OVERVIEW

• HSV type 1 most commonly infects the mouth and lips, causing sores known as fever blisters or cold sores. It is also an important cause of sores to the genitals.
• HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.

According to the Centers for Disease Control and Prevention, 1 out of 5 American teenagers and adults is infected with HSV-2. Women are more commonly infected than men. In the United States, 1 out of 4 women is infected with HSV-2.

Since the late 1970s, the number of people with genital herpes infection has increased 30 percent nationwide. The largest increase has been among teens and young adults.

TRANSMISSION

If you have genital herpes infection, you can easily pass or transmit the virus to an uninfected partner during sex.

Most people get genital herpes by having sex with someone who is shedding the herpes virus either during an outbreak or during a period with no symptoms. People who do not know they have herpes play an important role in transmission.

You can transmit herpes through close contact other than sexual intercourse, through oral sex or close skin-to-skin contact, for example.

The virus is spread rarely, if at all, by objects such as a toilet seat or hot tub.

Reduce your risk of spreading herpes

People with herpes should follow a few simple steps to avoid spreading the infection to other places on their body or other people.

• Avoid touching the infected area during an outbreak, and wash your hands after contact with the area.
• Do not have sexual contact (vaginal, oral, or anal) from the time of first genital symptoms until symptoms are completely gone.

TREATMENT

Although there is no cure for genital herpes, your health care provider might prescribe an antiviral medicine to treat your symptoms and to help prevent future outbreaks. This can decrease the risk of passing herpes to sexual partners. Medicines to treat genital herpes are

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

SYMPTOMS

Symptoms of herpes are called outbreaks. The first outbreak appears within 2 weeks after you become infected and can last for several weeks. These symptoms might include tingling or sores near the area where the virus has entered the body, such as on the genital or rectal area, on buttocks or thighs, or occasionally on other parts of the body where the virus has entered through broken skin. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into small blisters, and then become itchy, painful sores that might develop a crust and will heal without leaving a scar.

Sometimes, there is a crack or raw area or some redness without pain, itching, or tingling.

Other symptoms that may accompany the first (and less often future) outbreak of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

Often, though, people don’t recognize their first or subsequent outbreaks. People who have mild or no symptoms at all may not think they are infected with herpes. They can still transmit the virus to others, however.

Recurrence of herpes outbreaks

In most people, the virus can become active and cause outbreaks several times a year. This is called a recurrence, and infected people can have symptoms. HSV remains in certain nerve cells of your body for life. When the virus is triggered to be active, it travels along the nerves to your skin. There, it makes more virus and sometimes new sores near the site of the first outbreak.

Recurrences are generally much milder than the first outbreak of genital herpes. HSV-2 genital infection is more likely to result in recurrences than HSV-1 genital infection. Recurrences become less common over time.

Symptoms from recurrences might include itching, tingling, vaginal discharge, and a burning feeling or pain in the genital or anal area. Sores may be present during a recurrence, but sometimes they are small and easily overlooked.

Sometimes, the virus can become active but not cause any visible sores or any symptoms. During these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. This is called asymptomatic (without symptoms) shedding. Even though you are not aware of the shedding, you can infect a sexual partner during this time. Asymptomatic shedding is an important factor in the spread of herpes.

DIAGNOSIS

Your health care provider can diagnose typical genital herpes by looking at the sores. Some cases, however, are more difficult to diagnose.

The virus sometimes, but not always, can be detected by a laboratory test called a culture. A culture is done when your health care provider uses a swab to get and study material from a suspected herpes sore. You may still have genital herpes, however, even if your culture is negative (which means it does not show HSV).

A blood test cannot show whether you are having a herpes outbreak, but it can show if you are infected with HSV. Newer blood tests, called type-specific tests, can tell whether you are infected with HSV-1 or HSV-2. Blood tests cannot tell between genital and other herpes infections. Health experts assume, however, that if you are positive for HSV-2, you have had genital infection.

