Genital Herpes: What is Genital Herpes?

by Food and Drug Administration (FDA)

Genital herpes may not be deadly, but it can be physically painful and emotionally debilitating. Those who have it may suffer from painful sores as well as feelings of shame, regret, isolation, and undesirability.

"We, as a society, don't do well with STDs," says Terri Warren, R.N., owner of the Westover Heights Clinic in Portland, Ore., specializing in the treatment of sexually transmitted diseases. "When people have a lifelong STD, they feel dirty, damaged, and unapproachable. Most people have a dramatic drop in self-esteem."

Curtis Phinney of Rockville, Md., was devastated when he first discovered he had genital herpes. "I was very interested in finding a new successful long-term monogamous relationship," says Phinney, who had been divorced before he became infected. "I was having difficulty as it was. With herpes I thought it would be impossible. I thought I was unlovable, untouchable, undesirable."

Genital herpes is on the rise. Since the late 1970s, the number of Americans infected with the virus has increased 30 percent to about 45 million, according to the Centers for Disease Control and Prevention (CDC).

Genital herpes infects more than 1 of 5 adolescents and adults, the CDC says. It is more common in blacks than in whites, and more likely to infect women than men. Compared to 20 years ago, it's about five times more common in 12- to 19-year-old whites and twice as common in adults ages 20 to 29.

The scary part is that most people with genital herpes don't know they have it, and are unaware they may be spreading it to others, says Warren. Many have no symptoms or mistake their symptoms for something else, such as jock itch, insect bites, hemorrhoids, yeast infections, razor burn, or allergies to laundry detergent.

Of even greater concern is growing evidence that people with genital herpes are at greater risk of getting HIV (the virus that causes AIDS) if they have unprotected sex with someone infected with HIV. And HIV-infected people who are also infected with genital herpes may have more frequent and severe outbreaks and their episodes may be more difficult to treat.

In the past, genital herpes was diagnosed solely by visual inspection and laboratory culture of an active sore. Herpes may now be diagnosed with a blood test, even when no symptoms are apparent or after sores have healed. And while there is no cure for herpes, antiviral drugs have been approved by the Food and Drug Administration that greatly reduce the frequency of outbreaks and shorten their duration and severity.

What is Genital Herpes?

Genital herpes, a sexually transmitted disease (STD), is an infection caused by the herpes simplex virus (HSV). HSV is in the same family of viruses that causes chickenpox, shingles and mononucleosis. There are two types of HSV: HSV-1, which infects 80 percent of the U.S. population, usually appears on the lips in cold sores; HSV-2 is usually found in the genital area. However, if a person with HSV-1 oral herpes (cold sores) performs oral sex, it is possible for the partner to get HSV-1 genital herpes. And HSV-2 can infect the mouth through oral sex.

HSV can cause sores, or lesions, to appear in and around the vaginal area and within the cervix in women, and on the penis and scrotum in men. Both males and females may also get lesions in the urinary tract, around the anal opening, on the buttocks or thighs, and sometimes on other parts of the body.

The First Episode

Symptoms of genital herpes can vary in appearance and intensity. Some people have no symptoms or such mild symptoms that they don't suspect they have an infection. For others, the first episode of herpes (primary infection) can cause one or more very painful lesions to erupt on the skin.

For many people, this primary infection may be more severe and have more generalized symptoms than recurrent episodes. During a first episode, the lesions may be accompanied by flu-like symptoms such as fever, headache and muscle aches. Some people experience painful or difficult urination and swollen glands in the groin area. Women may also have a vaginal discharge.

Genital herpes lesions usually appear within two to 10 days after being exposed to the virus, and can last from two to four weeks. First to appear are small red bumps, which develop into blisters. Then the blisters become open sores, which later dry up, crust over, and heal without leaving a scar. Sometimes a second crop of lesions appears.

Recurrent Episodes

Once HSV infects a person, the virus travels through the nerves and settles at the base of the spine. During this inactive phase, the virus is dormant. But it may wake up later, travel along the nerve paths to the surface of the skin, and cause another outbreak of lesions. This recurrence of HSV usually causes lesions to appear around the same area of the first outbreak. (See "Harboring Herpesvirus" at right.)

Some people have only one or two recurrences in a lifetime, while others have them frequently. "The recurrence rate is far lower in HSV-1 than HSV-2," says Rhoda Ashley, Ph.D., director of the University of Washington's diagnostic virology laboratory at the Children's Hospital and Regional Medical Center in Seattle.

Most people diagnosed with HSV-2 affecting the genital area typically have four or five symptomatic recurrences the first year. After the first year, most people have fewer and milder recurrences, lasting a week or less. Many people get warning signals of a recurrence, known as prodrome. With prodrome, there may be a tingling or itching in the genital area, or pain in the buttocks, down the legs, or in the lower back. Sometimes these symptoms go away and no lesions appear.

Phinney's outbreaks were so frequent that they made him irritable, he says. "I would get an outbreak, and as that outbreak was fading over a week or so, suddenly a new one would crop up. As a result, I was really only 'clear' for as little as one week a month."

Researchers don't know why recurrences happen, or why their frequency and severity vary. Some people report that recurrences are triggered by stress, illness, poor nutrition, menstruation, and friction in the genital area, such as that caused by vigorous sex. However, many of these supposed triggers have no scientific basis, says Ashley. "You can't say stress is a trigger. It's like the chicken and the egg. Which came first — the herpes or the stress?" Nevertheless, for many people, trying to avoid their triggers seems to work for them, says Ashley.

Stress is a "huge factor" in triggering outbreaks for Pat Adams of Washington, D.C. Adams has had genital herpes for about 20 years. "Anything I can do to calm myself down during a stressful period and take better care of myself can help," says Adams. She finds that a good diet and exercise help her to keep the virus in check.

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