Genital Herpes/Herpes Simplex Herpes Is Becoming The Quiet Epidemic In This Country Today
Herpes simplex viruses — more commonly known as herpes — are categorized into two types: herpes type 1 (HSV-1, or oral herpes) and herpes type 2 (HSV-2, or genital herpes).
The Center For Disease Control estimates that annually, 776,000 people in the United States get new herpes infections.²³ Genital herpes infection is common in the United States. Nationwide, 15.5 % of persons aged 14 to 49 years have HSV-2 infection.²² The overall prevalence of genital herpes is likely higher than 15.5%, because an increasing number of genital herpes infections are caused by HSV-1². HSV-1 is typically acquired in childhood; as the prevalence of HSV-1 infection has declined in recent decades, people may have become more susceptible to genital herpes from HSV-1¹.
What Is Genital Herpes?
Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2. Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2).
HSV-2 infection is more common among women than among men (20.3% versus 10.6% in 14 to 49 year olds)²4. Infection is more easily transmitted from men to women than from women to men. HSV-2 infection is more common among non-Hispanic blacks (41.8%) than among non-Hispanic whites (11.3%). This disparity remains even among persons with similar numbers of lifetime sexual partners. For example, among persons with 2–4 lifetime sexual partners, HSV-2 is still more prevalent among non-Hispanic blacks (34.3%) than among non-Hispanic whites (9.1%) or Mexican Americans (13%).21 Most infected persons are unaware of their infection. In the United States, an estimated 87.4% of 14–49 year olds infected with HSV-2 have never received a clinical diagnosis.22
The percentage of persons in the United States who are infected with HSV-2 decreased from 21.2% in 1988–1994 to 15.5% in 2007-2010.22
How Do People Get Genital Herpes?
Infections are transmitted through contact with lesions, mucosal surfaces, genital secretions, or oral secretions. HSV-1 and HSV-2 can also be shed from skin that looks normal. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission most commonly occurs from an infected partner who does not have a visible sore and may not know that he or she is infected.4 In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10% of days, and on most of those days the person has no signs or symptoms.3
What Are The Symptoms Of Genital Herpes?
Most individuals infected with HSV-1 or HSV-2 are asymptomatic, or have very mild symptoms that go unnoticed or are mistaken for another skin condition. As a result, 87.4% of infected individuals remain unaware of their infection.24 When symptoms do occur, they typically appear as one or more vesicles on or around the genitals, rectum or mouth. The average incubation period after exposure is 4 days (range, 2 to 12).5 The vesicles break and leave painful ulcers that may take two to four weeks to heal. Experiencing these symptoms is referred to as having an “outbreak,” or episode.
Clinical manifestations of genital herpes differ between the first and recurrent outbreaks of HSV. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, and headache.6 Recurrent outbreaks of genital herpes are common, in particular during the first year of infection. Approximately half of patients who recognize recurrences have prodromal symptoms, such as mild tingling or shooting pains in the legs, hips and buttocks occurring hours to days before eruption of herpetic lesions. Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over time. Recurrences are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.7
What Are The Complications Of Genital Herpes?
Genital herpes causes painful genital ulcers in many adults that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. Both HSV-1 and HSV-2 can also cause rare but serious complications such as blindness, encephalitis (inflammation of the brain), and aseptic meningitis (inflammation of the linings of the brain). Development of extra-genital lesions in the buttocks, groin, thigh, finger, and eye may occur during the course of infection.6
Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. There can be can be considerable embarrassment, shame, and stigma associated with a herpes diagnosis and this can substantially interfere with a patient’s relationships.5 Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define options.8 Since a genital herpes diagnosis may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs.
There are also potential complications for a pregnant woman and her unborn child. See “How does herpes infection affect a pregnant woman and her baby?” below for information about this.
What Is The Link Between Genital Herpes And HIV?
Genital ulcerative disease caused by herpes make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if exposed to HIV when genital herpes is present.9-11 This is because genital herpes can cause ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum), which compromises the protection normally provided by the skin and mucous membranes against infections, including HIV. Herpetic genital ulcers can bleed easily, and when they come into contact with the mouth, vagina, or rectum during sex, they increase the risk of HIV transmission. In 1988–1994 to 15.5% and in 2007-2010 to 22%.
How Is Genital Herpes Diagnosed?
