This image displays a grouping of blisters on the buttocks in a patient with herpes simplex. This image displays a severe outbreak of herpes in the genital region.
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Genital Herpes  Information for adults

Picture of Genital Herpes: This image displays a grouping of blisters on the buttocks in a patient with herpes simplex. Divider line
This image displays a grouping of blisters on the buttocks in a patient with herpes simplex.
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Overview
Genital herpes is a recurrent, lifelong skin infection caused by the herpes simplex virus (HSV). There are 2 types of HSV: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Genital herpes is usually caused by HSV-2 but can occasionally be due to HSV-1. Herpes lesions on the face, sometimes referred to as cold sores, are primarily due to HSV-1. HSV infections are contagious and are spread to other people by skin-to-skin contact with the infected area.

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.
Who's At Risk
Genital herpes can affect anyone who is sexually active. In fact, approximately 10–60% of the general population is infected with genital herpes.

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.
Signs and Symptoms
A few days after exposure to HSV, a newly infected person typically develops a group of painful blisters or pus-filled bumps in the genital region. Because these fluid-filled lesions easily burst, many people never even notice them but instead see small, painful red sores or ulcers. These lesions usually last for 2–6 weeks for a primary infection and 5–10 days for recurrent infections. Eventually, a scab develops over each sore, which then falls off, leaving a red area that fades with time.

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
  • Stress
  • Trauma, such as those caused by dental work or cuts from shaving
  • Surgery
  • Immunosuppression
  • Friction to the area – for example, with sexual intercourse or tight-fitting clothes
Self-Care Guidelines
Acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) may help reduce pain, fever, and muscle aches that accompany the herpes sores. Applying ice packs or baking soda compresses may relieve some of the swelling and discomfort. Wear loose-fitting clothes and cotton underwear, and keep the infected area clean and dry.

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.
Unfortunately, the virus can still be spread even when someone does not have lesions. Therefore, condoms should be used between outbreaks, even if no sores are present.
When to Seek Medical Care
If you develop new painful sores in or around the genitals, see a physician as soon as possible because treatment is much more effective if started early.

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.
Treatments Your Physician May Prescribe
Most HSV infections are easy for physicians to diagnose. On occasion, however, a swab from the infected skin may be sent to the laboratory to confirm the diagnosis. A blood test may also be performed to determine if you have been exposed to the virus. Your doctor may also recommend a blood test for your partner to determine if he/she has been exposed to herpes in the past, or is at risk for contracting the virus.

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
If you have frequent or severe herpes outbreaks, your doctor may recommend taking an antiviral medication every day to decrease the frequency and severity of attacks. This type of therapy may also be effective in decreasing the chance that an uninfected partner will acquire the virus. If you are taking a daily antiviral medicine to suppress your outbreaks, talk to your doctor about stopping these medicines yearly to see if you still need daily treatment.



References

Bolognia, Jean L., ed. Dermatology, pp.1099, 2062-2063, 2167. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1236-1239. New York: McGraw-Hill, 2003.

Gupta R, Warren T, Wald A. Genital herpes. Lancet. 2007 Dec 22; 370(9605):2127-37.
Last Updated: 27 Apr 2011