Genital herpes, also commonly called "herpes," is a viral infection by the herpes simplex virus (HSV) that is transmitted through intimate contact with the mucous-covered linings of the mouth or the vagina or the genital skin. The virus enters the linings or skin through microscopic tears. Once inside, the virus travels to the nerve roots near the spinal cord and settles there permanently.

When an infected person has a herpes outbreak, the virus travels down the nerve fibers to the site of the original infection. When it reaches the skin, the typical redness and blisters occur. After the initial outbreak, subsequent outbreaks tend to be sporadic. They may occur weekly or even years apart.

Two types of herpes viruses are associated with genital lesions: herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2). HSV-1 more often causes blisters of the mouth area while HSV-2 more often causes genital sores or lesions in the area around the anus. The outbreak of herpes is closely related to the functioning of the immune system. Women who have suppressed immune systems, because of stress, infection, or medications, have more frequent and longer-lasting outbreaks.

It is estimated that as many as 50 million persons in the United States are infected with genital HSV. Genital herpes is spread only by direct person-to-person contact. It is believed that 60% of sexually active adults carry the herpes virus. Part of the reason for the continued high infection rate is that most women infected with the herpes virus do not know that they are infected because they have few or no symptoms. In many women, there are "atypical" outbreaks where the only symptom may be mild itching or minimal discomfort. Moreover, the longer the woman has had the virus, the fewer the symptoms they have with their outbreaks. Finally, the virus can shed from the cervix into the vagina in women who are not experiencing any symptoms.

Symptoms of genital herpes

Once exposed to the virus, there is an incubation period that generally lasts 3 to 7 days before a lesion develops. During this time, there are no symptoms and the virus cannot be transmitted to others. An outbreak usually begins as an itching or tingling sensation followed by redness of the skin. Finally, a blister forms. The blisters and subsequent ulcers that form when the blisters break, are usually very painful to touch and may last from 7 days to 2 weeks. The virus is contagious from the time of itching to the time of complete healing of the ulcer.

Diagnosis of genital herpes

Genital herpes is suspected when multiple painful blisters occur in a sexually exposed area. During the initial outbreak, cultures of the blisters are positive for the herpes virus in only 80% of patients. This means that in 20% of women with herpes the test will incorrectly suggest that they do not have the herpes virus. In other words, a negative test result from a blister is not as helpful as a positive test result, because the test may be a false-negative test. However, if a sample of a fluid-filled blister (in the early stage before it dries up and crusts) tests positive for herpes, the test result is very reliable.

In recurrent outbreaks of genital herpes, culturing the blister fluid during the recurrences detects the herpes virus in only 50% of the cultures. There are herpes blood tests that are used only for research purposes. The reason the blood tests are limited to research use is that they only indicate that someone is a "carrier" of the virus and do not mean he or she actually will get an attack of genital herpes that can be spread from person to person. This is the reason why it's best to go right to the blister and sample it, since what really needs to be known is whether a blister is filled with infectious herpes virus or not.

Treatment of genital herpes

Although there is no known cure for herpes, there are treatments for the outbreaks. There are oral medications, such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex) that prevent the virus from multiplying and even shorten the length of the eruption. Although topical (applied directly on the lesions) agents exist, they are generally less effective than other medications and are not routinely used. Medication that is taken by mouth, or in severe cases intravenously, is more effective. It is important to remember that there is still no cure for genital herpes and that these treatments only reduce the severity and duration of outbreaks.

Since the initial infection with HSV tends to be the most severe episode, an antiviral medication usually is warranted. These medications can significantly reduce pain and decrease the length of time until the sores heal, but treatment of the first infection does not appear to reduce the frequency of recurrent episodes.

In contrast to a new outbreak of genital herpes, recurrent herpes episodes tend to be mild, and the benefit of antiviral medications is only derived if therapy is started immediately prior to the outbreak or within the first 24 hours of the outbreak. Thus, the antiviral drug must be provided for the patient in advance. The patient is instructed to begin treatment as soon as the familiar pre-outbreak "tingling" sensation occurs or at the very onset of blister formation.

Finally, suppressive therapy to prevent frequent recurrences may be indicated for those with more than 6 outbreaks in a given year.

The treatment options for HSV include:

Herpes can be spread from one part of the body to another during an outbreak. Therefore, it is important not to touch the eyes or mouth after touching the blisters or ulcers. Thorough hand washing is a must during outbreaks. Clothing that comes in contact with ulcers should not be shared with others. Couples that want to minimize the risk of transmission should always use condoms if a partner is infected. Unfortunately, even when an infected partner isn't currently having an outbreak, herpes can be spread. Couples may also want to consider avoiding all sexual contact, including kissing, during an outbreak of herpes. Since an active genital herpes outbreak (with blisters) during labor and delivery can be harmful to the infant, pregnant women who suspect that they have genital herpes should tell their doctor. Women who have herpes and are pregnant can have a vaginal delivery as long as they are not experiencing symptoms or actually having an outbreak while in labor.