|Other names||Anogenital herpesviral infection, herpes genitalis|
|An outbreak of genital herpes affecting the vulva|
|Symptoms||None, small blisters that break open to form painful ulcers, flu-like symptoms|
|Complications||Aseptic meningitis, increased risk of HIV/AIDS if exposed, neonatal herpes|
|Usual onset||2–12 days after exposure|
|Duration||Up to 4 weeks (first outbreak)|
|Causes||Herpes simplex virus (HSV-1, HSV-2)|
|Diagnostic method||Testing lesions, blood tests for antigen|
|Differential diagnosis||Syphilis, chancroid, molluscum contagiosum, hidradenitis suppurativa|
|Prevention||Not having sex, using condoms, only having sex with someone who is not infected|
|Frequency||846 million (2015)|
Genital herpes is an infection by the herpes simplex virus (HSV) of the genitals. Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open to form painful ulcers. Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. Once infected further outbreaks may occur but are generally milder.
The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected. This may occur during sex, including anal and oral sex. Sores are not required for transmission to occur. The risk of spread between a couple is about 7.5% over a year. HSV is classified into two types, HSV-1 and HSV-2. While historically HSV-2 was more common, genital HSV-1 has become more common in the developed world. Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies.
Efforts to prevent infection include not having sex, using condoms, and only having sex with someone who is not infected. Once infected, there is no cure. Antiviral medications may, however, prevent outbreaks or shorten outbreaks if they occur. The long-term use of antivirals may also decrease the risk of further spread.
In 2015 about 846 million people (12% of the world population) had genital herpes. In the United States, more than one in six people between the ages of 14 and 49 have the disease. Women are more commonly infected than men. Rates of disease caused by HSV-2 have decreased in the United States between 1990 and 2010. Complications may rarely include aseptic meningitis, an increased risk of HIV/AIDS if exposed to HIV-positive individuals, and spread to the baby during childbirth resulting in neonatal herpes.
Signs and symptoms
In males, the lesions occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. In females, lesions appear on or near the pubis, clitoris or other parts of the vulva, buttocks or anus.
Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise. Women often experience additional symptoms that include painful urination (dysuria) and cervicitis. Herpetic proctitis (inflammation of the anus and rectum) is common for individuals participating in anal intercourse.
After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts. In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash. Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined.
After a first episode of herpes genitalis caused by HSV-2, there will be at least one recurrence in approximately 80% of people, while the recurrence rate for herpes genitalis caused by HSV-1 is approximately 50%. Herpes genitalis caused by HSV-2 recurs on average four to six times per year, while that of HSV-1 infection occurs only about once per year.
People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir. Suppressive therapy may be useful in those who have at least four recurrences per year but the quality of the evidence is poor. People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy. Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency.
Genital herpes can be spread by viral shedding prior to and following the formation of ulcers. The risk of spread between a couple is about 7.5% over a year (for unprotected sex). The likelihood of transferring genital herpes from one person to another is decreased by male condom use by 50%, by female condom by 50%, and refraining from sex during an active outbreak. The longer a partner has had the infection, the lower the transmission rate. An infected person may further decrease transmission risks by maintaining a daily dose of antiviral medications. Infection by genital herpes occurs in about 1 in every 1,000 sexual acts.
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Testing peoples' blood, including those who are pregnant, who do not have symptoms for HSV is not recommended. This is due to concerns of greater harm than benefit, as there is a high false-positive rate and receiving a positive test result can cause other problems, such as relationship difficulties.
Once infected, there is no cure. Antiviral medications, such as acyclovir, valacyclovir, may prevent outbreaks or shorten outbreaks if they occur. The long-term use of antivirals may also decrease the risk of further spread. The longer a person has the virus, the fewer outbreaks they experience and the harder it will be to transmit to others, due to these specialty antigens and a strengthened immune system response.
Acyclovir is an antiviral medication and reduces the pain and the number of lesions in the initial case of genital herpes. Furthermore, it decreases the frequency and severity of recurrent infections. It comes in capsules, tablets, suspension, injection, powder for injection, and ointment. The ointment is used topically and it decreases pain, reduces healing time, and limits the spread of the infection.
In people experiencing their first episode of genital herpes oral acyclovir may reduce the duration of symptoms and lesions but the risk of adverse effects is not certain. There may also be little or no difference between topical acyclovir and placebo in terms of duration of symptoms and lesions and the risk of adverse effects.
Valacyclovir is a prodrug that is converted to acyclovir once in the body. It helps relieve the pain and discomfort and speeds healing of sores. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir. An example usage is by mouth twice per day for ten days for primary lesion, and twice per day for three days for a recurrent episode.
Famciclovir is another antiviral drug that belongs to the same class. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. It has a longer duration of action than acyclovir and it only comes in tablets.
About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases. More than 85% of those with HSV-2 are unaware of their infection. Approximately 776,000 people in the United States get new herpes infections every year.
Tests for herpes are not routinely included among STD screenings. Performers in the pornography industry are screened for HIV, chlamydia, and gonorrhea with an optional panel of tests for hepatitis B, hepatitis C and syphilis, but not herpes. Testing for herpes is controversial since the results are not always accurate or helpful. Most sex workers and performers will contract herpes at some point in their careers whether they use protection or not.
Early 20th century public health legislation in the United Kingdom required compulsory treatment for sexually transmitted diseases but did not include herpes because it was not serious enough. As late as 1975, nursing textbooks did not include herpes as it was considered no worse than a common cold. After the development of acyclovir in the 1970s, the drug company Burroughs Wellcome launched an extensive marketing campaign that publicized the illness, including creating victim's support groups.
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