Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. Between the late 1970s and the early 1990s, the number of Americans with genital herpes infection increased 30 percent.
Genital HSV-2 infection
is more common in women (approximately one out of four women) than
in men (almost one out of five). This may be due to male-to-female
transmissions being more likely than female-to-male transmission.
HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to be broken or to have a sore. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can cause
genital herpes, but it more commonly causes infections of the mouth
and lips, so-called “fever blisters.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.
Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection may never have sores, or they may have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
Most people diagnosed
with a first episode of genital herpes can expect to have several
(typically four or five) outbreaks (symptomatic recurrences) within
a year. Over time these recurrences usually decrease in frequency.
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital
HSV can cause potentially fatal infections in babies. It is important
that women avoid contracting herpes during pregnancy because a
first episode during pregnancy causes a greater risk of transmission
to the baby. If a woman has active genital herpes at delivery,
a cesarean delivery is usually performed. Fortunately, infection
of a baby from a woman with herpes infection is rare.
Herpes may
play a role in the spread of HIV, the virus that causes AIDS.
Herpes can make people more susceptible to HIV infection, and it
can make
HIV-infected individuals more infectious.
The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks. Blood tests, which detect HSV-1 or HSV-2 infection, may be helpful, although the results are not always clear-cut.
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases
can occur in both male and female genital areas that are covered
or protected by a latex condom, as well as in areas that are not
covered. Correct and consistent use of latex condoms can reduce
the risk of genital herpes only when the infected area or site
of potential exposure is protected. Since a condom may not cover
all infected areas, even correct and consistent use of latex condoms
cannot guarantee protection from genital herpes.
Persons with herpes
should abstain from sexual activity with uninfected partners
when lesions or other symptoms of herpes are present. It is important
to know that even if a person does not have any symptoms he or
she can still infect sex partners. Sex partners of infected persons
should be advised that they may become infected. Sex partners
can
seek testing to determine if they are infected with HSV. A positive
HSV-2 blood test most likely indicates a genital herpes infection.
Division of STD
Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std
Personal health
inquiries and information about STDs:
CDC National STD
and AIDS Hotlines
(800) 227-8922 or (800) 342-2437
En Espanol (800) 344-7432
TTY for the Deaf and Hard of Hearing (800) 243-7889
National Herpes
Hotline
(919) 361-8488
National Herpes
Resource Center
http://www.ashastd.org/hrc
herpesnet@ashastd.org
Resources:
CDC National
Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
1-800-458-5231
1-888-282-7681 Fax
1-800-243-7012 TTY
www.cdcnpin.org
E-mail:
info@cdcnpin.org
American Social
Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877
www.ashastd.org
STD questions:
std-hivnet@ashastd.org
Sources
Centers
for Disease Control and Prevention. Sexually Transmitted Diseases
Treatment Guidelines 2002. MMWR 2002;51(no. RR-6)
Centers
for Disease Control and Prevention. Sexually Transmitted Disease
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