Everything You Need to Know About Genital Herpes

Symptoms, diagnosis, treatments, and prevention

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Genital herpes is a common sexually transmitted infection (STI) marked by genital pain and sores that likely affects approximately one out of every six people aged 14-49 in the United States. Once you're infected, you have it for life. While it remains dormant for much of the time, if you have genital herpes, you may experience periodic episodes of active herpes.

Earliest Symptoms of Genital Herpes

The symptoms of genital herpes can vary widely from person to person.

They usually appear within two to 10 days of transmission and last an average of two to three weeks. Some of the earliest symptoms can include:

  • An itching or burning sensation
  • Pain in the legs, buttocks, or genital area
  • Vaginal discharge
  • A feeling of pressure or fullness in the abdominal area

A few days following the initial symptoms, sores or lesions will erupt at the site of the infection. These sores can occur inside the vagina or on the cervix in women, as well as in the urinary passage in both men and women. Genital herpes lesions may first appear as small red bumps that develop into blisters, which eventually become painful, open sores. After several days, these sores become crusted and then heal without scarring.

Symptoms of Your First Episode

The first episode of genital herpes can also include symptoms such as:

  • Fever
  • Headache
  • Muscle aches
  • Urinary pain or difficulty
  • Swollen glands in the groin area

    After genital herpes invades the skin or mucous membranes, the virus travels to the sensory nerves at the end of the spinal cord, where it remains inside the nerve cells in an inactive state.

    Symptom Recurrence

    Most people experience a monthly recurrence of symptoms. Recurrent episodes of herpes can be triggered by minor trauma, other infections such as colds, menstruation, and stress.

    During a recurrent episode of genital herpes, the virus travels along the nerves to the skin where it multiplies at or near the site of the original herpes lesions, causing new sores to appear.

    Genital herpes can reactivate without any visible sores or lesions being present. During these periods of active virus, small amounts of the virus can shed at or near the site of the original lesions from genital secretions or from indiscernible lesions. Shedding occurs without any accompanying discomfort and may only last a day or two, but it's possible to infect a sexual partner during this time.

    How Genital Herpes Is Diagnosed

    Although sores may be visible to the naked eye, several laboratory tests may be necessary to determine whether the sores are caused by the herpes simplex virus (HSV) or another infection. These tests include:

    • PCR test: A polymerase chain reaction (PCR) test is the most accurate. It copies DNA from either your blood, tissue from a lesion, or your spinal fluid and looks for the presence of herpes.
    • Viral culture: With a viral culture, a new lesion is swabbed or scraped, with the sample added to a laboratory culture that contains healthy cells. These cells are then examined a day or two later under a microscope. This test works best if you have it done within 48 hours of your very first symptoms of herpes. It doesn't work as well if you've already had your first outbreak. 
    • Blood test: This can be performed to check for HSV antibodies and is an especially good test if you think you've been exposed to herpes in the past, but you don't have any lesions. If you were just exposed to herpes and have a negative blood test, that doesn't necessarily mean you don't have herpes since it takes a few weeks for the antibodies to form and show up on the test.

    Treatments for Genital Herpes

    Your doctor may prescribe a medication to shorten the length of the first episode and reduce the severity and frequency of recurrent episodes. You may be put on suppressive therapy, low dose antivirals that help suppress outbreaks, or episodic therapy, taking antivirals only when you have an outbreak.

    The infection cannot be fully eradicated, however.

    You can also help speed healing and avoid spreading the infection by following a few simple steps during periods of active herpes, including:

    • Keep the infected area clean and dry.
    • Don't touch the sores; if you do, wash your hands immediately.
    • Refrain from sex from the time you first notice symptoms until your sores/lesions are completely healed and covered by new skin.

    Overall Outlook

    In most cases, genital herpes does not cause long-term health consequences. However, those with weakened immune systems can experience long-lasting and severe episodes of herpes. And the open sores associated with herpes leave people at a higher risk of contracting HIV and AIDS.

    Herpes and Pregnancy

    Pregnant women, in particular, should be closely monitored for active episodes. If the first episode of herpes occurs during pregnancy, she can pass the virus to her unborn baby, and may also be at a higher risk of premature delivery.

    Approximately 50 percent of babies born with neonatal herpes die or suffer neurological damage. Babies can develop encephalitis, severe rashes, and eye problems; however, immediate treatment with medication greatly improves the outcome for many babies.

    The risk to babies depends greatly upon whether the mother is experiencing a first episode or a recurrent episode of genital herpes. Many physicians will perform a cesarean section on pregnant women diagnosed with genital herpes. However, if no active herpes is present at the time of birth, there is little or no risk to the baby with a vaginal delivery. If you're pregnant and have herpes, you should talk with your physician to determine the best delivery method for you.

    How You Can Protect Yourself and Your Partner From HSV

    You can avoid transmitting herpes to your partner by not having sex during periods when you notice symptoms. You should also wait for any sores to completely heal and cover with new skin. Condoms offer some protection during the times when you're not experiencing symptoms, although it's possible that not all affected areas are covered by a condom.

    If you suspect you may have herpes, discuss your symptoms with your healthcare provider.

    Sources:

    Albrecht MA. Patient Education: Genital Herpes (Beyond the Basics). UpToDate. Updated July 5, 2017.

    Centers for Disease Control and Prevention (CDC). Genital Herpes—CDC Fact Sheet. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Updated September 1, 2017.

    Mayo Clinic Staff. Genital Herpes. Mayo Clinic. Updated October 3, 2017.