What Is Genital Herpes?

Genital herpes is most often caused by herpes simplex type 2 (HSV-2) but it can also be caused by herpes simplex type 1 (HSV-1).The virus lives in nerve cells and "creeps" along the course of the nerves to reach the skin surface, once in a while causing the characteristic sores and blisters. The main difference between HSV and many other common viruses is that HSV establishes a permanent presence in the body. This means that the virus can cause symptoms even if it remains dormant for long periods of time. Recurrent attacks may either be rare, occurring only once a year, or be much more frequent. Recurrence is usually milder and of shorter duration than the initial infection.

Tests can determine whether an infection is herpes: a skin culture taken from an active sore is the most direct and accurate test. Or, a blood test can detect the presence of antibodies to HSV-2. Such antibodies are evidence of previous exposure, but they do not establish that current symptoms are due to the HSV-2 organism. Like other viruses, there is no cure. But, there are medicines available to treat an outbreak and to prevent an outbreak from occuring.

The first symptom of HSV-2 infection is a tingling or itching sensation in the genital area (called the prodromal phase), which may then be followed by sore red bumps that turn into blisters. In women, the sores usually occur on the vulva or around the anus, and in men on the head and shaft of the penis. Without treatment, the sores form scabs and heal in a few days.

How Is It Treated?

There are medicines for treating herpes that alleviate symptoms and keep the virus under control. Acyclovir (Zovirax) can be taken orally or topically, and is usually well-tolerated. Other drugs, like valacyclovir (Valtrex) and famciclovir (Famvir), have also been effective. These medicines are also used for treatment of recurrent episodes, either episodically (ie, at the time of appearance of the lesions) or continuously as suppressive therapy. medicines are most effective when started within the first 24 hours. If given as suppressive therapy, medicines reduce the rate of reactivation and decrease transmission to uninfected partners.

How Is It Transmitted?

Herpes is spread by direct skin-to-skin contact during vaginal, anal, or oral sex. If you have a cold sore on your mouth and have oral sex, you can give your partner genital herpes.

Herpes is most contagious during outbreaks, so you should abstain from sex when symptoms are present. The virus can also be transmitted when symptoms are not present, so it is advisable to always use condoms. Condoms, however, do not provide 100% protection since they may not cover all lesions. Taking daily suppressive medicine can also reduce the risk of transmission.

Some people contract herpes from partners whose symptoms are very mild or completely absent, so they don't know they have it. Others catch it from people who don't tell them of their condition. As with any STD, the best prevention is getting to know and trust your partner before having sex so that you can comfortably communicate about STDs.

It is important to note that not everyone with a herpes-infected partner catches the virus—some people in long-term relationships with an infected partner never do.

Herpes can also be transmitted from a mother to an infant during birth. It is very important to talk to your healthcare provider if you have herpes and become pregnant because there are ways to decrease the risk of transmission.

What Are the Emotional Aspects?

For many people, the hardest part of getting herpes is dealing with the social stigma. Herpes support groups have been established nationwide to help people share their emotions and feel less alone. Over time, most herpes sufferers are able to have a normal sex life.

How Can It Be Prevented?

As with any STD, the best prevention is getting to know and trust your partner before having sex so that you can comfortably talk about STDs. When you do decide to have sex, always use a condom.