Genital Herpes

In a pregnant woman with HSV infection (usually HSV-2), the virus may pass to the baby during delivery, causing infections of the newborn's skin, mouth, lungs or eyes. If the herpes virus spreads through the baby's bloodstream, serious infections of the brain and other vital organs may also occur.
 

According to government health experts, approximately 45 million Americans older than age 12 are infected with HSV-2. Genital herpes, with or without symptoms, currently affects approximately one in every four females and one in every five males in the total population of U.S. adults and adolescents (between ages 15 and 45). Within the past two decades, the number of genital herpes infections has increased significantly among Americans, with the most dramatic increases seen in adolescents and young adults.

What are the Symptoms?

Most people with an HSV-2 infection have no symptoms. When symptoms do appear, they are usually mild and may include itching, burning, soreness and small blisters in the genital area; small ulcers (skin sores) when the blisters break; local pain if urine contacts the genital ulcers; enlarged and/or painful lymph nodes (swollen glands) in the groin; headache, fever and a generally "sick" feeling. In some people with genital herpes, cold sores or fever blisters also can erupt around the mouth. In general, symptoms of genital herpes appear approximately one week after being exposed to someone with herpes infection.
 

The first episode of herpes symptoms is usually the worst. About 40 percent of infected people never have a second attack. Others, however, have four to five recurrences per year. In people who have recurrent herpes episodes, symptoms generally are most common after sexual intercourse, after sunbathing, and during times of physical or emotional stress.
 

In newborns who are infected with herpes during delivery, symptoms usually appear nine to 11 days after birth and may include skin blisters, red eyes and an abnormal eye discharge. If the virus spreads through the baby's bloodstream to the brain, there may be lethargy, irritability and seizures. If the virus spreads to the baby's lungs, the baby may have difficulty breathing and may need to be placed on a ventilator for breathing assistance.

Your doctor can make the diagnosis of genital herpes based on your sexual history, your symptoms and the results of your physical examination. Your doctor may want to confirm the diagnosis by scraping the affected skin area for laboratory testing. Because people who have one type of STD are at risk for others, your doctor may wish to perform tests for other STDs, such as syphilis, gonorrhea, chlamydia, chancroid and human immunodeficiency virus (HIV).

The HSV infection that causes genital herpes is a lifelong illness whose symptoms tend to recur. The pattern of recurrence is different for every person.

To help prevent the spread of genital herpes, people who have the illness should abstain from sexual activity when they have symptoms of a herpes recurrence. They should also tell all sex partners about their herpes infection and use condoms during sexual activity. Even without symptoms, the virus still can be shed and transmitted.
 

Pregnant women who have visible ulcers from genital herpes at the time of delivery usually are encouraged to undergo Caesarean section to prevent HSV from spreading to her newborn. Because the decision for Caesarean section is based on many factors, a pregnant woman with HSV infection should discuss the subject with her physician as early as possible in her pregnancy. If a pregnant woman in her third trimester feels a recurrence of herpes coming on, she should call her doctor right away.

How is it Treated?

Episodes of genital herpes can be treated with oral anti-viral medications, including acyclovir, famciclovir and valacyclovir. These medications do not cure the herpes infection; they can shorten the duration of skin symptoms but most often are used to prevent symptoms from recurring or make recurrences less severe. When herpes infection spreads through the bloodstream and causes widespread infection, it can be treated with antiviral medication given intravenously (directly into the veins).

When Should I Call My Doctor?

Call your doctor if you have blisters or sores in your genital area, especially if you are pregnant or have frequent bouts of symptoms.

What is the Prognosis?

Although there currently is no cure for genital herpes, the frequency of recurrences often decreases with time. Daily oral antiviral medication also can decrease the number of recurrences by at least 75 percent in people with frequent herpes episodes (six or more recurrences per year).

People with genital herpes are more likely to contract HIV infection if they are exposed through sexual intercourse. If you already have HIV, a simultaneous HSV-2 infection may make you more likely to spread HIV to others in high-risk situations.