How does someone get genital herpes?

Most people get genital herpes by having sex with someone who is having a herpes "outbreak." This outbreak means that HSV is active. When active, the virus usually causes visible lesions in the genital area. The lesions shed (cast off) viruses that can infect another person. Sometimes, however, a person can have an outbreak and have no visible sores at all. People often get genital herpes by having sexual contact with others who don't know they are infected or who are having outbreaks of herpes without any sores.

A person with genital herpes also can infect a sexual partner during oral sex.

The virus is spread only rarely, if at all, by touching objects such as a toilet seat or hot tub.

What are the symptoms?

Unfortunately, most people who have genital herpes don't know it because they never have any symptoms, or they do not recognize any symptoms they might have. When there are symptoms, they can be different in each person. Most often, when a person becomes infected with herpes for the first time, the symptoms will appear within 2 to 10 days. These first episodes of symptoms usually last 2 to 3 weeks.

Early symptoms of a genital herpes outbreak include

• Itching or burning feeling in the genital or anal area
• Pain in the legs, buttocks, or genital area
• Discharge of fluid from the vagina
• Feeling of pressure in the abdomen

Within a few days, sores appear near where the virus has entered the body, such as on the mouth, penis, or vagina. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over several days, the sores become crusty and then heal without leaving a scar.

Other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

Can outbreaks recur?

If you have been infected by HSV 1 and/or 2, you will probably have symptoms or outbreaks from time to time. After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the lesions are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it's inactive.

In most people, the virus can become active several times a year. This is called a recurrence. But scientists do not yet know why this happens. When it becomes active again, it travels along the nerves to the skin, where it makes more viruses near the site of the very first infection. That is where new sores usually will appear.

Sometimes, the virus can become active but not cause any sores that can be seen. At these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. You may not notice this shedding because it often does not cause any pain or feel uncomfortable. Even though you might not be aware of the shedding, you still can infect a sex partner during this time.

After the first outbreak, any future outbreaks are usually mild and last only about a week. An infected person may know that an outbreak is about to happen by a tingling feeling or itching in the genital area, or pain in the buttocks or down the leg. For some people, these early symptoms can be the most painful and annoying part of an episode. Sometimes, only the tingling and itching are present and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear.

The frequency and severity of recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight.

How is genital herpes diagnosed?

Because the genital herpes sores may not be visible to the naked eye, a doctor or other health care worker may have to do several laboratory tests to try to prove that symptoms are caused by the herpes virus. A person may still have genital herpes, however, even if the laboratory tests do not show the virus in the body.

A blood test cannot show whether a person can infect another with the herpes virus. A blood test, however, can show if a person has been infected at any time with HSV. There are also newer blood tests that can tell whether a person has been infected with HSV 1 and/or 2.

How is genital herpes treated?

Although there is no cure for genital herpes, your health care worker might prescribe one of three medicines to treat it as well as to help prevent future episodes.

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Recently, the Food and Drug Administration approved Valtrex for use in preventing transmission of genital herpes. (See section below: How can I protect myself or my sexual partner?)

During an active herpes episode, whether the first episode or a repeat one, you should follow a few simple steps to speed healing and avoid spreading the infection to other places on the body or to other people.

• Keep the infected area clean and dry to prevent other infections from developing.
• Try to avoid touching the sores.
• Wash your hands after contact with the sores.
• Avoid sexual contact from the time you first feel any symptoms until the sores are completely healed, that is, the scab has fallen off and new skin has formed where the sore was.

Can genital herpes cause any other problems?

Usually, genital herpes infections do not cause major problems in healthy adults. In some people whose immune systems do not work properly, genital herpes episodes can last a long time and be unusually severe. (The body's immune system fights off foreign invaders such as viruses.)

If a woman has her first episode of genital herpes while she is pregnant, she can pass the virus to her unborn child and may deliver a premature baby. Half of the babies infected with herpes either die or suffer from damage to their nerves. A baby born with herpes can develop serious problems that may affect the brain, the skin, or the eyes. If babies born with herpes are treated immediately with acyclovir, their chances of being healthy are increased.

If a pregnant woman has an outbreak, which is not the first episode, her baby's risk of being infected during delivery is very low. In either case, if you are pregnant and infected with genital herpes, you should stay in close touch with your doctor before, during, and after your baby is born.

If a woman is having an outbreak during labor and delivery and there are herpes lesions in or near the birth canal, the doctor will do a cesarean section to protect the baby. Most women with genital herpes, however, do not have signs of active infection with the virus during this time, and can have a normal delivery.

Is genital herpes worse in a person with HIV infection or AIDS?

Genital herpes, like other genital diseases that produce lesions, increases a person's risk of getting HIV, the virus that causes AIDS. Also, prior to better treatments for AIDS, persons infected with HIV had severe herpes outbreaks, which may have helped them pass both genital herpes and HIV infection to others.

How can I protect myself or my sexual partner?

If you have early signs of a herpes outbreak or visible sores, you should not have sexual intercourse or oral sex until the signs are gone and/or the sores have healed completely. Between outbreaks, using male latex condoms during sexual intercourse may offer some protection from the virus. When used with these precautions, Valtrex can also help prevent infecting your partner during heterosexual sex.

Is any research going on?

The National Institute of Allergy and Infectious Diseases (NIAID) supports research on genital herpes and on herpes simplex virus (HSV-1 and HSV-2). Studies are currently underway to develop better treatments for the millions of people who suffer from genital herpes.

While some scientists are carrying out clinical trials to determine the best way to use existing drugs, others are studying the biology of herpes simplex virus. NIAID scientists have identified certain genes and enzymes that the virus needs to survive. They are hopeful that drugs aimed at disrupting these viral targets might lead to the design of more effective treatments.

Meanwhile, other researchers are devising methods to control the virus' spread. Two important means of preventing HSV infection are vaccines and topical microbicides. Several different vaccines are in various stages of development. These include vaccines made from proteins on the HSV cell surface, peptides or chains of amino acids, and the DNA of the virus itself.

NIAID and GlaxoSmithKline Biologicals are supporting a large clinical trial in women of an experimental vaccine that may help prevent transmission of genital herpes. The trial is being conducted at more than 20 sites in 15 states nationwide. For more information, click here Herpevac Trial for Women.

Topical microbicides, preparations containing microbe-killing compounds, are also in various stages of development and testing. These include gels, creams, or lotions that a woman could insert into the vagina prior to intercourse to prevent infection.

Where can I get help if I'm upset about having genital herpes or I have an infected partner?

Genital herpes outbreaks can be distressing, inconvenient, and sometimes painful. Concern about transmitting the disease to others and disruption of sexual relations during outbreaks can affect personal relationships. If you or your partner has genital herpes, you can learn to cope with and treat the disease effectively by getting proper counseling and medicine, and by using ways to prevent getting infected or infecting someone else, as mentioned above.

More Information

National Herpes Resource Center and Hotline
American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
919-361-8488 (9 a.m. to 7 p.m. Eastern Time, Monday through Friday)

National STD and AIDS Hotline
1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)

National Institute of Allergy and Infectious Diseases
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520

National Library of Medicine
MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228

The American College of Obstetricians and Gynecologists
409 12th Street, S.W.
P.O. Box 96920
Washington, DC 20090-6920
202-863-2518

NIAID is a component of the National Institutes of Health (NIH), which is an agency of the Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda , MD 20892