An Ancient Virus That Affects Millions of Americans
In Greek the word "herpes" means "to creep." Since ancient times, herpes has crept into the lives of millions of people. Genital herpes is an infection caused by a virus, usually spread through sexual contact, that produces sores and blisters on or around the penis, buttocks, vagina, and vulva. While some people have only one outbreak, 90% of the time people with herpes have recurrent infections. Although it is rarely a serious health problem, herpes is uncomfortable and emotionally disturbing. And while there is no cure for this sexually transmitted infection, a couple of drugs may control its course and manage its symptoms. Education is an important part of herpes treatment since it can help you prevent and manage outbreaks and reduce the risk of spreading the disease.
There are two types of herpes simplex virus (HSV): type 1 and type 2. Type 1 typically infects the lips, mouth, or nasal membranes. These sores, which are known as cold sores and fever blisters, are not related to sexual activity. But type 1 can also infect the genitals and causes up to one-third of genital herpes cases. Usually though, type 2 causes genital herpes, and doesn't cause oral lesions.
Herpes is a virus spread through physical contact. Infection occurs when the virus penetrates the penis, vagina, urinary opening, cervix, or anus, usually through a break in the skin, and invades healthy cells. In an effort to defend itself, the body produces sores (lesions) and blisters. These may also become infected with bacteria.
A few days after being infected with the herpes virus you may notice flu-like symptoms, including fever, chills, and muscle aches. Small, fluid-filled blisters may appear on or around the sex organs.
Although these sores heal within a few weeks, some of the virus travels to nerve cells near the spine, where they remain inactive until something triggers a recurrence. It is not always clear what triggers new outbreaks, but stress, fatigue, infection, and the use immunosuppressive or anticancer drugs are all causes.
About 90% of people with herpes have recurrent infections. You may notice tingling, burning, itching, and irritation where the virus first entered your body (this is called the prodrome) just prior to a recurrence. You may also feel pain radiating to your buttocks and knees.
Herpes is a very individual infection: some people have only one or two outbreaks a year with painful symptoms while others might have many outbreaks a year with very mild symptoms. This first outbreak (known as the primary infection), usually lasts about three weeks and is generally the most painful. While recurrences may be common, they are usually less severe.
Besides the sex organs, genital herpes can affect the tongue, eyes, gum, lips, fingers, inside of the mouth, and other body parts.
There is no cure for herpes yet. But drugs, alternative therapies, and self-treatment can help you control the infection's course and manage pain. Herpes is not life-threatening in adults, but it can be very serious for newborns. If you're pregnant and have herpes or suspect you do, you'll need special medical attention to prevent passing the virus to your child, possibly a cesarean section if lesions are active in or near the birth canal.
How Common Is Genital Herpes?
According to the American College of Obstetricians and Gynecologists (ACOG), as many as 30 million Americans have genital herpes. Approximately 500,000 new cases appear each year. Because the virus is usually transmitted through sexual contact, it is more prevalent among young, sexually active people with more than one partner. Using condoms may keep you from exposing a sexual partner. The number of initial doctor's office visits for herpes has increased from about 25,000-50,000 in the early '70s to 160,000 in 1995.
What You Can Expect
Schedule a doctor's appointment right away if you have symptoms of herpes or think you may have been infected. The sooner your doctor diagnoses herpes, the more successfully you can treat it. And the sooner you know you have it, the less likely you are to spread it to someone else.
There are several tests to detect herpes. Don't wait until your sores are healed to see a doctor: it is much harder to diagnose herpes once the visible symptoms are gone.
If you are diagnosed with herpes, your doctor will probably prescribe a medicine called acyclovir that prevents the virus from multiplying. Acyclovir is available as an ointment, in capsules, or intravenously (by vein); in the capsule form, it can prevent or reduce the number of future outbreaks. The drug may be taken only during an outbreak, or if necessary, it may be taken continuously.
Your doctor will also offer self-care advice and tips on preventing recurrence.
Goals of Treatment
Although there is no cure for genital herpes yet your doctor can prescribe medications to reduce the pain, intensity, and duration of herpes outbreaks. Your doctor can also prescribe antiviral drugs to reduce the number of outbreaks. And, because herpes is highly contagious, your doctor can counsel you on ways to prevent spreading the virus.
If you are struggling with the emotional pain of genital herpes, a sense of contamination or dirtiness, your physician can also probably recommend a counselor or support group in your area.
