Genital Herpes simplex

What is genital herpes simplex?
Genital herpes simplex is an incurable sexually transmitted infection caused by the herpes simplex virus (HSV). There are two distinct subtypes of HSV. Type 2 is most commonly associated with genital infection. Type 1 has also been found to cause genital infection but is more commonly associated with oral herpes (cold sores). Most infected individuals experience no symptoms or mild symptoms. If present, symptoms include one or more blisters/inflammation at the site of infection and a burning sensation during urination. When the blisters break, they leave a tender sore, which may take a few weeks to heal. After the initial infection, HSV remains dormant in certain nerve cells of the affected area of the body for life. The dormant virus may reactivate and cause recurrences.

How do people get genital herpes simplex?
Genital herpes simplex is most commonly transmitted when the HSV-1 or HSV-2 viruses are released from sores during genital contact or unprotected vaginal or anal sex. It can also be spread via oral sex with someone who gets cold sores. It is important to note that the HSV virus may be active but may not cause any visible sores or other signs of infection. Under these circumstances small quantities of the virus may still be shed and transmitted to a sex partner.

What are the symptoms of genital herpes simplex?
Most people with genital herpes simplex infections are asymptomatic and may never know that they are infected. When symptoms do occur they are usually most severe during the first episode. Symptoms usually occur within two to ten days of infection and vary from person to person. They may include the following:

  • Itching, tingling or a burning sensation in the genital or anal area.
  • Pain in the legs, buttocks or genital area.
  • Vaginal discharge.
  • Blisters near where the infection entered the body. These develop into painful open sores, which may take a few weeks to heal. The blisters may occur in, on or around the vagina, anus, penis, scrotum, buttocks, urinary passage and mouth.
  • Influenza-like symptoms (fever, headache, muscle pains).
  • Burning on urination.

After the initial infection, HSV remains dormant in certain nerve cells of the affected area of the body for life. The dormant virus may reactivate and cause recurrences. Some people experience symptoms such as tingling, itching or pain in the affected area prior to the recurrence. Most people have several recurrences within a year of the initial episode, but these decrease in severity and frequency in time.

What complications can result from genital herpes simplex infections?
Genital herpes simplex is not curable but most people experience relatively mild symptoms. However, more severe, painful and frequent recurrences may be experienced by some people, particularly those who are immunosuppressed. Genital herpes simplex, like other genital ulcer diseases, has also been linked to increased risk of transmitting or acquiring HIV.

A pregnant woman may also transmit HSV infection to her baby. However, in general, the risk of a pregnant woman transmitting HSV to her baby during childbirth is very low. However, this risk increases if the woman experiences her first episode of genital herpes while she is pregnant. If this occurs, the baby may die, be delivered prematurely or develop skin, eye or brain problems.

How is genital herpes simplex diagnosed?
The appearance of the genital herpes sores is variable and it can be difficult to make a diagnosis using visual criteria alone. Genital herpes simplex is usually diagnosed by laboratory testing of a swab from the sore or less commonly, a blood sample. Testing is most commonly done at genitourinary medicine (GUM) clinics and antenatal clinics.

How is genital herpes simplex treated?
There is no cure for genital herpes simplex, but anti-viral medications can shorten or prevent outbreaks. As most recurrences are mild, antiviral drugs are mostly used during the initial episode or for severe recurrences. People who experience frequent severe episodes may take daily suppressive therapy. Even if the infection is left untreated, most people eventually stop having recurrences.

How do you protect yourself against genital herpes simplex?

  • Abstinence
  • Mutually monogamous relationship with an uninfected person. However, infection status can be difficult to ascertain as many people don’t have symptoms, but can still spread the virus.
  • Correct use of male latex condoms can reduce the risk of transmission of genital herpes but the virus is transmitted by skin to skin contact and the level of protection offered by condoms is dependent on the location of the infection.
  • Reducing the numbers of sexual partners and the frequency of new partners will reduce the risk of infection.
  • Sores may not be visible, but if they are, avoid having sex with someone who has an active genital sore or cold sore.

Last updated: 7 May 2008