Coping with herpes

A diagnosis of genital herpes can have emotional effects whether or not symptoms are present. If you have genital herpes, you are probably concerned about the effect of your disease on personal relationships. In addition, your sexual partner may be concerned about their risk of infection. Proper counseling and treatment can help you and your partner learn to cope with the disease.

PREVENTION

Because herpes can be transmitted from someone who has no symptoms, using these precautions is not enough to prevent transmission. Recently, the Food and Drug Administration approved Valtrex for use in preventing transmission of genital herpes. It has to be taken continuously by the infected person, and while it significantly decreases the risk of the transmission of herpes, transmission can still occur.

• Do not have oral genital contact in the presence of any symptoms or findings of oral herpes.
• Using barriers such as condoms during sexual activity may decrease transmission, but transmission can occur even if condoms are used correctly. Condoms may not cover all infected areas.

COMPLICATIONS

Genital herpes infections usually do not cause serious health problems in healthy adults. In some people whose immune systems do not work properly, genital herpes outbreaks can be unusually severe and long lasting.

Occasionally, people with normal immune systems can get herpes infection of the eye, called ocular herpes. Ocular herpes is usually caused by HSV-1 but sometimes by HSV-2. It can occasionally result in serious eye disease, including blindness.

A woman with herpes who is pregnant can pass the infection to her baby. A baby born with herpes might die or have serious brain, skin, or eye problems. Pregnant women who have herpes, or whose sex partner has herpes should discuss the situation with her health care provider. Together they can make a plan to reduce her or her baby’s risk of getting infected. Babies who are born with herpes do better if the disease is recognized and treated early.

Genital herpes, like other genital diseases that cause sores, is important in the spread of HIV infection.

RESEARCH

The National Institute of Allergy and Infectious Diseases (NIAID) supports research on genital herpes and HSV. Studies are currently underway to develop better treatments for the millions of people who suffer from genital herpes. While some scientists are carrying out clinical trials to determine the best way to use existing medicines, others are studying the biology of HSV. NIAID scientists have identified certain genes and enzymes (proteins) that the virus needs to survive. They are hopeful that drugs aimed at disrupting these viral targets might lead to the design of more effective treatments.

Meanwhile, other researchers are devising methods to control the virus?spread. Two important means of preventing HSV infection are vaccines and topical microbicides.

Several different vaccines are in various stages of development. These include vaccines made from proteins on the HSV cell surface, peptides or chains of amino acids, and the DNA of the virus itself. NIAID and GlaxoSmithKline are supporting a large clinical trial in women of an experimental vaccine that may help prevent transmission of genital herpes. The trial is being conducted at more than 35 sites nationwide. For more information, click here Herpevac Trial for Women or go to herpesvaccine.nih.gov.

Topical microbicides, preparations containing microbe-killing compounds, are also in various stages of development and testing. These include gels, creams, or lotions that a woman could insert into the vagina prior to intercourse to prevent infection.

An NIAID-supported clinical trial demonstrated that once-daily suppressive therapy using valacyclovir significantly reduces risk of transmission of genital herpes to an uninfected partner. This is the first time an antiviral medication had been shown to reduce the risk of transmission of an STI. This strategy may contribute to preventing the spread of genital herpes.

MORE INFORMATION

Centers for Disease Control and Prevention
CDC-INFO
1600 Clifton Road
Atlanta, GA 30333
1-800-CDC-INFO (1-800-232-4636)
1-888-232-6348 TTY
http://www.cdc.gov

The American College of Obstetricians and Gynecologists
409 12th Street, S.W.
P.O. Box 96920
Washington, DC 20090-6920
202-863-2518
http://www.acog.org

National Herpes Resource Center and Hotline
American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
919-361-8488 (9 a.m. to 7 p.m. Eastern Time, Monday through Friday)
http://www.ashastd.org/hrc/index.html

NIAID is a component of the National Institutes of Health (NIH), which is an agency of the Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892