There are two different types of therapy used to treat herpes. Episodic therapy involves taking antiviral medication during an outbreak to hasten healing and alleviate symptoms. Suppressive therapy involves taking an antiviral medication, such as acyclovir, every day to prevent or reduce the number of future outbreaks.
Because no cure for herpes exists, your doctor will prescribe drugs designed to relieve pain and discomfort and shorten the duration of the outbreak. The drug of choice is the antiviral drug acyclovir (Zovirax). In the form of ointment, capsules, or intravenous (by vein) medication, acyclovir prevents the herpes virus from multiplying. Taken on a daily basis, it can also reduce the number of future attacks and, in many cases, prevent them altogether.
Other drugs commonly prescribed to treat genital herpes include the following:
Over-the-counter pain relievers often alleviate the severity of minor symptoms. You may want to try the following:
Appropriate Healthcare Settings
Genital herpes is usually treated on an outpatient basis. Rarely, a urinary catheter must be used because herpes lesions are so sensitive that urine flow is irritating, or urine flow is too painful.
Healthcare Professionals Who May Be Involved in Treatment
Physicians who may be involved in treating and managing herpes include the following:
- Family medicine physicians
- Infectious disease specialists
Activity & Diet Recommendations
If you (or your partner) have genital herpes, abstain from sex until the lesions, sores, and blisters have completely healed. Once infected with the herpes virus, you should always use condoms, even if you are not experiencing symptoms. Female condoms provide better protection than do male condoms. But be aware that abstinence is the only way to absolutely prevent transmitting the disease to someone else
Since outbreaks seem to occur when you are under physical and/or emotional stress, be sure to get plenty of rest, eat a balanced, healthy diet, and learn to cope with stress.
In the past, some studies have suggested that women with genital herpes may have a higher risk of cervical cancer, but this theory has never been proven. There are, however, other complications associated with genital herpes that you should be aware of:
- Although it is rare, it is possible to accidentally reinfect yourself in another part of your body (spreading the infection this way is referred to as autoinoculation). To prevent this, avoid touching your sores, and wash your hands immediately if you do touch them.
- If you give birth to a baby vaginally while you have active herpes lesions in and around the birth canal, you risk transmitting the virus to your child.
Quality of Life
Feelings of guilt, shame, anger, and worry are common in people with herpes. Working through these issues with a supportive doctor, therapist, or support group can be an important part of coming to terms with this condition.
And remember, although there is no cure for herpes, there are rarely complications, and there are numerous ongoing research projects that may someday uncover a cure.
Considerations for Women
During pregnancy, herpes bouts are usually more severe. If you are pregnant and have or have had symptoms of herpes, tell your doctor so that he or she can prevent complications.
If a woman suffers her first bout of herpes during pregnancy, it could cause premature birth, or even stillbirth, but this is very rare.
By giving birth to a baby vaginally, a mother with herpes can infect her child. As a result, the baby may suffer severe skin infection, nervous system damage, mental retardation, blindness, or death. If you have an active infection when you go into labor, your doctor may suggest a C-section to reduce the risk of passing on the virus. For the most part, though, mothers with a history of herpes have normal vaginal delivery. And, according to the American College of Obstetricians and Gynecologists (ACOG), of the approximately four million babies born in this country annually, far less than 1% are born with herpes.
Considerations for Children and Adolescents
Symptoms of herpes in children may suggest sexual abuse. Professional evaluation and treatment are important for the psychological, emotional, and physical health of a young child with these symptoms.
Adolescents who contract herpes need an emphasis on education. Teaching them to recognize the symptoms of a herpes outbreak, to avoid sexual intercourse during active infection, and to use a condom during intercourse will be a crucial part of treatment.
Considerations for Older People
Because of the increase in prescriptions of anticancer and immunosuppressive drugs in older people, herpes can be a more serious condition in this population. Lowered immune systems and increased vulnerability to illness also make treating the elderly for herpes a more complicated matter.
Last updated 27 May 2012
- Herpes genitalis
- Herpes simplex virus (HSV)
Genital herpes is caused by type 1 and type 2 of the herpes simplex virus (HSV-1 and HSV-2). HSV is one of a group of viruses that cause chickenpox, cold sores, and mono (mononucleosis). About 90% of genital herpes are caused by the type 2 virus, although type 1, which usually causes cold sores around the mouth, may also cause genital herpes.
