Genital Herpes

• Herpes is very common.
• Among people aged 14 to 49, an estimated one out of every six people (15.5% of the population) has HSV-2, the virus that is predominantly responsible for genital herpes.
• Estimates suggest that there are 776,000 new genital herpes infections in the United States in a single year.
• The virus is more common in women than in men.
• Transmission from men to women is known to occur more readily than from women to men.
• According to WHO estimates, 67% of all humans under the age of 50 have HSV-1 globally. The majority of people who have HSV-1 are not aware of it.

• Herpes is transmitted by direct unclothed skin to skin contact. Genital herpes is transmitted by oral, vaginal or anal sex, or oral, vaginal, or anal contact with those specific mucous membranes of someone who has herpes.
• Because a person may spread the disease even when they do not have signs or symptoms of herpes, avoiding sexual contact with someone with active blisters does not guarantee protection against transmission.

Many people with genital herpes have mild symptoms or symptoms that are mistaken for another condition. It also is possible to have herpes and have no symptoms. People can have herpes and be unaware they have it.

Common symptoms

When signs and symptoms are present, they consist of:

• Typically painful fluid-filled blisters or paper-cut like lesions 
• Blisters on or around the vagina, penis, anus, or buttocks. Blisters may be internal, on the cervix or in the urethra.
• Ulcer formation after the blisters break open
• Blisters take 2 to 4 weeks to heal.

Signs of the first outbreak

With the first outbreak of genital herpes, a person may also experience flu-like symptoms including:

• Fever
• Chills
• Body aches
• Swollen lymph nodes

Immediately prior to an outbreak, there may be an itching, burning, or tingling sensation on the skin. This is called prodrome.

After the initial infection, a person may or may not have outbreaks later in life.

• The average incubation period (time until symptoms develop) of herpes after exposure is 4 days, but symptoms may develop anywhere from 2 to 12 days after you have been exposed to the virus.
• Individual outbreaks of herpes vary among affected people in terms of their frequency and severity.
• Outbreaks can be related to the function of the immune system and are typically worse in cases in which the immune system is suppressed or compromised.
• For example, at times of physical or emotional stress, during illness, or when taking certain medications, genital herpes outbreaks may be more likely.

• Laboratory tests, such as viral culture and nucleic acid amplification (polymerase chain reaction or PCR) swabs to detect the genetic material of the virus, are available.
• Immunologic tests to identify antibodies to genital herpes are other possible tests to establish whether there is an infection.

Antiviral medicines are available that can help manage the severity and duration of outbreaks if taken immediately prior to (when there are tingling or unusual skin sensations but no blisters) or within 24 hours of a herpes outbreak. The medications typically used are:

• acyclovir (Zovirax),
• famciclovir (Famvir), or
• valacyclovir (Valtrex).

These are all typically taken by mouth. In severe cases, antiviral medications may be given intravenously, but this is not usually needed for herpes. Topical medications that are applied directly to the herpes sores are also available, but these are less effective than oral medications and are not generally used.

These medications may also be taken daily as suppressive therapy to decrease the number of outbreaks in people who have frequent herpes outbreaks (more than six outbreaks per year), or for those who wish to reduce transmission.

There is no cure for herpes.

• Oral antiviral medications may be used during pregnancy.
• One serious concern with genital herpes in pregnancy is the transmission of the infection to the baby during delivery. In a newborn, a herpes infection can spread through the bloodstream and have serious consequences.
• Cesarean delivery (C-section) is performed for women who go into labor while there is an active outbreak of genital herpes in order to prevent transmission to the baby during birth.
• The American College of Obstetricians and Gynecologists recommends that pregnant women with recurrent genital herpes be offered oral antiviral medication at or beyond 36 weeks until delivery in order to increase the chances of being able to deliver vaginally.

• Herpes can be transmitted both during an outbreak and when there are no symptoms.
• Condoms may help prevent the spread of genital herpes to sexual partners during sexual activity, though it may also be spread from skin contact in areas not covered by a condom, or during oral to genital contact.
• Antiviral medication may be taken daily to help suppress viral shedding, which can help reduce the risk of transmission.