Numerous herpes diagnostic tests are available. Direct (or Virologic) tests detect viable virus, viral antigen, or viral nucleic acid. Viral culture is currently the reference standard for diagnosing genital herpes. HSV culture requires collection of a sample from the sore and, once viral growth is seen, specific cell staining to differentiate between HSV-1 and HSV-2. Nucleic acid amplification techniques (NAATs), such as Polymerase Chain Reaction (PCR), test for viral DNA or RNA and allow for more rapid and accurate results. 15 Indirect (or serologic) tests are blood tests that detect antibodies to the herpes virus. Several Enzyme-Linked Immuno Assay (ELISA) -based serologic tests are FDA approved and available commercially. Older assays that do not accurately distinguish HSV-1 from HSV-2 antibody remain on the market, so providers should specifically request serologic type-specific assays when blood tests are performed for their patients. HSV-1 ELISA results are considered to be reliable because HSV-1 is ubiquitous in most populations. However, false positive HSV-2 ELISA results are more often seen when testing is done in populations with a lower prevalence of HSV-2.16
For the symptomatic patient, testing with both direct and indirect assays can determine whether it is a new infection or a newly-recognized old infection. A primary infection would be supported by a positive virologic test and a negative serologic test, while the diagnosis of recurrent disease would be supported by positive virologic and serologic test results.17
The Communicable Disease Center (CDC) does not recommend screening for HSV-1 or HSV-2 in the general population. Several scenarios where type-specific HSV tests may be useful include:
- Patients with recurrent genital symptoms or atypical symptoms and negative HSV cultures
- Patients with a clinical diagnosis of genital herpes but no laboratory confirmation
- Patients who report having a partner with genital herpes
- Patients presenting for an STD evaluation (especially those with multiple partners)
- Persons with HIV infection
- Methylsulfonylmethane (MSM) at increased risk for HIV acquisition7
About 1 out of 6 adults in the United States have antibodies to HSV-2, the virus typically linked to genital herpes. A herpes infection cannot be cured.After you become infected with HSV, the virus stays in the body for life. It “hides” in a certain type of nerve cell and causes more outbreaks of sores in some people. Recurring infections can be triggered by stress, fatigue, sunlight, or another infection, such as a cold or flu. Medicine can relieve symptoms and shorten the length of the outbreaks, but medicine cannot cure the infection.
Is There A Cure Or Treatment For Herpes?
There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy (i.e. daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.
Several clinical trials have tested vaccines against genital herpes infection, but there is currently no commercially available vaccine that is protective against genital herpes infection. One vaccine trial showed efficacy among women whose partners were HSV-2 infected, but only among women who were not infected with HSV-1. No efficacy was observed among men whose partners were HSV-2 infected. A subsequent trial testing the same vaccine showed some protection from genital HSV-1 infection, but no protection from HSV-2 infection.
Genital Herpes: Signs And Symptoms
A person usually gets HSV-2 (herpes simplex type 2) through sexual contact. About 20% of sexually active adults in the United States carry HSV-2. Some people are more likely to get HSV-2. These people:
- Are female
- Have had many sex partners
- Had sex for the first time at a young age
- Have (or had) another sexually transmitted infection
- Have a weakened immune system due to a disease or medicine
How People Get Herpes On Their Genitals
- You can get genital herpes after coming into contact with HSV-1 or HSV-2. Most people get genital herpes from HSV-2, which they get during sex. If someone has a cold sore and performs oral sex, this can spread HSV-1 to the genitals — and cause herpes sores on the genitals.
- Mothers can give the herpes virus to their baby during childbirth. If the baby is born during the mother’s first episode of genital herpes, the baby can have serious problems.
What Causes Herpes Simplex?
Herpes simplex viruses spread from person to person through close contact. You can get a herpes simplex virus from touching a herpes sore. Most people, however, get herpes simplex from an infected person who does not have sores. Doctors call this “asymptomatic viral shedding.”
A Person With HSV-1 (Herpes Simplex Type 1) Can Pass It To Someone Else By:
- Touching the person’s skin, such as pinching a child’s cheek
- Sharing objects such as silverware, lip balm, or a razor
What Happens Once You Have HSV-1 Or HSV-2?
Once a person becomes infected with a herpes virus, the virus never leaves the body. After the first outbreak, the virus moves from the skin cells to nerve cells. The virus stays in the nerve cells forever. But it usually just stays there. In this stage, the virus is said to be dormant, or asleep. But it can become active again.
Some Things That Can Trigger (Wake Up) The Virus Are:
- Sun exposure
- Menstrual periods
…And More About Symptoms:
Sunburn can trigger herpes simplex: If a person has HSV-1, a bad sunburn can trigger a herpes simplex outbreak. Outbreaks usually develop around the mouth or on the genitals, but the sores can appear almost anywhere on the skin. Many people who get the virus that causes herpes never see or feel anything. If signs (what you see) or symptoms (what you feel) occur, a person may experience: tingling, itching, or burning. Before the blisters appear, the skin may tingle, itch, or burn for a day or so.
Sores: One or more painful, fluid-filled blisters may appear. Blisters break open and often ooze fluid and form a crust, before healing. The first time sores appear, they will show up between 2 and 20 days after a person has contact with an infected person. The sores can last from 7 to 10 days. Where the sores appear often varies with type.
Oral herpes (HSV-1): Most blisters appear on the lips or around the mouth. Sometimes blisters form on the face or on the tongue. Although these are the most common places to find oral herpes, the sores can appear anywhere on the skin.
Genital herpes (HSV-2): Sores typically occur on the penis, vagina, buttocks, or anus. Women can have sores inside the vagina. Like oral herpes, these sores can appear anywhere on the skin.
Flu-like symptoms. Fever, muscle aches, or swollen lymph nodes (glands) in the neck (oral herpes) or groin (genital herpes) are possible.
Problems urinating. People (most often women) with genital herpes may have trouble urinating or have a burning feeling while urinating.
Eye infection (Herpes Keratitis). Sometimes the herpes simplex virus can spread to one or both eyes. If this happens, you can have pain, light sensitivity, discharge, and a gritty feeling in the eye. Without prompt treatment, scarring of the eye may result. Scarring can lead to cloudy vision and even loss of vision.
If You Develop Signs And Symptoms Of Herpes Simplex, You Can Expect To Have These For As Long As Listed Below:
- Oral (mouth) herpes: 2 to 3 weeks
- Genital herpes: 2 to 6 weeks (the first outbreak) 25
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