HSV is spread by the following:
- Sexual intercourse
- Oral sex
- Anal sex
- Vaginal birth by a woman with genital herpes
Although doctors don't fully understand what causes the recurrence of genital herpes, they believe new bouts may be triggered by the following:
- Sunshine: exposure to ultraviolet (UV) light
- Physical stress, such as fatigue, injury, or illness
- Emotional stress
- Other, unknown causes
Drugs That Can Cause or Aggravate Genital Herpes
Herpes is caused by a viral infection. Drugs that weaken the immune system make you more suspectible to the virus that causes herpes.
Women are at a greater risk of contracting genital herpes from sexual intercourse than men. Most risk factors involve sexual contact that can lead to transmission of the virus from an infected partner, including:
- Multiple sexual partners
- Sexual intercourse without a condom
- Other sexually transmitted diseases
Symptoms & Diagnosis
The signs and symptoms of genital herpes include the following:
- Blisters and lesions on or around genitals
- Muscle aches
- Enlarged lymph nodes in the groin area
- Tingling, itching, or soreness of the genital region
- Pain that radiates to the buttocks or knees
- Discomfort during urination, especially in women
It should be noted that some people with genital herpes have no symptoms at all.
Conditions That May Be Mistaken for Genital Herpes
The following sexually transmitted diseases and infections, which also cause genital blisters, sores, and lesions, can be mistaken for genital herpes:
- Human papilloma virus, which causes genital warts (condylomata acuminata)
- Lymphogranuloma venerum
- Granuloma inguinale
Your doctor can diagnosis herpes by examining samples from your sores under a microscope. In order to confirm the diagnosis, your doctor may send swabs from a sore to a laboratory for culture. The results of cultures are usually available within two days.
Your doctor may do an internal examination to check for ulcers on the cervix (in women) or urethra (in men).
Although a blood test can detect herpes antibodies, these tests only become positive six to eight weeks after an initial infection, and they are not always reliable. So don't wait until your sores are healed to see a doctor: it is much harder to diagnose herpes once the visible symptoms are gone.
One amino acid, arginine, increases replication of the herpes virus that causes cold sores, while another amino acid, lysine, helps prevent this. Several studies show that avoiding foods high in arginine and taking supplemental lysine (see below) may be helpful. Foods to be avoided because they are high in arginine include grains, cereals, nuts, seeds, chocolate, beer, and soft drinks.
Studies showing the benefit of a low-arginine/high-lysine approach typically include lysine supplementation of 500 to 1,000 mg three times a day. NOTE: Lysine supplements may raise cholesterol levels. If yours is elevated, do not try this treatment. Consult your doctor first.
- Garlic. In large doses, garlic has an antiviral action that can help speed healing and prevent recurrences. Use deodorized garlic capsules and follow package directions.
- Echinacea. This herb stimulates the immune system to fight the cold-sore virus. During outbreaks, take one teaspoon of echinacea tincture (or its equivalent) three times a day.
Stress-management techniques, including meditation, biofeedback, visualization, and hypnotherapy, may help reduce the severity of cold sore outbreaks and prevent recurrences.
Self care & Prevention
Preventing Genital Herpes
The primary way to prevent herpes is to avoid having sex with a partner who has the virus. Aside from abstinence, honest communication about sexually transmitted disease history and the use of condoms is the best way to avoid herpes infections.
In general, chocolate and other foods do not increase the risk of acne. But there are some exceptions. If you suspect a certain food, avoid eating it for a month and see if that helps.
- Herpes sores, including cold sores, are highly contagious, so don't kiss or perform oral sex on anyone until your sore has completely healed. You're also contagious from the moment you feel a sore beginning to erupt. Some people with herpes are contagious even when no symptoms are present (this is called viral shedding).
- Avoid stress, particularly in therapies where immunosuppressive or anticancer drugs are prescribed. Stress may diminish the immune system's ability to suppress the herpes virus.
- Aspirin, ibuprofen, and acetaminophen can be used for pain.
- While you have a herpes sore, wear loose clothing, including loose underwear, to prevent painful chafing.
- For women with herpes sores, urinating can sometimes be painful. By urinating when standing in the shower or in the bathtub, or through a tube, the urine stream doesn't contact the lesions. A small, rolled-up plastic or paper cup with the bottom removed can serve this purpose.
- Sexual activity should be avoided when you have active herpes. However, if you choose to have intercourse, use condoms. They help protect against transmission if they cover the sore. If they don't, condoms provide no protection.
- You owe it to your sexual partner(s) to mention that fact that you have herpes before you become sexually intimate. Wear condoms and practice safe sex.