Genital herpes is a common, highly infectious disease caused by a virus. It is transmitted from one person to another during sexual activity. Genital herpes causes blisters or groups of small ulcers (open sores) on and around the genitals in both men and women. Genital herpes cannot be cured; however, there are medications that can be prescribed to treat outbreaks and minimize the symptoms. 

Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms of an active infection. 

At least 45 million Americans are infected with the genital herpes virus, with approximately one million new infections each year. As many as 80%-90% of those infected fail to recognize genital herpes symptoms or have no symptoms at all. 

The highest rates of infection are seen among the poor, those with less education, those using cocaine, and those with many sexual partners. 

Genital Herpes Causes 

Genital herpes is caused by the herpes simplex virus (HSV). There are two types: HSV-1  and HSV-2.  Most genital herpes infections are  caused by HSV-2. HSV-1 is the usual cause of what most people call "fever blisters" in and around the mouth and can be transmitted from person to person through kissing. Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores caused by either virus look the same. 

Genital herpes is spread by direct contact with an infected person. Sexual intercourse and oral sex are the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is capable of spreading herpes. 

Note: People with herpes may spread the disease even if they do not realize they  have an infection. Furthermore, there is strong evidence that people with herpes can transmit infection even while their disease appears to be inactive and  no sores can be visibly seen. 

Many people remember having an episode of genital herpes when it occurs. But as many as 90% of those infected fail to recognize the symptoms  or have no  symptoms at all. It is not clear whether these people never had an initial herpes outbreak  or whether they never noticed a mild  infection.

In these individuals genital herpes is still contagious, and  they may have additional outbreaks, nonetheless. 

Genital Herpes Symptoms 

Signs of genital herpes tend to develop within three to seven days of skin-to-skin contact with an infected person. Genital herpes infections look like small  blisters or ulcers (round areas of broken skin) on  the genitals. Each blister  or ulcer is typically only 1 to 3 millimeters (1/32 inch to 1/8th inch) in size, and the  blisters or  ulcers tend  to be grouped into "crops." Usually the blisters form first, then soon open  to form ulcers. Herpes infections may be painless or slightly tender. In some people, however,  the blisters or ulcers  can be very tender and painful. 

Location of genital herpes 

• In men, genital herpes sores (lesions) usually  appear on or around  the penis. 
• In women,  the lesions may be visible outside  the vagina, but they commonly occur inside  the vagina where they can cause discomfort or vaginal discharge but cannot be seen except during  a doctor's examination. 
• The ulcers or blisters may also be found anywhere around the genitals (the perineum) and in and around the anus. 

First outbreak of genital herpes 

The first genital herpes outbreak is usually the most painful, and the initial episode may last longer than later outbreaks. Symptoms may last for two to four weeks. 

Some people develop other signs of genital herpes infection, particularly with the first episode including: 

• fever,
• muscle aches, 
• headaches (may be severe), 
• vaginal discharge or painful urination, and 
• swollen and tender lymph nodes  in the groin (these swell as  the body tries to fight  the infection). 

Later outbreaks  of genital herpes

• If the disease returns, later outbreaks generally have much less severe symptoms. Many people with recurrent disease develop pain or a tingling sensation  in the area  of the infection even before any blisters or ulcers can be seen.  This is  due to irritation and inflammation of the nerves leading to the infected area of skin. 

• These are signs  that an outbreak is about to begin. The condition is particularly contagious during this period, even though  the skin still appears normal. 

When  to Seek Medical Care 

With an initial outbreak, if an individual has signs  or symptoms of a genital herpes infection,  he or she should seek the care of a doctor as soon as possible, particularly if the diagnosis of genital herpes has not been previously diagnosed. Although genital herpes infections generally are not medical emergencies, treatment  is more effective when  it is started within  the first few days  of the outbreak. 

Later outbreaks rarely need immediate medical attention. 

• If an individual has had a genital herpes outbreak before, discuss options for preventing further outbreaks with a doctor. 
• People with severe underlying medical problems (particularly HIV  or AIDS) are at higher risk  of severe illness if  the disease is untreated. These individuals should contact  a doctor immediately upon noticing genital herpes  sores.
• A pregnant woman with signs or  symptoms of genital herpes must inform her doctor  as soon as possible. Prompt medical therapy may reduce  the risk of transmitting the disease to newborn children by exposure in  the birth canal. 

In otherwise healthy people, genital herpes outbreaks rarely require hospital visits. If an individual is experiencing an initial episode of genital herpes  and cannot be seen by a regular doctor within  the first few days of  the illness, it  is advisable go  to a hospital's emergency department to have medical treatment started. 

• Some people can become quite ill from genital herpes infections. If an individual has a high fever, severe headache, shortness  of breath, or extreme fatigue, he or she  should go to  the hospital for evaluation. 
• People with severe medical illnesses (particularly HIV or AIDS) may become very ill from genital  herpes infections.  The herpes virus  may quickly spread  to the brain, lungs,  and other organs. Individuals in this situation should seek prompt medical attention for genital herpes outbreaks and go  to a hospital if there  is any sign of illness other than sores on  the genitals. 

Notes: Dr. Nelson Crumfield

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EditText of this page (last edited June 17, 2010)