Genital Herpes—Herpes Simplex Virus (HSV)

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What is herpes?

Herpes is an STD caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most individuals have no or only minimal 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. These 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 is almost always less severe and shorter than the first episode. Although the infection can stay in the body indefinitely, the number of outbreaks tends to go down over a period of years.

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 have a sore. During sexual contact with someone who has a genital HSV-2 infection, a person almost always gets the infection. HSV-1 also causes infections of the mouth and lips, or so-called "fever blisters." A person can get HSV-1 by coming into contact with the saliva of an infected person, and therefore HSV-1 infection of the genitals is almost always caused by oral-genital sexual contact with a person with the oral form of the disease.

Prevalence of herpes

Results of a recent national study show that genital herpes infection is common in the United States. Nationwide, 45 million people ages 12 and older—or one out of every five people in the total adolescent and adult population—are infected with HSV-2. HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five), which may be due to more efficient male-to-female transmission. HSV-2 infection is also more common in African-Americans (45.9 percent) than in Caucasians (17.6 percent).

Since the late 1970s, the number of Americans with genital herpes infection has increased by 30 percent. The largest increase is currently occurring in young white teens, with HSV-2 infection now five times more common in 12- to 19-year-old whites, and twice as common in young adults ages 20 to 29, than it was two decades ago. In addition, HSV-2 may play a major role in the heterosexual spread of HIV, the virus that causes AIDS. Herpes not only makes people more susceptible to HIV infection, but it can also make HIV-infected individuals more contagious.

Symptoms of herpes

HSV-2 usually produces only mild symptoms, or no signs at all. However, HSV-2 can cause painful, recurrent genital sores, and the infection can be severe in people with suppressed immune systems. Genital herpes frequently causes psychological distress in people who know they are infected.

In addition, HSV-2 can cause potentially fatal infections in infants if the mother is shedding virus at the time of delivery. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy implies a greater risk of transmission to the newborn. If a woman has active genital herpes at delivery, a cesarean birth is usually performed. Fortunately, infection of an infant from a woman with HSV-2 infection is rare.

The 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). However, HSV infections can be difficult to diagnose between outbreaks. Blood tests that detect HSV-1 or HSV-2 infection may be helpful, but the results are not always clear-cut.

Treatment and prevention of herpes

There is no treatment that can cure herpes, but antiviral medications (acyclovir, valacyclovir and famciclovir) can shorten and prevent outbreaks during the period when the patient is taking medication.

The consistent and correct use of latex condoms can help protect against infection. However, condoms do not provide complete protection because the condom may not cover the herpes sore(s), and because viral shedding may occur. It is best to abstain from sex when symptoms are present, and to use latex condoms between outbreaks. In two recent clinical trials, a vaccine containing HSV-2 glycoprotein D (gD2) provided HSV-seronegative women significant protection (73 to 74 percent) against HSV-2 genital disease and limited protection (39 to 46 percent) against infection. [Source: Stanberry LR et al. New England Journal of Medicine. 2002 Nov 21;347(21):1652-61].

Genital Herpes Fact Sheet (CDC)