By Lucy Gleysteen
From PHN Issue 38, Fall 2018
Overview
Genital herpes is a common virus that impacts 50 million people in the United States (one in every six people). Herpes is a lifelong infection characterized by painful or itchy sores and blisters around the mouth and/or genitals. Herpes is caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Many people do not have any symptoms of herpes but can still carry HSV-1 or HSV-2. This article will focus on genital herpes.
The Herpes Viruses
Herpes Simplex Virus Type 1 (HSV-1) typically causes oral herpes. This often appears as blisters and cold sores around the mouth. HSV-1 can be transmitted through direct contact between the infected area and broken skin (a cut or a break) or mucous membrane tissue (this can be the mouth or genitals). It is possible for HSV-1 to be transmitted through kissing or other forms of skin- to-skin contact. HSV-1 can be spread from mouth to genitals through oral sex. Even though the virus is different, HSV-1 can still cause genital herpes.
Herpes Simplex Virus Type 2 (HSV-2) more frequently causes genital herpes. HSV-2 is considered a sexually transmitted infection because most of the time, the HSV-2 infection is spread through genital contact with someone who has genital HSV-2. HSV-2 is more common among women than among men. This is because genital infection is more likely to occur for a person with a vagina during penile-vaginal sex than for a person with a penis.
It is possible to have both HSV-1 and HSV-2. While barrier methods (like condoms or dental dams) can reduce infection, they don’t eliminate it. It’s possible to spread the infection even when no sores are present.
Transmission of HSV-2
Genital herpes can be spread by having vaginal, anal or oral sex with someone who has herpes. It is possible for herpes to be transmitted through a herpes sore, saliva or genital secretion, or skin near the oral area of a partner. It is possible to get herpes from a sex partner who does not have symptoms or who does not know that they have the virus. It is possible to get genital herpes if you receive oral sex from a partner who has oral herpes. HSV-2 does not live for very long outside of the body, so it is not spread from toilet seats, bedding, or other objects.
The only way to avoid transmission is to not have vaginal, anal or oral sex.
However, being in a monogamous sexual partnership and/or using condoms every time you have sex significantly reduces the risk of herpes transmission.
While condoms are important in reducing transmission of HSV-2, herpes sores can be present in areas that are not covered by a condom, so condoms do not offer full protection.
Symptoms
Many people who have genital herpes do not have symptoms or have mild symptoms. The most common symptoms are herpes sores. Herpes sores present as blisters around the genitals, rectum, or mouth. These blisters can be painful, especially when they break, and can take two to twelve days to heal. When blisters appear, this is called an outbreak. Outbreaks are sometimes accompanied by flu-like symptoms such as fever, aches and swollen glands. The first outbreak usually lasts the longest and is more severe than all subsequent outbreaks. Additional symptoms can include soreness, burning when urinating, or bad-smelling genital discharge. If you notice any of these symptoms, try and schedule a sick visit with your facility’s medical provider.
Herpes and HIV
For people with suppressed immune systems such as people living with HIV, herpes may cause painful genital ulcers. Herpes makes it easier to transmit and acquire HIV through sexual contact because it increases the number of CD4 cells (the target cells for HIV entry). It is estimated that it is 2 to 4 times more likely to acquire HIV if individuals with genital herpes are exposed to HIV.
Diagnosis
Medical providers might diagnose herpes based on the presenting symptoms. They also can take a sample from a sore and test it. If there are no symptoms, a blood test to look for herpes antibodies will be necessary. If you think you might have been exposed to HSV-1 or HSV-2, tell your medical provider, because testing might not be a routine part of your medical visit.
Treatment
While there is no cure for herpes, there are antiviral medications that prevent or shorten outbreaks. Taking daily herpes medication (daily suppressive therapy) reduces the risk of transmitting herpes to sexual partners. Without treatment, it is possible for herpes to spread to other body parts. For instance, if you touch sores and do not wash your hands, it is possible to spread the infection to areas such as your eyes.
Implications
It is possible for people with genital herpes to experience anxiety, depression and hopelessness following their diagnosis. While it can sometimes be frustrating and painful to have genital herpes, it does not have major health implications for people who do not have other health concerns. Genital herpes does not impact fertility, it cannot evolve into cancer, and it is not life-threatening. There is medication to help reduce symptoms and outbreaks.
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