected with HSV actually develop visible blisters or sores, which means that approximately 80% of people with HSV have not been diagnosed and are unaware of their condition. Therefore, they can unknowingly transmit the infection to their sexual partners.
In women, the most common locations for HSV-2 infection are the external genitalia, vagina, cervix, and anus. In men, the most common locations for HSV-2 infection are the penis, scrotum, upper thighs, buttocks, and anus.
Primary genital HSV infection can be severe, with many painful blisters causing pain or burning with urination and vaginal or urethral discharge. People may also develop fever, headache, muscle ache, and fatigue with a primary outbreak.
Recurrent HSV infections are usually milder than the primary infection, though the lesions look similar. Many people with recurrent HSV infections have burning, tingling, or pain in the area of the outbreak up to 24 hours before any visible signs. This is called the prodromal phase of the infection. Because many people never develop the symptoms of a primary HSV infection, they may mistake a recurrent infection for a primary infection.
Most people will have a recurrence of genital herpes during the first year after a primary infection. On average, most people will get about 4 outbreaks per year, although the frequency of recurrence is extremely variable and tends to decrease over the years.
A recurrence of genital herpes usually occurs spontaneously, but it can also be triggered by the following:
- Fever or illness
- Sun exposure
- Hormonal changes, such as those due to menstruation or pregnancy
- Trauma, such as those caused by dental work or cuts from shaving
- Friction to the area – for example, with sexual intercourse or tight-fitting clothes
Because HSV infections are very contagious, it is important to take the following steps to prevent spread of the virus during the prodrome phase (burning, tingling, or pain) and active phase (presence of blisters or sores) of genital HSV infections:
- Avoid sharing towels and other personal care items.
- Wash your hands with soap and water if you touch an active lesion. HSV can be spread to other parts of your body via infected hands.
- Avoid sexual contact (including oral, vaginal, and anal sex) during both the prodrome phase and the active phase.
Recurrent outbreaks of genital HSV usually do not require a visit to the doctor. However, because some people have milder forms of herpes, you should also see a doctor for any recurring rash in the genital area, even if you think it is from bug bites, jock itch, or any other condition.
If you have an underlying medical condition such as cancer or HIV, if you have undergone organ transplantation, or if you are pregnant, you are at higher risk for more serious complications from genital herpes. Seek medical advice as soon as possible if you develop any lesions.
Genital herpes can also be passed to a newborn baby during delivery through contact with a lesion in the mother's genital tract. Be sure to speak with your obstetrician about the possible risk to your baby if you have genital herpes.
Untreated HSV infections will go away on their own, but antiviral medications can reduce symptoms, shorten the duration of outbreaks, and decrease the chance of spreading the virus. These medicines are most effective if taken during the first 24 hours of symptoms. If you experience burning and tingling before the appearance of blisters, you can start the medicine as soon as you feel these symptoms. Unfortunately, these medicines do not cure HSV infections.
Treatment for primary and recurrent HSV infections are oral antiviral medications, such as acyclovir (Zovirax®), valacyclovir (Valtrex®), and famciclovir (Famvir®). Each of these medications is equally effective and usually taken for 7–10 days for primary infections and 1–5 days (depending on dose) for recurrent infections. Talk to your doctor about getting a prescription for these medicines for possible future outbreaks, as they are most effective if taken early on.
More severe HSV infections may require additional medications such as:
- Oral antibiotics if the area is also infected with bacteria
- Oral antifungals if the area is also infected with yeast
- Topical anesthetic cream, such as lidocaine ointment, to reduce pain