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.
